Quantifying Antibiotic Prescribing in Children With Tracheostomies.

Area of Science:

• Pediatric pulmonology
• Infectious diseases
• Antimicrobial stewardship

Background:

• Children with tracheostomies often require complex medical care.
• Antibiotic prescribing patterns in this vulnerable population are not well-characterized.

Purpose of the Study:

• To quantify and characterize systemic antibiotic use in children with tracheostomies.
• To identify factors associated with higher antibiotic prescribing.

Main Methods:

• Retrospective cohort study of 548 children with tracheostomies (2 months–18 years).
• Antibiotic courses and days of therapy (DOT) were recorded and analyzed.
• Multivariable analyses identified predictors of antibiotic prescribing.

Main Results:

• Median antibiotic exposure was 4 courses and 33.8 DOT per child per year.
• Most antibiotic courses (72.7%) were broad-spectrum.
• Antibiotic prescribing decreased by 30-33% from 2010 to 2018.
• Ventilator use was linked to lower DOT; higher complexity and ICU days to higher DOT.

Conclusions:

• Children with tracheostomies exhibit high systemic antibiotic use, predominantly broad-spectrum agents.
• Chronic ventilator use is associated with reduced antibiotic prescribing.
• Findings can inform antimicrobial stewardship interventions for this population.