Antibiotic Prophylaxis for Percutaneous Tracheostomy: A Survey of Current Practice in the UK

Abstract

Percutaneous tracheostomy (PT) is a commonly-performed invasive procedure in intensive care units. Infections (including bacteraemia and nosocomial pneumonia) are recognised complications that occur following PT. The recently published document ‘Standards for care of adult patients with temporary tracheostomies' produced by the Intensive Care Society UK (ICS) made no recommendations regarding antibiotic prophylaxis (AP) for PT, and we were unaware of whether AP is used for this procedure in the UK. We therefore conducted a survey of the current practice in 130 critical care units; 65 responded. None gave antibiotics for routine PT, but in the presence of known colonisation with methicillin-resistant Staphyloccocus aureus (MRSA), six units (9%) would give antibiotic prophylaxis. Only three units (5%) had a policy for antibiotic prophylaxis. Twenty-six critical care units (40%) reported infectious complications occurring following PT. Despite a high level of awareness among clinicians that PT is associated with a significant risk of infective complications, only a small number administer AP prior to PT insertion even in patients colonised with MRSA and those with positive sputum cultures. The majority of units do not have a policy or guidelines for administration of AP prior to PT despite the fact that administration of appropriate antibiotics has been shown to reduce perioperative infectious complications for this procedure.