(823) Today's Culture: Multidrug-Resistant Respiratory Organisms in Tracheostomy-Dependent Children

Introduction: Tracheostomy-dependent children (TDC) can live in the community or in skilled nursing facilities (SNF) and comprise a significant and growing portion of children requiring critical care. Tracheal aspirate cultures (TAC) are used to guide therapy for respiratory infections in this population. High healthcare utilization among TDC increases the risk for multi-drug resistant organisms (MDRO). Current research has not established a link between SNF residency and MDRO presence in pediatrics. We are uniquely able to study this population due to our diverse patient population and role as a referral center for multiple SNF in our region. We aim to compare the organisms in TAC and presence of MDRO obtained on admission from the community vs SNF.

Methods: This is a single-center, retrospective chart review of admissions to the Children’s Hospital at Montefiore PICU from January 2019-December 2022. Inclusion criteria were age ≤18, pre-existing tracheostomy status, and TAC obtained ≤72h after admission. Demographics, medical history, laboratory and culture results, tracheostomy data, and respiratory requirement were also collected. MDRO were defined as resistant to ≥ 2 antibiotics or resistant to one with intermediate sensitivity to another. Descriptive statistics were performed to characterize microbiological data.

Results: 170 admissions of 76 patients were included: 125 from private homes, 42 from SNF, 2 hospital transfers, and one from a family shelter (median age 5, IQR 9.56, 50.6% male). Pseudomonas was the most common organism in TAC overall, in 64 cultures, 46 from home and 16 from SNF. 64 cultures yielded MDRO: 40 from home, 22 from SNF, one on hospital transfer and one from a shelter. Serratia marcescens was the most frequently isolated MDRO, in 19 cultures: 8 admissions from home, 10 from SNF, and the admission from the shelter. MDR Pseudomonas was less prevalent, found in 11 samples, 7 from homes, 3 from SNF and one from an outside hospital.

Conclusions: This study elucidates the respiratory microbiome of the unique and relatively under-studied population of tracheostomy-dependent children living in SNF. Analysis is ongoing to permit further comparisons, determine additional relationships, and isolate risk factors regarding presence of MDRO in TDC.