The Effect of an Antimicrobial Drain Sponge Dressing on Specific Bacterial Isolates at Tracheostomy Sites
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P atients with tracheostomies frequently experience nosocomial complications such as bacteremia, sepsis, pneumonia, and multi antibiotic-resistant bacterial infections.1 The resultant increased morbidity may require prolonged treatment and cause extended or multiple hospitalizations.
Dry gauze dressings, including fenestrated gauze or drainage sponges, are used around tracheostomy sites to protect the tube and absorb small amounts of drainage. However, standard gauze is porous and does not provide a barrier to bacteria. Drainage sponges that contain the broad-spectrum antimicrobial component polyhexamethylene biguanide (PHMB) have been available for a number of years. Because PHMB resists bacterial colonization and penetration, drain sponges impregnated with PHMB function as a bacterial barrier.2
A controlled, descriptive study was conducted to compare the effect of applying an antimicrobial drain sponge dressing to a non-antimicrobial drain sponge on four bacterial pathogens and the resident normal skin flora around mature tracheostomy sites.
Wound infection of the tracheostomy site frequently occurs following extended periods of intubation. The results of one study3 demonstrated the presence of polymicrobial aerobic-anaerobic flora wound infections in patients hospitalized for long periods and who required a tracheostomy for 3 months to 2 years. Of the 145 isolates recovered (an average of 5.8 isolates per specimen), the most frequent aerobic isolates identified were alpha-hemolytic Streptococci, Pseudomonas aeruginosa, Enterobacter cloacae, and Staphylococcus aureus. The most common anaerobic bacteria were Peptostreptococcus sp., Bacteroides sp., and Fusobacterium sp. It was concluded that the polymicrobial aerobic-anaerobic flora of tracheostomy wound site infections and the frequent presence of beta lactamase-producing bacteria may have important implications for clinical management.
In another study1 involving 106 patients, the incidence of positive post-tracheostomy blood cultures was 10.4 %, compared to 6.6% for blood cultures in patients who did not have a tracheostomy. Staphylococcus epidermidis was the most common organism cultured (6.6% of post-tracheostomy cultures, compared to 2.8% for other cultures). Bacteremia was cited as a common complication of percutaneous tracheostomy and was caused by organisms from the patients’ own trachea or skin. In this study, no significant differences were observed between patients who did or did not receive prophylactic antibiotics.
Curtis et al4 conducted a retrospective review of patients who had undergone coronary artery bypass graft (CABG) to determine if postoperative tracheostomy was associated with a higher incidence of mediastinitis and mortality. In 6,057 patients, the mortality of patients with a tracheostomy was 24.7% compared to 5.2% in patients not requiring the procedure. While some patients who required a tracheostomy may already have been infected and the incidence of other confounding risk factors that created the need for the tracheostomy may have been higher in those who had mediastinitis, it was concluded that patients who require a tracheostomy after CABG have a higher incidence of mediastinitis and a higher mortality rate than patients who do not require tracheostomy.
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