Antibiotic Choice and Outcomes for Respiratory Infections in Children With Tracheostomies

Respiratory infections are a major cause of hospitalization in children with tracheostomies, contributing significantly to hospital expenses. Limited data exist to describe optimal diagnostic strategies or management recommendations for these infections. This study aimed to explore factors associated with antibiotic therapy, including usage, administration route, duration, variables influencing the decision to prescribe antibiotics, and outcomes in children with tracheostomies experiencing episodes of respiratory infection other than pneumonia (tracheobronchitis and nonspecific respiratory episodes [NSRE]).

We conducted a retrospective cohort study using the medical records of 83 children who underwent tracheostomy and received treatment at a tertiary hospital from 2010 to 2021.

A total of 164 episodes of tracheobronchitis and 98 episodes of NSRE were analyzed. Children with tracheobronchitis were more frequently treated with antibiotics: 75% in nonhospitalized cases and 76% in hospitalized cases. In NSRE, antibiotic prescription dropped to 40% and 29%, respectively. Out of 51 tracheobronchitis and 15 NSRE initially treated with oral antibiotics, a switch to intravenous administration was deemed necessary in only 7 tracheobronchitis cases (14%). Fever was significantly associated with antibiotic prescription in tracheobronchitis and NSRE, regardless of hospitalization status. Two children died within the 28-day period following the onset of tracheobronchitis symptoms.

Many cases identified as tracheobronchitis, along with a greater number of NSRE cases, resolved without requiring antibiotics. Although fever was associated with increased antibiotic prescription, it does not necessarily indicate severity. Therefore, careful consideration should be given before prescribing antibiotics, especially in febrile cases, to avoid unnecessary treatments.