Factors associated with tracheostomy-associated infection treatment: A multicenter observational study

John M. Morrison, Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Naoko Kono, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Margaret Rush, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washingto, District Columbia, USA.
Andrea Hahn, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washingto, District Columbia, USA.
Catherine S. Forster, Divisions of Pediatric Hospital Medicine and Pediatric Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jonathan D. Cogen, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington, USA.
Joanna Thomson, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Sarah Hofman DeYoung, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington, USA.
Sowgand Bashiri, Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
Wendy J. Mack, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Michael N. Neely, Division of Infectious Disease, Children's Hospital Los Angeles, Los Angeles, California.
Tamara D. Simon, Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
Christopher J. Russell, Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.

Document Type

Journal Article

Publication Date

6-11-2024

Journal

Pediatric pulmonology

DOI

10.1002/ppul.27117

Keywords

Pseudomonas aeruginosa; pediatrics; pneumonia; tracheitis; tracheostomy

Abstract

OBJECTIVE: To characterize factors that influence the decision to treat suspected pediatric bacterial tracheostomy-associated respiratory infections (bTRAINs; e.g., pneumonia, tracheitis). METHODS: We conducted a multicenter, prospective cohort study of children with pre-existing tracheostomy hospitalized at six children's hospitals for a suspected bTRAIN (receipt of respiratory culture plus ≥1 doses of an antibiotic within 48 h). The primary predictor was respiratory culture growth categorized as Pseudomonas aeruginosa, P. aeruginosa + ≥1 other bacterium, other bacteria alone, or normal flora/no growth. Our primary outcome was bTRAIN treatment with a complete course of antibiotics as documented by the discharge team. We used logistic regression with generalized estimating equations to identify the association between our primary predictor and outcome and to identify demographic, clinical, and diagnostic testing factors associated with treatment. RESULTS: Of the 440 admissions among 289 patients meeting inclusion criteria, 307 (69.8%) had positive respiratory culture growth. Overall, 237 (53.9%) of admissions resulted in bTRAIN treatment. Relative to a negative culture, a culture positive for P. aeruginosa plus ≥1 other organism (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.02-5.0)] or ≥1 other organism alone (aOR: 2.8; 95% CI: 1.4-5.6)] was associated with treatment. Several clinical and diagnostic testing (respiratory Gram-stain and chest radiograph) findings were also associated with treatment. Positive respiratory viral testing was associated with reduced odds of treatment (aOR: 0.5; 95% CI: 0.2-0.9). CONCLUSIONS: Positive respiratory cultures as well as clinical indicators of acute illness and nonculture test results were associated with bTRAIN treatment. Clinicians may be more comfortable withholding antibiotics when a virus is identified during testing.

Department

Pediatrics

Link to Full Text

Share

COinS