CLINICAL QUESTION: Among hospitalized children with tracheostomies who develop respiratory symptoms (tracheobronchitis and nonspecific respiratory episodes), what is the pattern of antibiotic use, what factors influence treatment decisions, and what are the associated outcomes?
BACKGROUND: Children with tracheostomies are frequently admitted for respiratory symptoms, yet differentiating viral from bacterial illness and distinguishing true infection from colonization remains challenging. Despite the absence of a consensus definition for what constitutes a likely bacterial infection in this population with high rates of airway colonization, antibiotics are often started empirically, and few studies have systematically evaluated antibiotic use and outcomes in this group.
STUDY DESIGN: Retrospective cohort study
SETTING: Single tertiary children’s hospital in Spain (from 2010 to 2021)
SYNOPSIS: In this small study of 83 children with tracheostomies, with 164 symptomatic episodes, the authors found that those diagnosed with tracheobronchitis (as defined by the authors’ proposed definition) received antibiotics about 75% of the time, compared to 29% to 40% for those with nonspecific respiratory episodes. Children with pneumonia were excluded. Two children died during their illness episode; both received antibiotics. Children with fever were significantly more likely to receive antibiotics compared to those without. 25% of those with tracheobronchitis and more than 60% of those with nonspecific respiratory episodes improved without antibiotics. Among children who received antibiotics that were resistant to the organism eventually isolated, over 50% (10 out of 18) improved without a change to a susceptible antibiotic. Given the small size and retrospective nature of this study, as well as the inclusion of multiple episodes in the same patient, more studies are needed to support the development of guidelines for the management of respiratory infections in this population, with particular attention to when antibiotics are necessary to treat true bacterial infection.
BOTTOM LINE: Children with tracheostomies are frequently treated with antibiotics for respiratory infections despite high rates of bacterial colonization and lack of clear mechanisms to identify those with true bacterial infection; further prospective research is needed to correctly categorize and treat these patients.
CITATION: García-Boyano M, et al. Antibiotic choice and outcomes for respiratory infections in children with tracheostomies. Hosp Pediatr. 2025;15(1):17-27. doi: 10.1542/hpeds.2024-007973.
Dr. Slemmer
Dr. Slemmer is a pediatric hospitalist in the department of hospital medicine at Nationwide Children’s Hospital and an assistant professor of medicine at The Ohio State University College of Medicine, both in Columbus, Ohio.
Dr. Stone
Dr. Stone is a pediatric hospitalist in the division of hospital pediatrics at Nationwide Children’s Hospital and an assistant professor of pediatrics at The Ohio State University College of Medicine, both in Columbus, Ohio.