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Background: While bacteria identification on respiratory
cultures is associated with poor short-term outcomes in children with
bronchopulmonary dysplasia (BPD) and tracheostomies, the influence on
longer-term respiratory support needs remains unknown.
Objective: To determine if respiratory culture growth of
pathogenic organisms is associated with ongoing need for respiratory
support, decannulation, and death at 3 years post-tracheostomy placement
in children with BPD and tracheostomies.
Methods: This single center, retrospective cohort study
included infants and children with BPD and tracheostomies placed
2010-2018 and > 1 respiratory culture obtained in 36
months post-tracheostomy. Primary predictor was any pathogen identified
on respiratory culture. Additional predictors were any Pseudomonas
aeruginosa and chronic P. aeruginosa identification. Outcomes
included continued use of respiratory support (e.g., oxygen, positive
pressure), decannulation, and death at 3 years post-tracheostomy. We
used Poisson regression models to examine the relationship between
respiratory organisms and outcomes, controlling for patient-level
covariates and within-patient clustering.
Results: Among 170 children, 59.4% had a pathogen identified,
28.8% ever had P. aeruginosa , and 3.5% had chronic P.
aeruginosa . At 3 years, 33.1% of alive children required ongoing
respiratory support and 24.8% achieved decannulation; 18.9% were
deceased. In adjusted analysis, any pathogen and P. aeruginosawere not associated with ongoing respiratory support or mortality.
However, P. aeruginosa was associated with decreased risk of
decannulation (aRR 0.48, 95% CI 0.23-0.98). Chronic P.
aeruginosa was associated with lower survival probability.
Conclusion : Our findings suggest that respiratory pathogens
including P. aeruginosa may not promote long-term respiratory
dysfunction, but identification of P. aeruginosa may delay
decannulation.