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Latinoamericana de lnfectología Pediátrica.
Órgano de la Asociación Mexicana de
Infectología Pediátrica, A.C.
Órgano difusor de la Sociedad Española
de lnfectología

2025, Number 2

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Rev Latin Infect Pediatr 2025; 38 (2)

Bacterial respiratory infections in children with tracheostomy

García-Boyano M, Calvo C, Escosa GL

Language: Spanish
References: 127
Page: 46-64
PDF size: 613.90 Kb.


ABSTRACT

Respiratory infections are the most common cause of hospital readmission in children with tracheostomy. The loss of protective functions of the upper airways, combined with early formation of bacterial biofilms on tracheostomy cannulas and a high burden of comorbidities, significantly increases the risk of infection. Diagnosis is particularly challenging due to the difficulty in distinguishing chronic bacterial colonization from active infection. The high frequency of positive cultures in asymptomatic patients compromises the diagnostic value of tracheal aspirates. Available clinical, radiological, and microbiological criteria are not specific enough for identifying bacterial etiology. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequently isolated pathogens, both in infectious episodes and colonization states, raising doubts about their clinical significance in each case. There is also no consensus on the utility of surveillance cultures or on the systematic empirical use of antipseudomonal antibiotics. The optimal duration of treatment and the preferred route of administration are also not clearly established. The coexistence of viral infections, rising bacterial multidrug resistance, lack of specific biomarkers, and variability in clinical practice further complicate management. All these factors underscore the urgent need to develop specific and standardized clinical guidelines for the care of this vulnerable population.


REFERENCES

  1. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014; 59 (6): 895-919.

  2. Brand-Saberi BEM, Schafer T. Trachea: anatomy and physiology. Thorac Surg Clin. 2014; 24 (1): 1-5.

  3. Di Cicco M, Kantar A, Masini B, Nuzzi G, Ragazzo V, Peroni D. Structural and functional development in airways throughout childhood: Children are not small adults. Pediatr Pulmonol. 2021; 56 (1): 240-251.

  4. Epstein SK. Anatomy and physiology of tracheostomy. Respir Care. 2005; 50 (4): 476-482.

  5. Jeffery PK, Li D. Airway mucosa: secretory cells, mucus and mucin genes. Eur Respir J. 1997; 10 (7): 1655-1662.

  6. Haji A, Kimura S, Ohi Y. A model of the central regulatory system for cough reflex. Biol Pharm Bull. 2013; 36 (4): 501-508.

  7. McAllister A, Sjölander P. Children's voice and voice disorders. Semin Speech Lang. 2013; 34 (2): 71-79.

  8. Brown TCK. Endotracheal tubes and intubation. Paediatr Anaesth. 2012; 22 (11): 1135-1138.

  9. Wyllie JP. Neonatal endotracheal intubation. Arch Dis Child Educ Pract Ed. 2008; 93 (2): 44-49.

  10. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004; 32 (8): 1689-1694.

  11. Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005; 33 (11): 2527-2533.

  12. Astrachan DI, Kirchner JC, Goodwin WJ. Prolonged intubation vs. tracheotomy: complications, practical and psychological considerations. Laryngoscope. 1988; 98 (11): 1165-1169.

  13. Freeman BD. Tracheostomy update: when and how. Crit Care Clin. 2017; 33 (2): 311-322.

  14. Watters KF. Tracheostomy in infants and children. Respir Care. 2017; 62 (6): 799-825.

  15. Fuller C, Wineland MA, Richter GT. Update on pediatric tracheostomy: Indications, technique, education, and decannulation. Curr Otorhinolaryngol Rep. 2021; 9 (2): 188-199.

  16. Rane S, Bathula S, Thomas RL, Natarajan G. Outcomes of tracheostomy in the neonatal intensive care unit: is there an optimal time? J Matern Fetal Neonatal Med. 2014; 27 (12): 1257-1261.

  17. Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child. 2012; 97 (10): 866-869.

  18. Wakeham MK, Kuhn EM, Lee KJ, McCrory MC, Scanlon MC. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intensive Care Med. 2014; 40 (6): 863-870.

  19. Arcand P, Granger J. Pediatric tracheostomies: changing trends. J Otolaryngol. 1988; 17 (2): 121-124.

  20. Campisi P, Forte V. Pediatric tracheostomy. Semin Pediatr Surg. 2016; 25 (3): 191-195.

  21. Lee JH, Smith PB, Quek MBH, Laughon MM, Clark RH, Hornik CP. Risk factors and in-hospital outcomes following tracheostomy in infants. J Pediatr. 2016; 173: 39-44.e1.

