SUSPECTED RESPIRATORY-TRACT INFECTION IN THE TRACHEOSTOMIZED CHILD - THE PEDIATRIC PULMONOLOGISTS APPROACH

Study objectives: It is difficult to determine, in the child with a lo ng-term tracheostomy, when bacterial airway colonization has progresse d to a respiratory infection requiring antibiotic treatment. Our aim w as to investigate whether there is a consensus regarding this and rela ted chronic care issues among clinicians treating these patients. Desi gn and setting: A questionnaire asking about practices regarding use o f tracheal aspirate cultures and antibiotics was distributed to 47 ped iatric pulmonary centers. Participants: Individuals representing 34 ce nters (72%), caring for 10 to 400 patients, responded. Interventions: None. Results: At 65% of centers, management is variable, dependent on the patient's underlying condition. The most common indications to ob tain a culture were change in secretions (91%) or fever without an obv ious source (21 centers). Indications to treat with antibiotics includ ed many leukocytes in secretions (21 centers) or a respiratory illness (18 centers). When treating, 97% prescribe antibiotics empirically, m ost often enterally; nine centers use inhaled antibiotics. In most cen ters (79%), management is often done by telephone. Conclusions: Althou gh pediatric pulmonologists tend to have similar approaches to assessm ent and management of suspected respiratory tract infections in trache ostomized children, no clear consensus exists, and much of current pra ctice is empirical. To optimize care of these patients, studies should be conducted to develop criteria to objectively differentiate bacteri al airway from ''infection.''.