Yapay Zeka Hızlı Bakış & Çıkarımlar
AI InsightHigher mortality among patients admitted from long-term care facilities warrants further investigation in larger, prospective studies.
📌 3 Maddede Bu Makale
Abstract
Aims: Children with tracheostomies are at increased risk for respiratory tract infections and resistant pathogens due to impaired airway defense mechanisms, frequent healthcare exposure, and extensive antibiotic use. This study aimed to compare the microbiological characteristics of tracheal aspirate cultures, antimicrobial resistance patterns, and clinical outcomes according to pre-admission care setting (home care or long-term care facility) in children with established tracheostomies admitted to the pediatric intensive care unit (PICU) with pneumonia. Methods: This single-center, retrospective, observational study included children with tracheostomies admitted to the PICU with pneumonia. A total of 54 patients with positive tracheal aspirate cultures obtained at admission were analyzed. Results: Of the 54 patients, 31 were in the home care group and 23 in the long-term care facility (LTCF) group. Patients admitted from LTCFs were significantly older (median 15 months vs. 7 months; p=0.003). Gram-negative bacteria predominated in tracheal aspirate cultures in both groups. The distribution of pathogens differed by care setting: Klebsiella pneumoniae was more frequently isolated in the home care group, whereas Pseudomonas aeruginosa was significantly more common in the LTCF group. High rates of ≥MDRO and ≥XDR were observed in both groups without significant differences. Mortality was higher in the LTCF group; however, this finding should be interpreted cautiously due to baseline differences between groups (34.8% vs. 9.7%; p=0.024). Conclusion: Gram-negative pathogens predominate in children with tracheostomies, and pathogen distribution may vary according to care setting. The high resistance burden highlights the importance of careful empirical antimicrobial selection. Higher mortality among patients admitted from long-term care facilities warrants further investigation in larger, prospective studies.