  22. Dinwiddie R. Congenital upper airway obstruction. Paediatr Respir Rev. 2004; 5 (1): 17-24.

  23. DeMauro SB, Wei JL, Lin RJ. Perspectives on neonatal and infant tracheostomy. Semin Fetal Neonatal Med. 2016; 21 (4): 285-291.

  24. Berry JG, Graham DA, Graham RJ, Zhou J, Putney HL, O'Brien JE, et al. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics. 2009; 124 (2): 563-572.

  25. Friesen TL, Zamora SM, Rahmanian R, Bundogji N, Brigger MT. Predictors of pediatric tracheostomy outcomes in the United States. Otolaryngol Head Neck Surg. 2020; 163 (3): 591-599.

  26. Muller RG, Mamidala MP, Smith SH, Smith A, Sheyn A. Incidence, epidemiology, and outcomes of pediatric tracheostomy in the United States from 2000 to 2012. Otolaryngol Head Neck Surg. 2019; 160 (2): 332-338.

  27. Ogilvie LN, Kozak JK, Chiu S, Adderley RJ, Kozak FK. Changes in pediatric tracheostomy 1982-2011: a Canadian tertiary children's hospital review. J Pediatr Surg. 2014; 49 (11): 1549-1153.

  28. Wallis C, Paton JY, Beaton S, Jardine E. Children on long-term ventilatory support: 10 years of progress. Arch Dis Child. 2011; 96 (11): 998-1002.

  29. Amin R, Sayal P, Syed F, Chaves A, Moraes TJ, MacLusky I. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol. 2014; 49 (8): 816-824.

  30. Sherman JM, Davis S, Albamonte-Petrick S, Chatburn RL, Fitton C, Green C, et al. Care of the child with a chronic tracheostomy. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161 (1): 297-308.

  31. Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, et al. Clinical consensus statement: Tracheostomy care. Otolaryngol Head Neck 2013; 148 (1): 6-20.

  32. Liu P, Teplitzky TB, Kou YF, Johnson RF, Chorney SR. Long-term outcomes of tracheostomy-dependent children. Otolaryngol Head Neck Surg. 2023; 169 (6): 1639-1646.

  33. Schweiger C, Manica D, Lubianca Neto JF, Sekine L, Krumenauer R, Caixeta JA, et al. Determinants of successful tracheostomy decannulation in children: a multicentric cohort study. J Laryngol Otol. 2020; 134 (1): 63-67.

  34. Zhu H, Das P, Roberson DW, Jang J, Skinner ML, Paine M, et al. Hospitalizations in children with preexisting tracheostomy: a national perspective. Laryngoscope. 2015; 125 (2): 462-468.

  35. Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatr Crit Care Med. 2008; 9 (1): 96-100.

  36. Russell CJ, Simon TD, Mamey MR, Newth CJL, Neely MN. Pseudomonas aeruginosa and post-tracheotomy bacterial respiratory tract infection readmissions. Pediatr Pulmonol. 2017; 52 (9): 1212-1218.

  37. Russell CJ, Mamey MR, Koh JY, Schrager SM, Neely MN, Wu S. Length of stay and hospital revisit after bacterial tracheostomy-associated respiratory tract infection hospitalizations. Hosp Pediatr. 2018; 8 (2): 72-80.

  38. Russell CJ, Thurm C, Hall M, Simon TD, Neely MN, Berry JG. Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy. Pediatr Pulmonol. 2018; 53 (3): 349-357.

  39. Funamura JL, Yuen S, Kawai K, Gergin O, Adil E, Rahbar R, et al. Characterizing mortality in pediatric tracheostomy patients. Laryngoscope. 2017; 127 (7): 1701-1706.

  40. Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, et al. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child. 2010; 95 (9): 703-710.

  41. Teplitzky TB, Brown AF, Brooks RL, Bailey CH, Whitney C, Sewell A, et al. Mortality among children with a tracheostomy. Laryngoscope. 2023; 133 (2): 403-409.

  42. McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, et al. A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis. Pediatr Pulmonol. 2017; 52 (7): 946-953.

  43. Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope. 2001; 111 (11 Pt 1): 1925-1928.

