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A systematic review of antimicrobial therapy in children with tracheostomies
  • +2
  • Helen Pearce,
  • Benjamin James Talks,
  • Steven Powell,
  • Malcolm Brodlie,
  • Jason Powell
Helen Pearce
Newcastle University Biosciences Institute
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Benjamin James Talks
Newcastle University Biosciences Institute
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Steven Powell
Royal Victoria Infirmary Great North Children's Hospital
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Malcolm Brodlie
Great North Children's Hospital Paediatric Respiratory Unit
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Jason Powell
Royal Victoria Infirmary Great North Children's Hospital

Corresponding Author:jason.powell@newcastle.ac.uk

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Abstract

Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or to manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/ prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centres. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from paediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy associated infections; this is largely based upon theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy associated infections remains largely unproven. This systematic review summarises the current evidence base for antimicrobial selection, duration, and administration route in paediatric tracheostomy associated infections. It also highlights significant variation in practice between centres and the urgent need for further prospective evidence to guide the management of these vulnerable patients.
12 Aug 2023Submitted to Pediatric Pulmonology
12 Aug 2023Submission Checks Completed
12 Aug 2023Assigned to Editor
12 Aug 2023Review(s) Completed, Editorial Evaluation Pending
30 Aug 2023Reviewer(s) Assigned
18 Oct 2023Editorial Decision: Revise Minor
05 Nov 20231st Revision Received
07 Nov 2023Submission Checks Completed
07 Nov 2023Assigned to Editor
07 Nov 2023Reviewer(s) Assigned
07 Nov 2023Review(s) Completed, Editorial Evaluation Pending
11 Nov 2023Editorial Decision: Accept