Methods: Deep tracheal aspirate or sputum cultures from 34 patients with tracheostomy were studied with a convenience sample of 50 patients admitted for surgeries or with viral bronchiolitis, burns, or seizures between January 2013 and December 2014. The isolates were analyzed by using multi-locus sequence typing (MLST). Serotype PCR is underway. E-tests were done for penicillin susceptibilities.
Results: Of the tracheostomy tube group, 21 (62%) had additional bacterial species isolated from the cultures. The mean age was 6.4 years. 27 MLST sequence types (STs) were identified including nine novel STs. Of 50 patients with no previous history of chronic lung disease, 15 had additional bacteria species isolated and mean age was 4.6 years. 22% of tracheostomy isolates were penicillin resistant (vs 2% in comparison group).
Of 35 STs identified, seven STs were identified in more than one patient, ST 439, 654 and 1451 were identified in three or more patients. 5 STs were identified in both groups. Serotype PCRs are underway, but predicted pneumococcal serotypes based on MLST data were highly variable. In the tracheostomy group 15 serotypes were predicted and only serotype 19A, 21, 23B and 35 B were predicted to colonize three or more patients (52%). In non-tracheostomy patients serotype 6A, 11A, 19A, 23B were common predictions (52%). In tracheostomy patients only 19% of predicted serotypes were included in 13-valent conjugate vaccine vs 44% in patients with colonization and without tracheostomy tubes.
Conclusion: MLST and serotype predictions showed a wide variety among colonized patients with or without tracheostomy tubes. Serotypes associated with invasive disease in the US were not common. In patients with tracheostomies penicillin resistance was high and predicted vaccine coverage was low.
A. Brusnahan, None
A. Moore, None
W. Barson, None
A. Leber, None
S. Atici, None
S. King, None
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