  44. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36 (5): 309-332.

  45. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171 (4): 388-416.

  46. Centers for Disease Control and Prevention (CDC). Pneumonia (ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event. 2021 [Cited 05 June 2025]. Available in: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf

  47. Rusakow LS, Guarín M, Wegner CB, Rice TB, Mischler EH. Suspected respiratory tract infection in the tracheostomized child: the pediatric pulmonologist's approach. Chest. 1998; 113 (6): 1549-1554.

  48. Gipsman A, Prero M, Toltzis P, Craven D. Tracheobronchitis in children with tracheostomy tubes: overview of a challenging problem. Pediatr Pulmonol. 2022; 57 (4): 814-821.

  49. Morrow BM, Argent AC. Pediatric ventilator-associated tracheobronchitis and pneumonia: time to regroup? Pediatr Crit Care Med. 2013; 14 (5): 553-555.

  50. Muszynski JA, Steward S, Brilli RJ. It is time to care about ventilator-associated tracheobronchitis. Pediatr Crit Care Med. 2015; 16 (6): 593-594.

  51. Dallas J, Kollef M. VAT vs VAP: are we heading toward clarity or confusion? Chest. 2009; 135 (2): 252-255.

  52. Zhao A, Sun J, Liu Y. Understanding bacterial biofilms: from definition to treatment strategies. Front Cell Infect Microbiol. 2023; 13: 1137947.

  53. Hoiby N, Ciofu O, Johansen HK, Song Z Jun, Moser C, Jensen PO, et al. The clinical impact of bacterial biofilms. Int J Oral Sci. 2011; 3 (2): 55-65.

  54. Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatr Respir Rev. 2006; 7 (3): 162-168.

  55. Del Pozo JL, Patel R. The challenge of treating biofilm-associated bacterial infections. Clin Pharmacol Ther. 2007; 82 (2): 204-209.

  56. Jamal M, Ahmad W, Andleeb S, Jalil F, Imran M, Nawaz MA, et al. Bacterial biofilm and associated infections. J Chin Med Assoc. 2018; 81 (1): 7-11.

  57. Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001; 358 (9276): 135-138.

  58. Solomon DH, Wobb J, Buttaro BA, Truant A, Soliman AMS. Characterization of bacterial biofilms on tracheostomy tubes. Laryngoscope. 2009; 119 (8): 1633-1638.

  59. Raveendra N, Rathnakara SH, Haswani N, Subramaniam V. Bacterial biofilms on tracheostomy tubes. Indian J Otolaryngol Head Neck Surg. 2022; 74: 4995-4999.

  60. Inglis TJ, Millar MR, Jones JG, Robinson DA. Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol. 1989; 27 (9): 2014-2018.

  61. Adair CG, Gorman SP, Feron BM, Byers LM, Jones DS, Goldsmith CE, et al. Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med. 1999; 25 (10): 1072-1076.

  62. Jarrett WA, Ribes J, Manaligod JM. Biofilm formation on tracheostomy tubes. Ear Nose Throat J. 2002; 81 (9): 659-661.

  63. Hess DR, Altobelli NP. Tracheostomy tubes. Respir Care. 2014; 59 (6): 956-973.

  64. Barros CE de, Almeida JA de, Silva MHE, Ayres GH da S, Oliveira CG de, Braga CA da SB, et al. Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review. Rev Assoc Med Bras (1992). 2019; 65 (12): 1502-1507.

  65. Cline JM, Woods CR, Ervin SE, Rubin BK, Kirse DJ. Surveillance tracheal aspirate cultures do not reliably predict bacteria cultured at the time of an acute respiratory infection in children with tracheostomy tubes. Chest. 2012; 141 (3): 625-631.

  66. Kowalski S, Macaulay K, Thorkelsson R, Girling L, Bshouty Z. Assessment of cough strength in patients with a tracheostomy. Can J Anaesth. 2017; 64 (12): 1284-1285.

  67. Choi WA, Park JH, Kim DH, Kang SW. Cough assistance device for patients with glottis dysfunction and/or tracheostomy. J Rehabil Med. 2012; 44 (4): 351-354.

  68. Plotnikow GA, Accoce M, Navarro E, Tiribelli N. Humidification and heating of inhaled gas in patients with artificial airway. A narrative review. Rev Bras Ter Intensiva. 2018; 30 (1): 86-97.

