WITHDRAWN: Pneumonia in children with complex chronic conditions with tracheostomy: An emerging challenge

Abstract Purpose: Despite respiratory infections being a leading cause of hospitalization in children with tracheostomy tubes, there are no published guidelines for their diagnosis and management. This study aims to outline the clinical, laboratory, and microbiological aspects of pneumonia in these children, along with the antibiotics used and outcomes. Additionally, it seeks to determine pneumonia incidence and associated risk factors. Methods: We conducted a retrospective study using medical records of tracheostomized children at La Paz University Hospital in Madrid from 2010 to 2021. Results: Thirty-three pneumonia cases were observed in 25 tracheostomized children. Pseudomonas aeruginosa was the predominant bacterium (52%), followed by E. coli, S. aureus, and S. marcescens. The same microorganism isolated in the tracheal aspirate culture during pneumonia was previously isolated in 83% of cases that had a similar culture with some growth obtained within 7 to 30 days prior. Multiplex respiratory PCR detected respiratory viruses in 73% of cases tested. Antibiotic treatment was administered in all cases except one, mostly intravenously (81%), with piperacillin/tazobactam and meropenem being commonly used. Only one of the described episodes had a fatal outcome. Conclusions: It is advisable to include coverage for P. aeruginosa, E. coli, S. aureus, and S. marcescens in the empirical antibiotic treatment for pneumonia in tracheostomized children, along with the microorganisms identified in tracheal cultures obtained within 7 to 30 days prior, if available. A positive PCR for respiratory viruses is often discovered in bacterial pneumonia in tracheostomized children.