title: Comparison of respiratory infections before and after percutaneous tracheostomy.
abstract: BACKGROUND
  A tracheostomy is often performed when patients cannot be weaned from mechanical ventilation. Respiratory infections (ventilator-associated pneumonia and infection of the lower respiratory tract) complicate the course of hospitalization in patients receiving mechanical ventilation.
  
  
  OBJECTIVE
  To evaluate respiratory infections before and after a percutaneous tracheostomy and to describe their outcomes.
  
  
  METHODS
  Medical records of adults who had percutaneous tracheostomy during a 1-year period at a tertiary care hospital in the southeastern United States were reviewed retrospectively.
  
  
  RESULTS
  Data for 322 patients were analyzed. Patients were predominately male (63.0%) and white (57.8%), with a mean age of 57.4 years. Ventilator-associated pneumonia or infection of the lower respiratory tract was identified in 90 patients (28.0%); the majority of infections were lower respiratory infections. Of all infections, 52% occurred before the tracheostomy, and 48% occurred after the procedure. Respiratory infections were associated with longer stays and higher costs, which were significantly higher in patients in whom the infection developed after the tracheostomy. Gram-negative organisms were responsible for the majority of infections.
  
  
  CONCLUSIONS
  Data related to respiratory infections that occurred before a tracheostomy were similar to data related to infections that occurred after a tracheostomy. Most infections were classified as lower respiratory infection rather than pneumonia. Infection, before or after a tracheostomy, resulted in longer stays and higher costs for care. Interventions focused on preventing infection before and after tracheostomy are warranted.
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida. Mary.Sole@ucf.edu.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Sole
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
authors.forename: Steven
authors.initials: S
authors.lastname: Talbert
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
authors.forename: Daleen Aragon
authors.initials: DA
authors.lastname: Penoyer
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
authors.forename: Melody
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
authors.forename: Steven
authors.initials: S
authors.lastname: Sokol
authors.affiliation: Mary Lou Sole is a professor, University of Central Florida, Orlando, and a nurse scientist, Orlando Health, Orlando, Florida. Steven Talbert is a clinical assistant professor at University of Central Florida. Daleen Aragon Penoyer is the director of nursing research, and Steven Sokol is a clinical informatics specialist, Orlando Health. Melody Bennett is an adjunct faculty member, University of Central Florida, and a clinical research coordinator at Orlando Health. Jason Wilson is a consultant with WeizerMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
authors.forename: Jason
authors.initials: J
authors.lastname: Wilson
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D012121:Respiration, Artificial / Q000379:methods; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D014139:Tracheostomy / Q000379:methods* / Q000706:statistics & numerical data*; D015300:Ventilator Weaning