Frequency of Resistant Microorganism Colonization and Risk Factors in Patients with Tracheostomy in Palliative Care

Yıl 2025, Cilt: 8 Sayı: 4, 379 - 383, 31.12.2025

Dilara Donmez Guler , Esra Ateş Bulut

https://doi.org/10.36516/jocass.1761725

https://izlik.org/JA59XR89DA

Öz

Introduction: Patients who had a tracheostomy for various reasons have an increased risk of infection due to the artificial opening. In this study, we aimed to determine the frequency of resistant microorganism colonization isolated from endotracheal aspirate and the risk factors for colonization in the adult population with tracheostomy in the palliative care inpatient service.
Materials and Methods: Patients with tracheostomy who were hospitalized and followed up in the palliative care service between April 2022 and August 2023 were retrospectively examined and the microorganisms in aspirate cultures and antibiotic resistance status were determined.
Results: There were 74 tracheal aspirate cultures obtained from a total of 46 patients. There were 36 (78.3%) patients who had extensive drug resistance (XDR) or pan drug resistance (PDR) microorganisms in the culture. While the frequency of resistant colonization was found to be significantly higher in patients hospitalized in intensive care in the last three months (p = 0.04), no significant relationship was found between other clinical conditions and comorbidities.
Discussion: We believe that adherence to isolation practices and appropriate antibiotic use can lower mortality rates and healthcare expenses in patients being monitored with tracheostomy, where colonization of resistant microorganisms is common.

Anahtar Kelimeler

Palliative care , tracheostomy , resistant microorganism , tracheal aspirate culture , antibiotic resistance

Etik Beyan

Etik kurul onayı Adana Şehir Hastanesi Klinik Araştıamalar Etik Kurulu'nca onaylanmıştır. (03.08.2023 tarih ve 2742 onay kodu)

Destekleyen Kurum

Bulunmamaktadır.

PALYATİF BAKIM SERVİSİNDE TRAKEOSTOMİLİ HASTALARDA DİRENÇLİ MİKROORGANİZMA KOLONİZASYON SIKLIĞI VE RİSK FAKTÖRLERİ

https://izlik.org/JA59XR89DA

Öz

Giriş: Çeşitli nedenlerle trakeostomi açılmış olan hastalarda yapay açıklık nedeniyle artmış enfeksiyon riski mevcuttur. Bu çalışmamızda, palyatif bakım servisinde trakeostomili erişkin popülasyonda endotrakeal aspirattan izole edilen dirençli mikroorganizma kolonizasyon sıklığının ve kolonizasyon için risk faktörlerinin belirlenmesi amaçlandı.
Gereç ve Yöntemler: Palyatif bakım servisinde Nisan 2022–Ağustos 2023 tarihleri arasında yatırılarak takip edilen trakeostomili hastalar retrospektif olarak incelenip aspirat kültürlerinde üreyen mikroorganizmalar ve antibiyotik direnç durumları belirlendi.
Sonuç: Toplam 46 hastadan elde edilen 74 trakeal aspirat kültürü mevcuttu. 36(%78,3) hastanın kültüründe extensively drug resistance (XDR) veya pan drug resistance (PDR) üreme vardı. Son üç ay içinde yoğun bakım yatışı olan hastalarda dirençli kolonizasyon sıklığı anlamlı olarak yüksek bulunurken (p=0,04) diğer klinik durumlar ve komorbiditeler arasında anlamlı ilişki bulunmadı.
Tartışma: Dirençli mikroorganizma kolonizasyonunun sıklıkla görüldüğü trakeostomi ile takip edilen hastalarda izolasyon kurallarına uymanın ve akılcı antibiyotik kullanımının mortaliteyi ve sağlık masraflarını azaltacağını düşünmekteyiz.

Anahtar Kelimeler

Palyatif bakım , trakeostomi , dirençli mikroorganizma , trakeal aspirat kültürü , antibiyotik direnci

