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It is a routine practice among pediatric surgeons to get the culture of tracheal aspirate done in children with tracheostomy tubes and suffering from lower respiratory tract infection. It is believed that the bacteria in the culture of tracheal aspirate must be the bacteria responsible for the respiratory tract infection. However, a new study published in the journal Chest has found that the surveillance tracheal aspirate culture is not of much use at it does not correctly predict the bacteria causing the respiratory tract infection.

 

The researchers, led by Dr. Jay M. Cline, carried out this study to analyze whether selecting an antibiotic for lower respiratory tract infection in children on the basis of surveillance tracheal aspirate culture is appropriate. They also tried to find out how prevalent the practice of tracheal aspirate culture is among pediatric otolaryngologists and pulmonologists. For this purpose, they interviewed the doctors regarding their surveillance culture practices. They also analyzed the records of children with tracheostomy tubes between the periods from January 2003 to July 2007. Reports of the cultures that these children underwent were studied carefully. In case a child had a culture before the infection and another one after he was ill and had received antibiotics, the cultures were compared for similarity of bacteria and antibiotic sensitivity. Similarly the cultures obtained during two different episodes of hospitalization were also compared.

 

The researchers noted that 79 out of 146 pulmonologists and 5 out of 33 otolaryngologists routinely got surveillance tracheal aspirate culture done and almost 97% of pulmonologists prescribed antibiotics for LRTI on the basis of these culture reports. Tracheal flora changes when the child is suffering from LRTI and prescribing an antibiotic on the basis of a previous culture is most likely to miss the bacteria involved. The researchers have therefore opined that surveillance tracheal aspirate culture is of limited value and puts an unnecessary burden on the health care system.

 

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