  69. Morar P, Singh V, Jones AS, Hughes J, Van Saene R. Impact of tracheotomy on colonization and infection of lower airways in children requiring long-term ventilation: a prospective observational cohort study. Chest. 1998; 113 (1): 77-85.

  70. Birru F, Gerdung CA, Castro-Codesal M. Microbiology and management of respiratory infections in children with tracheostomy. Paediatr Respir Rev. 2023; 48: 39-46.

  71. Kumarasinghe D, Wong E, Duvnjak M, Sritharan N, Smith MC, Palme C, et al. Risk factors associated with microbial colonisation and infection of tracheostomy tubes. Am J Otolaryngol. 2020; 41 (4): 102495.

  72. Chiotos K, Tamma PD, Flett KB, Naumann M, Karandikar M V, Bilker WB, et al. Multicenter study of the risk factors for colonization or infection with carbapenem-resistant Enterobacteriaceae in children. Antimicrob Agents Chemother. 2017;61(12):e01440-17.

  73. Nour I, Eldegla HE, Nasef N, Shouman B, Abdel-Hady H, Shabaan AE. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. J Hosp Infect. 2017; 97 (1): 52-58.

  74. Zhang Y, Guo LY, Song WQ, Wang Y, Dong F, Liu G. Risk factors for carbapenem-resistant K. pneumoniae bloodstream infection and predictors of mortality in Chinese paediatric patients. BMC Infect Dis. 2018; 18 (1): 248.

  75. Ficke B, Rajasurya V, Sanghavi DK, Cascella M. Chronic aspiration. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [Cited 18 December 2024]. Available in: https://www.ncbi.nlm.nih.gov/books/NBK560734/

  76. Durvasula VSPB, O'Neill AC, Richter GT. Oropharyngeal dysphagia in children: Mechanism, source, and management. Otolaryngol Clin North Am. 2014; 47 (5): 691-720.

  77. Serel Arslan S, Demir N, Karaduman AA. Both pharyngeal and esophageal phases of swallowing are associated with recurrent pneumonia in pediatric patients. Clin Respir J. 2018; 12 (2): 767-771.

  78. Conley P, McKinsey D, Graff J, Ramsey AR. Does an oral care protocol reduce VAP in patients with a tracheostomy? Nursing. 2013; 43 (7): 18-23.

  79. Panitch HB. Viral respiratory infections in children with technology dependence and neuromuscular disorders. Pediatr Infect Dis J. 2004; 23 (11 Suppl): S222-227.

  80. Cherchi C, Chiarini Testa MB, Deriu D, Schiavino A, Petreschi F, Ullmann N, et al. All you need is evidence: What we know about pneumonia in children with neuromuscular diseases. Front Pediatr. 2021; 9: 625751.

  81. Leonard M, Dain E, Pelc K, Dan B, De Laet C. Nutritional status of neurologically impaired children: Impact on comorbidity. Arch Pediatr. 2020; 27 (2): 95-103.

  82. Brook I. Bacterial colonization, tracheobronchitis, and pneumonia following tracheostomy and long-term intubation in pediatric patients. Chest. 1979; 76 (4): 420-424.

  83. Vasconcellos Severo G, Schweiger C, Manica D, Marostica PJC. Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis. 2023; 140 (2): 71-76.

  84. Pozzi M, Pellegrino P, Galbiati S, Granziera M, Locatelli F, Carnovale C, et al. Prevalence of respiratory colonisations and related antibiotic resistances among paediatrictracheostomised patients of a long-term rehabilitation centre in Italy. Eur J Clin Microbiol Infect Dis. 2015; 34 (1): 169-175.

  85. McLaren D, Chitakis M, Burns H, Kapur N. Airway microbiology in tracheostomized children. Respir Care. 2021; 66 (2): 281-285.

  86. Russell CJ, Simon TD, Neely MN. Development of Chronic Pseudomonas aeruginosa-positive respiratory cultures in children with tracheostomy. Lung. 2019; 197 (6): 811-817.

  87. Kim SK, Lee JH. Biofilm dispersion in Pseudomonas aeruginosa. J Microbiol. 2016; 54 (2): 71-85.

  88. Perkins J, Mouzakes J, Pereira R, Manning S. Bacterial biofilm presence in pediatric tracheotomy tubes. Arch Otolaryngol Head Neck Surg. 2004; 130 (3): 339-343.

