Abstract
This prospective cohort study aimed to: (1) describe types, concentrations and sensitivity profiles of bacteria found in gastric aspirates of neurologically impaired children; (2) compare flora between outpatients and those admitted with aspiration pneumonia; and (3) examine predictors of bacterial colonization. Gastric aspirates from gastrostomy fed, neurologically impaired children on antacid medication were measured for pH and sent for microbiological testing. The outpatient arm included 26 children at their baseline; the inpatient arm included 31 children with a clinical diagnosis of aspiration pneumonia. Descriptive statistics summarized the ecology and resistance patterns of microbial flora. Predictors of total bacterial colonization were explored with linear regression. High concentrations of potentially pathogenic fecal-type bacteria were detected in 50/57 (88%) gastric aspirates. pH was found to be the only predictor of bacterial growth; children with gastric pH ≥ 4 had significantly higher concentrations of aerobic growth, while those with no bacterial growth had a pH < 4. Further studies to evaluate optimal gastric pH, the role of gastric bacteria in causing aspiration pneumonia, and the optimal empiric therapy for aspiration pneumonia are recommended.
Highlights
Children with neurological impairment often suffer from oropharyngeal incoordination, placing them at increased risk of feeding-related difficulties
In an effort to better understand the relationship between gastric acid suppression in neurologically impaired children and the potential for bacterial colonization, this study aimed to: (1) describe the type, concentration and sensitivity profile of bacteria found in gastric aspirates of this population; (2) compare the gastric microbial flora among inpatients admitted with a clinical diagnosis of aspiration pneumonia to an outpatient group with similar characteristics, but no clinical aspiration pneumonia; and (3) to examine predictors of bacterial colonization of the stomach, including types and degree of acid suppression, the method of gastric feeding and recent antibiotic use
This study examines bacterial growth in the gastric aspirates of a group of patients prone to aspiration pneumonia—neurologically impaired children fed via a gastrostomy tube and treated with acid suppression medication
Summary
Children with neurological impairment often suffer from oropharyngeal incoordination, placing them at increased risk of feeding-related difficulties. Targeted strategies to address feeding challenges, such as acid suppression medications and the use of enterostomy tubes (i.e., gastrostomy, gastro-jejunostomy), can result in improved nutritional and growth outcomes in neurologically impaired children, they fail to prevent secondary aspiration events, such as aspiration pneumonitis. Practitioners have traditionally prescribed these medicines in an attempt to protect patients from developing chemical pneumonitis related to the potential aspiration of caustic gastric contents [4,9]. Recent data have shown that this approach may paradoxically place patients at an increased risk of pneumonia by increasing the probability of developing bacterial lung infections, possibly related to enhanced bacterial growth in the stomach as a result of gastric acid suppression [10,11,12,13]
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