Patient and treatment characteristics
Eighty- two patient charts were reviewed. Ten patients did not have any treatment episodes and were not included in the study. Baseline demographic and clinical characteristics are outlined in Table 1. There were 355 treatment episodes amongst 72 patients over the 7 year study period. The majority of patients were white and male. The most common indications for tracheostomy were prematurity and neuromuscular disease. Sixty-four of the 72 patients were ventilator dependent at some point over the course of this study. Two patients died during the study period with median age at death of 6 years.
Of the 355 treatment episodes, 160 (45%) episodes involved increasing AWC alone and 195 (55%) were given an antibiotic in addition to increasing AWC. Inhaled tobramycin was the most commonly prescribed antibiotic, followed by amoxicillin-clavulanate (Table 2).Pseudomonas aeruginosa was the most common species on respiratory culture followed by Stenotrophomonas maltophilia and then methicillin resistant Staphylococcus aureus (MRSA) (Table 3). Those who cultured P. aeruginosa at any time were more likely to be treated with inhaled tobramycin compared to other outpatient antibiotics. Patients who never cultured P. aeruginosa were often treated with anti-pseudomonal therapy. Children who ever culturedS. maltophilia were often treated with antibiotics that did not provide coverage.