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.