School of Medicine and Health Sciences Poster Presentations

Title

Tracheal Aspirate Cultures in Intubated Neonates: A Descriptive Epidemiological Cohort Study

Poster Number

276

Document Type

Poster

Status

Medical Student

Abstract Category

Immunology/Infectious Diseases

Keywords

Infectious Disease, Antibiotic Stewardship, Neonatal Intensive Care Unit, Neonates

Publication Date

Spring 2018

Abstract

BACKGROUND: Considerable variability in antibiotic prescribing practices in neonatal intensive care units (NICUs) and increasing knowledge about the adverse consequences of antibiotic exposure in neonates highlights the need for a better understanding of antibiotic prescribing practices. Antibiotic prescribing practices related to positive tracheal aspirate culture results, which could represent either colonization or invasive infection, is unknown.

METHODS: We conducted a retrospective cohort study of intubated neonates admitted to Children’s National Health System (CNHS) who had one or more tracheal aspirate cultures sent May to December 2016. Data collected through chart review included changes in vital signs, secretion characteristics, ventilator settings, oxygen requirement, white blood cell count, C-reactive protein (CRP), and chest x-ray results in the 48 hours preceding tracheal aspirate culture order. Outcome measures collected include duration of antibiotic therapy, hospital and NICU length of stay, ventilator days, discharge on respiratory support, recurrence of respiratory infection, bronchopulmonary dysplasia, colonization with multidrug-resistant organism (MDRO), and mortality. Clinical factors present in those with an identified pathogen were compared with those without, using chi squared for dichotomous and t-test for continuous variables.

RESULTS: We identified 51 intubated neonates who met inclusion criteria; 43 (84%) were preterm with median gestation 28 weeks (IQR 25-31). Median birth weight was 1140 g (IQR 744-2360) and 47% were female. A pathogen was identified in 37% of isolates. S. aureus (7) was the most frequently isolated pathogen, followed by K. pneumoniae (5) and Enterobacter spp (4). Hemodynamic instability and abnormal laboratory values were the common clinical factors in the 48 hours preceding cultures. Antibiotics were prescribed for 45 (88%) neonates with a median of 14 days (IQR 6-16). The most frequently prescribed antibiotics were vancomycin (67%) and gentamicin (63%). Those with respiratory culture positive for a pathogen had a higher odds of having had change in respiratory secretion characteristics (OR 14.3; 95% CI 1.3-130.9) and increase in oxygen requirement (OR 4.1; 95% CI 1.0-16.6).

CONCLUSIONS: Although most neonates are treated with antibiotics, fewer than half of respiratory cultures identified a pathogen. Those with an identified pathogen were more likely to have changes in respiratory secretion characteristics and increased oxygen requirement.

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Tracheal Aspirate Cultures in Intubated Neonates: A Descriptive Epidemiological Cohort Study

BACKGROUND: Considerable variability in antibiotic prescribing practices in neonatal intensive care units (NICUs) and increasing knowledge about the adverse consequences of antibiotic exposure in neonates highlights the need for a better understanding of antibiotic prescribing practices. Antibiotic prescribing practices related to positive tracheal aspirate culture results, which could represent either colonization or invasive infection, is unknown.

METHODS: We conducted a retrospective cohort study of intubated neonates admitted to Children’s National Health System (CNHS) who had one or more tracheal aspirate cultures sent May to December 2016. Data collected through chart review included changes in vital signs, secretion characteristics, ventilator settings, oxygen requirement, white blood cell count, C-reactive protein (CRP), and chest x-ray results in the 48 hours preceding tracheal aspirate culture order. Outcome measures collected include duration of antibiotic therapy, hospital and NICU length of stay, ventilator days, discharge on respiratory support, recurrence of respiratory infection, bronchopulmonary dysplasia, colonization with multidrug-resistant organism (MDRO), and mortality. Clinical factors present in those with an identified pathogen were compared with those without, using chi squared for dichotomous and t-test for continuous variables.

RESULTS: We identified 51 intubated neonates who met inclusion criteria; 43 (84%) were preterm with median gestation 28 weeks (IQR 25-31). Median birth weight was 1140 g (IQR 744-2360) and 47% were female. A pathogen was identified in 37% of isolates. S. aureus (7) was the most frequently isolated pathogen, followed by K. pneumoniae (5) and Enterobacter spp (4). Hemodynamic instability and abnormal laboratory values were the common clinical factors in the 48 hours preceding cultures. Antibiotics were prescribed for 45 (88%) neonates with a median of 14 days (IQR 6-16). The most frequently prescribed antibiotics were vancomycin (67%) and gentamicin (63%). Those with respiratory culture positive for a pathogen had a higher odds of having had change in respiratory secretion characteristics (OR 14.3; 95% CI 1.3-130.9) and increase in oxygen requirement (OR 4.1; 95% CI 1.0-16.6).

CONCLUSIONS: Although most neonates are treated with antibiotics, fewer than half of respiratory cultures identified a pathogen. Those with an identified pathogen were more likely to have changes in respiratory secretion characteristics and increased oxygen requirement.