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EARLY INVASIVE BACTERIAL INFECTION AFTER ASPIRATION AND ACUTE RESPIRATORY FAILURE

This study was performed to determine the clinical importance, incidence, and early identifying features of infection occuring in children in the first 48 hr after severe acute lung injury from aspiration. Charts from the past 6 yrs. were reviewed for all children at high risk for aspiration of pharyngeal secretions, requiring mechanical ventilation. (Drowning (13), aspirated foreign body (5), known aspiration of gastric contents (2), hydrocarbon aspiration (1)). Criteria for inclusion included survival ≥24 hr, and a blood culture obtained in the first 48 hr. Invasive infection was identified by positive blood culture. Possible infection was defined as: T>38.5°C, blood white cell count >10,000 or <5,000, and a potential pathogen in cultures of tracheal secretions. Of 21 high risk patients, 7 (.33%) had infections in the first 48 hr after aspiration. Five had invasive infection (S. pneumoniaet(4), P. cepacia (1)). Two possible infections occurred (S. pneumoniae, E. aerogenes). One child died in septic shock. Older age was associated with infection (mean 60 and 21 mo in infected and noninfected patients, respectively; p<.05). Other variables had no predictive value: immune deficiency, cardiac arrest, neutrophil count and trend, arterial to alveolar pO2 ratio and trend, antibiotic usage, assymetry on chest X-ray, and temperature. These observations are consistent with experimental data indicating the potential for invasive infection when bacteria are innoculated into severely injured lung. Since infection is difficult to predict in this high risk group, consideration should be given to immediate initiation of antibiotic therapy, and aggressive bacterioiogic surveillance.