Kaynakça

• 1.Mallick A, Bodenham AR. Tracheostomy in critically ill patients. European Journal of Anaesthesiology| EJA 2010; 27 (8): 676-82. [Crossref]
• 2.De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G et al. Tracheotomy: clinical review and guidelines. European journal of cardio-thoracic surgery 2007; 32 (3): 412-21. [Crossref]
• 3.Heffner JE. The role of tracheotomy in weaning. Chest 2001; 120 (6): 477S-81S. [Crossref]
• 4.Schönenberger S, Niesen W-D, Fuhrer H, Bauza C, Klose C et al. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2). International Journal of Stroke 2016; 11 (3): 368-79. [Crossref]
• 5.Lusuardi M, Capelli A, Cerutti C, Gnemmi I, Zaccaria S et al. Influence of clinical history on airways bacterial colonization in subjects with chronic tracheostomy. Respiratory Medicine 2000; 94 (5): 436-40. [Crossref
• 6.Ferro A, Kotecha S, Auzinger G, Yeung E, Fan K. Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients. British Journal of Oral and Maxillofacial Surgery 2021; 59 (9): 1013-23. [Crossref]
• 7.DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Critical Care Medicine 1990; 18 (12): 1328-30. [Crossref]
• 8.Ozden M, Demirdag K, Kalkan A, Kılıc SS. Frequency and resistance to antibiotics of bacteria isolated from patients who were followed up in intensive care units and developed nosocomial infections. Infection Journal 2003; 17 (2): 179-83.
• 9.Inan D, Saba R, Keskin S, Ogunç D, Ciftci C et al. Nosocomial infections in Akdeniz University Hospital intensive care units. Intensive Care Journal 2002; 2 (2): 129-35.
• 10.Koseoglu-Eser O, Kocagoz S, Ergin A, Altun B, Hascelik G. Evaluation of gram-negative bacilli as infectious agents in intensive care units. Journal of Infection 2005; 19 (1): 75-80.
• 11.Gales AC, Jones RN. Respiratory tract pathogens isolated from patients hospitalized with suspected pneumonia in Latin America: frequency of occurrence and antimicrobial susceptibility profile: results from the SENTRY Antimicrobial Surveillance Program (1997-2000). Diagnostic microbiology and infectious disease 2002; 44 (3): 301-11. [Crossref]
• 12.Weber DJ, Rutala WA, Sickbert-Bennett EE, Samsa GP, Brown V et al. Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia. Infection Control & Hospital Epidemiology 2007; 28 (7): 825-31. [Crossref]
• 13.Oliveira J, Reygaert WC. Gram negative bacteria. 2019.
• 14.Ak O, Batirel A, Ozer S, Čolakoğlu S. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospecive cohort study. Medical science monitor: international medical journal of experimental and clinical research 2011; 17 (5): PH29. [Crossref]
• 15.Hormozi SF, Vasei N, Aminianfar M, Darvishi M, Saeedi AA. Antibiotic resistance in patients suffering from nosocomial infections in Besat Hospital. European journal of translational myology 2018; 28 (3). [Crossref]
• 16.Suárez CJ, Lolans K, Villegas MV, Quinn JP. Mechanisms of resistance to β-lactams in some common Gram-negative bacteria causing nosocomial infections. Expert Review of Anti-infective Therapy 2005; 3 (6): 915-22. [Crossref]
• 17.Gales AC, Jones R, Forward K, Linares J, Sader HS et al. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997-1999). Clinical Infectious Diseases 2001; 32 (Supplement_2): S104-S13. [Crossref]
• 18.Porreca AM, Sullivan KV, Gallagher JC. The epidemiology, evolution, and treatment of KPC-producing organisms. Current infectious disease reports 2018; 20: 1-12. [Crossref]
• 19.Soedarsono S, Widyaningsih PD, Mertaniasih NM. The Risk Factors of Multidrug-Resistant Organisms in Hospitalized Patients with Community-Acquired Pneumonia in Dr. Soetomo Hospital Surabaya, Indonesia. Acta Medica Indonesiana 2021; 53 (2): 169-76.
• 20.Lepainteur M, Ogna A, Clair B, Dinh A, Tarragon C et al. Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy. Respiratory Medicine 2019; 152: 32-6. [Crossref]
• 21.Ścibik Ł, Ochońska D, Gołda-Cępa M, Kotarba A, Brzychczy-Włoch M. Microbiological analysis of tracheostomy tube biofilms and antibiotic resistance profiles of potentially pathogenic microorganisms. Otolaryngologia Polska 2022; 76 (5). [Crossref]
• 22.Falagas ME, Karageorgopoulos DE. Pandrug resistance (PDR), extensive drug resistance (XDR), and multidrug resistance (MDR) among Gram-negative bacilli: need for international harmonization in terminology. Clinical infectious diseases 2008; 46 (7): 1121-2. [Crossref]
• 23.Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clinical nutrition 2003; 22 (4): 415-21. [Crossref]
• 24.Acharya R, Wakode P, Bhandary S, Khanal B, Khatiwada S. Colonization and infection in tracheostomized patients at tertiary care hospital in Eastern Nepal. Health Renaissance 2014; 12 (2): 68-73. [Crossref]
• 25.Cader SHA, Shah FA, Nair SR. Tracheostomy colonisation and microbiological isolates of patients in intensive care units-a retrospective study. World Journal of Otorhinolaryngology-Head and Neck Surgery 2020; 6 (01): 49-52. [Crossref]
• 26.Sopena N, Heras E, Casas I, Bechini J, Guasch I et al. Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study. American journal of infection control 2014; 42 (1): 38-42. [Crossref]
• 27.Sole ML, Talbert S, Penoyer DA, Bennett M, Sokol S et al. Comparison of respiratory infections before and after percutaneous tracheostomy. American Journal of Critical Care 2014; 23 (6): e80-e7. [Crossref]