New research is changing the way doctors diagnose, treat and prevent respiratory infections in children with tracheostomies, according to a recent review published in the journal Current Opinion in Pediatrics.
A tracheostomy is a hole that surgeons make through the front of the neck and into the windpipe to help with breathing. Tracheostomy-associated respiratory infections, including pneumonia and tracheitis, are the most common reason children with tracheostomies end up in the hospital. Children with thymidine kinase 2 deficiency (TK2d) who require tracheostomies are among those at risk for such infections.
To check whether a child with a tracheostomy has a respiratory infection, doctors often collect a sample of mucus from the airway and grow bacteria from it in a lab. However, researchers have found these “culture tests” are not reliable for diagnosing infections. Because children with tracheostomies almost always have bacteria in their airways — even when perfectly healthy — a positive result does not mean the child is truly infected.
New expert guidelines now recommend using culture tests only to help guide treatment once a diagnosis has already been made, not to decide whether an infection is present in the first place.
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Choosing the right antibiotic is also complicated. Doctors are learning that basing treatment only on the detection of a common airway bacterium, called Pseudomonas aeruginosa, may not be appropriate.
When a child is suspected of inhaling food or liquid into the lungs, doctors may use specific antimicrobial agents that target anaerobic bacteria (germs that grow in the absence of oxygen).
For prevention of tracheostomy-associated respiratory infections, treatment with an inhaled antibiotic called tobramycin, alternating 28 days on and 28 days off, has shown early promise in reducing the number of infections and hospital stays, but more research is needed.
“Antibiotic clinical trials are needed to optimize treatment and prevention of TRAINs [tracheostomy-associated respiratory infections],” the review’s authors said.
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