  89. Grønhøj C, Charabi B, Buchwald C von, Hjuler T. Indications, risk of lower airway infection, and complications to pediatric tracheotomy: report from a tertiary referral center. Acta Otolaryngol. 2017; 137 (8): 868-871.

  90. Steuart R, Ale GB, Woolums A, Xia N, Benscoter D, Russell CJ, et al. Respiratory culture organism isolation and test characteristics in children with tracheostomies with and without acute respiratory infection. PediatrPulmonol. 2023; 58 (5): 1481-1491.

  91. García-Boyano M, Climent FJ, Rodríguez A, García M, Zubiaur O, Rabanal I, et al. Tracheobronchitis in noncritically ill children with tracheostomy: can quantitative tracheal cultures assist in the management? PediatrPulmonol. 2025; 60 (1): e27489.

  92. Willson DF, Conaway M, Kelly R, Hendley JO. The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. PediatrCriti Care Med. 2014; 15 (4): 299-305.

  93. Castellani C, Duff AJA, Bell SC, Heijerman HGM, Munck A, Ratjen F, et al. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros. 2018; 17 (2): 153-178.

  94. Sethi S, Evans N, Grant BJB, Murphy TF. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 2002; 347 (7): 465-471.

  95. García-Boyano M, Climent FJ, Rodríguez A, García M, Zubiaur O, Rabanal I, et al. Microbiological patterns of bacterial infections in tracheostomized children: Reducing uncertainty in continuous care. PediatrPulmonol. 2023; 58 (12): 3507-3515.

  96. Grosse-Onnebrink J, Rudloff J, Kessler C, Werner C, Dougherty GW, Kerschke L, et al. Acinetobacter baumannii is a risk factor for lower respiratory tract infections in children and adolescents with a tracheostomy. Pediatr Infect Dis J. 2019; 38 (10): 1005-1009.

  97. Pérez-Losada M, Graham RJ, Coquillette M, Jafarey A, Castro-Nallar E, Aira M, et al. Tracheal microbiota in patients with a tracheostomy before, during and after an acute respiratory infection. Pediatr Infect Dis J. 2018; 37 (11): e269-e271.

  98. Griese M, Felber J, Reiter K, Strong P, Reid K, Belohradsky BH, et al. Airway inflammation in children with tracheostomy. PediatrPulmonol. 2004; 37 (4): 356-361.

  99. Akangire G, Manimtim W, Nyp M, Townley N, Dai H, Norberg M, et al. Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age. J Perinatol. 2017; 37 (7): 857-863.

  100. Smith CJ, Sierra CM, Robbins J, Cobbina E. Enteral antipseudomonal fluoroquinolones for ventilator-associated tracheobronchitis in children with pre-existing tracheostomy. Pediatr Pulmonol. 2022; 57 (4): 1064-1071.

  101. Miyakawa R, Barreto NB, Kato RM, Neely MN, Russell CJ. Early use of anti-influenza medications in hospitalized children with tracheostomy. Pediatrics. 2019; 143 (3): e20182608.

  102. Russell CJ, Mack WJ, Schrager SM, Wu S. Care variations and outcomes for children hospitalized with bacterial tracheostomy-associated respiratory infections. Hosp Pediatr. 2017; 7 (1): 16-23.

  103. Maurice NM, Bedi B, Sadikot RT. Pseudomonas aeruginosa biofilms: host response and clinical implications in lung infections. Am J Respir Cell Mol Biol. 2018; 58 (4): 428-439.

  104. Torres A, Valencia M. Does ventilator-associated tracheobronchitis need antibiotic treatment? Crit Care. 2005; 9 (3): 255-256.

  105. Tan CY, Chiu NC, Lee KS, Chi H, Huang FY, Huang DTN, et al. Respiratory tract infections in children with tracheostomy. J Microbiol Immunol Infect. 2020; 53 (2): 315-320.

  106. Lipovy B, Brychta P, Rihová H, Suchanek I, Hanslianová M, Cvanová M, et al. Effect of timing of tracheostomy on changes in bacterial colonisation of the lower respiratory tract in burned children. Burns. 2013; 39 (2): 255-261.

  107. McCaleb R, Warren RH, Willis D, Maples HD, Bai S, O'Brien CE. Description of respiratory microbiology of children with long-term tracheostomies. Respir Care. 2016; 61 (4): 447-452.

