Resistencia antibiótica y exposición bacteriana de pacientes pediátricos en ventilación mecánica con humidificadores térmicos e intercambiadores de calor y humedad

Introduction

Invasive mechanical ventilation is essential for children with severe respiratory failure but increases the risk of infections due to exposure to pathogenic microorganisms. There are 2 main humidification technologies: heated humidifiers and heat and moisture exchangers. Although some studies suggest that the latter may reduce respiratory infections, the results are inconclusive, especially in children and infants.

Objective

To evaluate bacterial exposure and antibiotic resistance profile in mechanically ventilated pediatric patients using heated humidifiers and heat and moisture exchangers.

Methods

Descriptive cross-sectional study between 2016 to 2023, of 1920 endotracheal cultures taken after 48 hours of intubation in mechanically ventilated pediatric patients and classified according to the type of humidifier. The frequency and resistance profile of the identified bacteria were determined.

Results

The percentage of positivity and the most frequently identified bacterial species were the same in both groups. The strains from heated humidifiers showed greater antibiotic resistance, 56% of which presented only 1 or 2 therapeutic options, compared to 28% in the group of heat and humidity exchangers. In addition, 50% of the strains in the heat and humidity exchangers had 4 or more therapeutic options, compared to 39% in the heat exchanger group.

Conclusions

No significant differences in bacterial exposure were found between the 2 technologies. However, heated humidifier strains showed higher antibiotic resistance, suggesting a higher potential risk of infections with limited therapeutic options.