BMJ Open Respir Res. 2026 Sep 9;13(1):e004378. doi: 10.1136/bmjresp-2026-004378.
ABSTRACT
OBJECTIVES: This prospective longitudinal study characterised respiratory microbiome dynamics following new tracheostomy placement among infants.
SETTING: A tertiary care paediatric hospital system in the United States.
PARTICIPANTS: Fifteen infants ≤12 months of age contributed 84 tracheal aspirate samples collected from day 1 through 3-4 months post-placement.
PRIMARY AND SECONDARY OUTCOME MEASURES: Bacterial composition, including abundance, from 16S rRNA gene sequencing; alpha and beta diversity measures over time.
RESULTS: 16S rRNA gene sequencing revealed immediate and sustained bacterial community shifts. Staphylococcus abundance increased and alpha diversity decreased in the first 30 days post-tracheostomy (p<0.05) before returning to baseline. Beta diversity demonstrated compositional changes immediately and with ongoing divergence through 3-4 months. Time and clinical factors (prematurity, ventilation and neurologic impairment) were significantly associated with microbiome structure (p=0.001).
CONCLUSIONS: This study provides novel evidence that new tracheostomy placement induces rapid and prolonged airway microbiome disruption in infants, highlighting a previously uncharacterised window of vulnerability with implications for respiratory health.
PMID:42716577 | DOI:10.1136/bmjresp-2026-004378
