Lack of utility of tracheal aspirates in the management of suspected pneumonia in intubated neonates.

Abstract

To evaluate the utility of tracheal aspirates in suspected pneumonia in intubated neonates and to measure the burden of antibiotic use associated with a positive tracheal aspirate culture. Retrospective cohort study between January 2016 and December 2017. A level IV neonatal intensive care unit (NICU). Intubated patients with a tracheal aspirate culture. Data on temporally associated clinical measures of illness, laboratory and radiographic testing, and clinical demographic information were analyzed. Positive tracheal aspirate cultures were associated with lower birth weight and a normal immature to total neutrophil ratio (I/T ratio). Positive tracheal aspirates were not significantly associated with clinical, laboratory, or radiographic markers used in clinical practice to screen for infection. Despite the lack of positive clinical associations, a positive tracheal aspirate culture was associated with increased risk of prolonged antibiotic exposure. These findings suggest that positive tracheal aspirates do not always represent clinical infection and may result in unnecessary antibiotic exposure.