Residence-Associated Differences in Airway Microbiology Among Tracheostomy-Dependent Children.

BACKGROUND: Tracheostomy-dependent children (TDC) experience chronic airway instrumentation and frequent healthcare exposure, increasing their risk for colonization and infection with multidrug-resistant organisms (MDROs). Most TDC reside either in the community or in healthcare facilities, yet the impact of residential setting on airway microbiology in these children is not well characterized. METHODS: We conducted a retrospective chart review of TDC ≤ 18 years admitted to an academic tertiary pediatric intensive care unit (PICU) between Jan 2017 and Dec 2022 who underwent tracheal aspirate cultures (TACs) within 72 h of admission. Airway microbiology and MDRO prevalence were compared between children presenting from healthcare facilities and the community. Multivariate mixed-effect logistic regression models evaluated factors associated with MDRO isolation, adjusting for age, number of admissions, and cuffed tracheostomy status. RESULTS: Among 109 children (282 admissions; 207 community, 75 facility), facility residence was associated with higher odds of isolating any MDROs in bivariate analysis (OR 2.73 95% CI 1.19-6.25 p = 0.017). In multivariate analysis, ≥ 5 prior hospital admissions and cuffed tracheostomy remained independently associated with MDRO isolation. Although facility residence no longer retained statistical significance after adjustment, the adjusted odds ratio remained similar to the bivariate estimate. CONCLUSIONS: Healthcare facility residence is associated with increased MDRO isolation. Cumulative healthcare exposure and cuffed tracheostomy status may also be important risk factors for MDRO presence. Respiratory microbiology differs between facility- and community-based TDC. Awareness of local airway microbiologic patterns and cumulative healthcare exposure may improve interpretation of TACs and guide empiric antimicrobial therapy.