RESPIRATORY-TRACT COLONIZATION AND INFECTION IN PATIENTS WITH CHRONICTRACHEOSTOMY - A ONE-YEAR STUDY IN PATIENTS LIVING AT HOME

The high rate of complications, especially respiratory tract infection (RTI), reported in patients with chronic tracheostomy (CT) has discou raged physicians from using this method. However, previous studies of CT have concerned mainly hospitalized patients. We have followed the b acterial colonization patterns of the upper and lower respiratory trac t and recorded all RTIs in 39 outpatients with CT during a 12-mo perio d. Patients were colonized with one or more potential pathogens at the stomal site and in the trachea in 95% and 83%, respectively, of all s ampling occasions. Staphylococcus aureus, gram-negative enteric bacter ia (GNEB), and Pseudomonas aeruginosa were the most common colonizing bacteria at these sites. Seventy percent of bronchial-protected brush cultures were negative, despite simultaneous heavy colonization of the stomal site or the trachea. Only 18 of 39 (46%) patients were treated with antibiotics because of RTIs on a total of 30 occasions during th e study year. Of these, only five episodes of pneumonia in four patien ts were registered, corresponding to an incidence of about 10 per 100 person years. We conclude that outpatients with chronic tracheostomy c an be managed with a low risk for developing severe RTIs, despite mass ive airway colonization with potentially pathogenic bacteria.