<div>Title: Outpatient Treatment of Lower Respiratory Tract Infections in
Children with Tracheostomy</div><div>Authors: Parevi Majmudar DO<sup>1</sup>, D.B. Sanders
MD<sup>1</sup>, Andrew Beardsley MD<sup>2</sup>, James
Slaven MS<sup>3</sup>, A. Ioana Cristea MD<sup>1</sup></div><div><sup>1</sup> Division of Pulmonary, Allergy and Sleep Medicine,
Riley Hospital for Children at Indiana University Health, Indianapolis,
IN</div><div><sup>2</sup>Division of Pediatric Critical Care Medicine, Riley
Hospital for Children at Indiana University Health, Indianapolis, IN</div><div><sup>3</sup> Department of Biostatistics, Indiana University
School of Medicine, Indianapolis, IN</div><div>Funding: None.</div><div>Meetings: This work will be presented at the virtual American Thoracic
Society meeting in 2020.</div><div>Correspondence: Parevi Majmudar, 705 Riley Hospital Dr, ROC 4270,
Indianapolis, IN 46202</div><div>Telephone: 317-948-0949, Fax: 317-944-5791</div><div>Email: Parevipm@gmail.com</div><div>Keywords: tracheitis, inhaled tobramycin, hospitalization, complex
medical conditions</div><div>Abstract</div><div>RATIONALE: Outpatient treatment of lower respiratory tract infection
(LRTI) in tracheostomy dependent children varies. The objective of this
study was to identify whether increasing frequency of airway clearance
(AWC) alone increased the odds of hospitalization within 28 days of
treatment. Our hypothesis was that those treated with antibiotics were
less likely to be hospitalized.</div><div>METHODS: We reviewed medical records of children who were tracheostomy
dependent between 2012-2019 and followed at our institution. We recorded
recommendations provided at each sick call or clinic visit, i.e.
prescription of antibiotics and/or increase in frequency of AWC, for
physician defined LRTI. Generalized estimating equation models were used
to determine whether the recommendation to increase AWC frequency was
associated with an increased risk of hospitalization within 4 weeks, as
compared to the prescription of oral and/or inhaled antibiotics.</div><div>RESULTS: Among the 82 patients reviewed, there were 283 unique episodes
of LRTI. Increasing AWC alone was recommended for 160 (45%) episodes
and antibiotics were prescribed for 195 (55%) in addition to increasing
AWC. Of those who received AWC only, 21.7% were hospitalized within 28
days of treatment, compared to 13.8% prescribed oral/inhaled
antibiotics, p= 0.08. Those who received AWC alone did not have
significantly higher odds of hospitalization within 28 days of
treatment: adjusted OR 1.47 (95% CI: 0.75, 2.86); p=.26.</div><div>CONCLUSIONS: In this retrospective cohort study of pediatric patients
with tracheostomy, a recommendation to increase AWC alone was not
associated with increased odds of hospitalization compared to antibiotic
prescriptions.</div>