Conclusions
Children with tracheostomy represent a vulnerable population of patients
who often have multiple complex co-morbidities and have high level of
resource utilization and antibiotic exposure. Our study shows that these
children are frequently treated for respiratory illness. Successfully
treating illnesses at home would minimize healthcare costs and avoid
hospitalizations. We did not find a difference in subsequent 28 day
hospitalization between starting outpatient antibiotics versus only
increasing AWC, indicating that antibiotics may not help with avoiding
hospitalization and should be used only after careful consideration of
the patient’s clinical status and medical history. Prospective studies
to determine optimal outpatient treatment strategies are needed.
References
1. Russell CJ, Simon TD. Care of children with medical complexity in the
hospital setting. Pediatric annals 2014;43:e157-e62.
2. Russell CJ, Mack WJ, Schrager SM, Wu S. Care variations and outcomes
for children hospitalized with bacterial tracheostomy-associated
respiratory infections. Hospital pediatrics 2017;7:16-23.
3. Rogerson CM, Beardsley AL, Nitu ME, Cristea AI. Health Care Resource
Utilization for Children Requiring Prolonged Mechanical Ventilation via
Tracheostomy. Respiratory Care 2020.
4. Zhu H, Das P, Roberson DW, et al. Hospitalizations in children with
preexisting tracheostomy: a national perspective. The Laryngoscope
2015;125:462-8.
5. Rusakow LS, Guaría M, Wegner CB, Rice TB, Mischler EH. Suspected
respiratory tract infection in the tracheostomized child: the pediatric
pulmonologist’s approach. Chest 1998;113:1549-54.
6. Edson RS, Brey RH, McDonald TJ, Terrell CL, McCarthy JT, Thibert JM.
Vestibular toxicity due to inhaled tobramycin in a patient with renal
insufficiency. Mayo Clinic Proceedings; 2004: Elsevier. p. 1185-91.
7. Kahler DA, Schowengerdt KO, Fricker FJ, Mansfield M, Visner GA, Faro
A. Toxic serum trough concentrations after administration of nebulized
tobramycin. Pharmacotherapy: The Journal of Human Pharmacology and Drug
Therapy 2003;23:543-5.
8. Patatanian L. Inhaled tobramycin-associated hearing loss in an
adolescent with renal failure. The Pediatric infectious disease journal
2006;25:276-8.
9. Niederman MS, Ferranti RD, Zeigler A, Merrill WW, Reynolds HY.
Respiratory infection complicating long-term tracheostomy: the
implication of persistent gram-negative tracheobronchial colonization.
Chest 1984;85:39-44.
10. McCaleb R, Warren RH, Willis D, Maples HD, Bai S, O’Brien CE.
Description of respiratory microbiology of children with long-term
tracheostomies. Respiratory care 2016;61:447-52.
11. Henry RL, Mellis CM, Petrovic L. Mucoid Pseudomonas aeruginosa is a
marker of poor survival in cystic fibrosis. Pediatric pulmonology
1992;12:158-61.
12. Zemanick ET, Emerson J, Thompson V, et al. Clinical outcomes after
initial pseudomonas acquisition in cystic fibrosis. Pediatric
pulmonology 2015;50:42-8.
13. Kosorok MR, Zeng L, West SE, et al. Acceleration of lung disease in
children with cystic fibrosis after Pseudomonas aeruginosa acquisition.
Pediatric pulmonology 2001;32:277-87.
14. Dasenbrook EC, Checkley W, Merlo CA, Konstan MW, Lechtzin N, Boyle
MP. Association between respiratory tract methicillin-resistant
Staphylococcus aureus and survival in cystic fibrosis. Jama
2010;303:2386-92.
15. Russell CJ, Simon TD, Mamey MR, Newth CJ, Neely MN. Pseudomonas
aeruginosa and post‐tracheotomy bacterial respiratory tract infection
readmissions. Pediatric pulmonology 2017;52:1212-8.
16. Mogayzel Jr PJ, Naureckas ET, Robinson KA, et al. Cystic Fibrosis
Foundation pulmonary guideline. Pharmacologic approaches to prevention
and eradication of initial Pseudomonas aeruginosa infection. Annals of
the American Thoracic Society 2014;11:1640-50.
17. Rosenfeld M, Emerson J, Accurso F, et al. Diagnostic accuracy of
oropharyngeal cultures in infants and young children with cystic
fibrosis. Pediatric pulmonology 1999;28:321-8.
18. Solomon DH, Wobb J, Buttaro BA, Truant A, Soliman AM.
Characterization of bacterial biofilms on tracheostomy tubes. The
Laryngoscope 2009;119:1633-8.
19. Cline JM, Woods CR, Ervin SE, Rubin BK, Kirse DJ. Surveillance
tracheal aspirate cultures do not reliably predict bacteria cultured at
the time of an acute respiratory infection in children with tracheostomy
tubes. Chest 2012;141:625-31.
20. Bartlett JG, Faling LJ, Willey S. Quantitative tracheal
bacteriologic and cytologic studies in patients with long-term
tracheostomies. Chest 1978;74:635-9.
21. Morar P, Singh V, Jones AS, Hughes J, Van Saene R. Impact of
tracheotomy on colonization and infection of lower airways in children
requiring long-term ventilation: a prospective observational cohort
study. Chest 1998;113:77-85.
22. Tillman EM, Firmani SE, Ackerman VL, Slaven JE, Cristea AI.
Evaluation of the Treatment of Stenotrophomonas maltophilia in
Tracheostomy-Dependent Pediatric Patients. The Journal of Pediatric
Pharmacology and Therapeutics 2019;24:510-6.
23. Cristea AI, Ackerman VL, Davis SD, et al. Median household income:
association with mortality in children on chronic ventilation at home
secondary to bronchopulmonary dysplasia. Pediatric allergy, immunology,
and pulmonology 2015;28:41-6.
24. Beardsley AL, Nitu ME, Cox EG, Benneyworth BD. An evaluation of
various ventilator-associated infection criteria in a PICU. Pediatric
Critical Care Medicine 2016;17:73-80.
25. Willson DF, Hall M, Beardsley A, et al. Pediatric
Ventilator-Associated Events: Analysis of the Pediatric
Ventilator-Associated Infection Data. Pediatric critical care medicine
2018;19:e631-e6.