Lack Of Utility Of Tracheal Aspirates In The Management Of Suspected Pneumonia In Intubated Neonates

Objectives: 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. Design: Retrospective cohort study between January 2016 and December 2017. Setting: A level IV neonatal intensive care unit (NICU). Patients: Intubated patients with a tracheal aspirate culture. Methods: Data on temporally associated clinical measures of illness, laboratory and radiographic testing, and clinical demographic information were analyzed. Results: 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. Conclusion: These findings suggest that positive tracheal aspirates do not always represent clinical infection and may result in unnecessary antibiotic exposure.