  108. Pérez-Losada M, Graham RJ, Coquillette M, Jafarey A, Castro-Nallar E, Aira M, et al. The temporal dynamics of the tracheal microbiome in tracheostomised patients with and without lower respiratory infections. PLoSOne. 2017; 12 (8): e0182520.

  109. El Cheikh MR, Barbosa JM, Caixêta JAS, Avelino MAG. Microbiology of tracheal secretions: What to expect with children and adolescents with tracheostomies. Int Arch Otorhinolaryngol. 2018; 22 (1): 50-54.

  110. Atag E, Unal F, Arslan H, Teber BG, Telhan L, Ersu R, et al. The effect of nebulized antibiotics in children with tracheostomy. Int J Pediatr Otorhinolaryngol. 2021; 143: 110665.

  111. Miller AL, Hart CK, Kao DD, Bellew LE, Hysinger EB. Patient factors associated with positive respiratory cultures following tracheostomy in pediatric patients. Int J Pediatr Otorhinolaryngol. 2024; 184: 112075.

  112. Maynard R, Larson J, Hustvet D, Wheeler W. Incidence, management, and outcome of tracheobronchitis in a tracheostomized home care population. Chest. 2012; 142 (4): 761A.

  113. García-Boyano M, Climent FJ, Rodríguez A, García M, Zubiaur O, Rabanal I, et al. Antibiotic choice and outcomes for respiratory infections in children with tracheostomies. Hosp Pediatr. 2025; 15 (1): 17-27.

  114. Bassetti M, Vena A, Russo A, Croxatto A, Calandra T, Guery B. Rational approach in the management of Pseudomonas aeruginosa infections. Curr Opin Infect Dis. 2018; 31 (6): 578-586.

  115. Brook I. Treatment of aspiration or tracheostomy-associated pneumonia in neurologically impaired children: effect of antimicrobials effective against anaerobic bacteria. Int J Pediatr Otorhinolaryngol. 1996; 35 (2): 171-177.

  116. Morrison JM, Hassan A, Kysh L, Dudas RA, Russell CJ. Diagnosis, management, and outcomes of pediatric tracheostomy-associated infections: a scoping review. Pediatr Pulmonol. 2022; 57 (5): 1145-1156.

  117. García-Boyano M, Climent FJ, Rodríguez A, García M, Zubiaur O, Rabanal I, et al. Pneumonia in children with complex chronic conditions with tracheostomy: an emerging challenge. Pediatr Infect Dis J. 2024; 43 (10): 919-923.

  118. Eckerland M, Bock C, Olivier M, Pichlmaier L, Steindor M, Stehling F. Reducing the frequency of respiratory tract infections in severe neurological disorders by inhaled antibiotics: a retrospective data analysis. ERJ Open Res. 2019; 5 (3): 00149-2018.

  119. Chen JK, Martin-McNew BL, Lubsch LM. Nebulized gentamicin as an alternative to nebulized tobramycin for tracheitis in pediatric patients. J Pediatr Pharmacol Ther. 2017; 22 (1): 9-14.

  120. Gipsman A, Prero M, Toltzis P, Craven D. Inhaled antibiotics in children with tracheostomy tubes: a descriptive study. Pediatr Pulmonol. 2023; 58 (4): 1028-1033.

  121. Solé-Lleonart C, Rouby JJ, Blot S, Poulakou G, Chastre J, Palmer LB, et al. Nebulization of antiinfective agents in invasively mechanically ventilated adults: a systematic review and meta-analysis. Anesthesiology. 2017; 126 (5): 890-908.

  122. Niederman MS, Chastre J, Corkery K, Fink JB, Luyt CE, García MS. BAY41-6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with Gram-negative pneumonia. Intensive Care Med. 2012; 38 (2): 263-271.

  123. Ormsby J, Conrad P, Blumenthal J, Carpenter J, Jones S, Sandora TJ, et al. Practice improvement for standardized evaluation and management of acute tracheitis in mechanically ventilated children. Pediatr Qual Saf. 2020; 6 (1): e368.

  124. Tamma PD, Turnbull AE, Milstone AM, Lehmann CU, Sydnor ERM, Cosgrove SE. Ventilator-associated tracheitis in children: does antibiotic duration matter? Clin Infect Dis. 2011; 52 (11): 1324-1331.

  125. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017; 50 (3): 1700582.

  126. Pugh R, Grant C, Cooke RPD, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2015; 2015 (8): CD007577.

  127. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63 (5): e61-111.




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