Microbiology of stents in laryngotracheal reconstruction

Objectives. Granulation tissue often forms around a laryngotracheal stent, tracheostomy tube, or other airway prosthesis, especially if infection occurs. We studied the types and frequency of organisms colonizing stents used in pediatric laryngotracheal. reconstruction. Study Design: This prospective study included 21 patients undergoing 23 consecutive laryngotracheal reconstructions with stents between 1991 and 1999. Methods. After endoscopic removal, each laryngotracheal stent was placed immediately in a sterile container and transported to the laboratory. Specimens for culture were obtained from biofilms on the stents and plated on agars for growth of aerobic, anaerobic, and fungal organisms. Culture results were analyzed with regard to patient age, duration of stenting, and graft type. Results: All stents were colonized with more than one pathogen (range 2-7). The most frequent aerobic isolates were Streptococcus viridians, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenza, and Neisseria species. Anaerobic organisms were isolated in 26% of cases. Candida species were isolated in 57% of the cases; patients whose stents were colonized with Candida were significantly (P = .007) older (mean 77.5 months) than those not colonized with this organism (mean 26.1 months) Conclusions. The antibiotic agents currently used for children undergoing laryngotracheal reconstruction target mainly aerobic organisms. Despite prophylactic measures, the incidence of granulation tissue formation is clinically significant, and the prevalence of anaerobic, including fungal, pathogens is high. Antibiotic therapy directed toward controlling anaerobic and fungal organisms could help in controlling local inflammation and thus granulation tissue formation.