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Pediatric tracheostomy-associated respiratory infections: an evolving paradigm
John M Morrison1,2, Rebecca Steuart3,4, Christopher J Russell5
1Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida.
Current Opinion in Pediatrics
|April 7, 2026
Summary
Tracheostomy-associated infections (TRAINs) in children are shifting in diagnosis and treatment. New research focuses on airway microbiome and inflammation, moving away from routine cultures for better TRAIN management.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Microbiome Research
Background:
- Children with tracheostomy are susceptible to tracheostomy-associated infections (TRAINs), including pneumonia and tracheitis.
- Current diagnostic and treatment strategies for TRAINs are evolving.
Purpose of the Study:
- To review current evidence on the diagnosis, treatment, and prevention of TRAINs in children.
- To highlight recent advances in understanding TRAIN pathobiology.
Main Methods:
- Literature review of recent evidence on TRAINs.
- Analysis of diagnostic limitations and emerging tools.
- Evaluation of current and novel treatment strategies.
Main Results:
- Respiratory culture testing has limitations due to the dynamic airway microbiome in children with tracheostomies.
- Routine respiratory cultures are not recommended without specific clinical symptoms.
- Microbiome shifts and host inflammation show potential as diagnostic markers.
- Selective anaerobic antibiotic coverage and shorter treatment courses are suggested.
- Inhaled tobramycin may reduce TRAIN frequency and hospitalizations.
Conclusions:
- The diagnosis, treatment, and prevention of TRAINs are undergoing a paradigm shift.
- Further research is needed on the airway microbiome and host inflammation in TRAINs.
- Optimizing antibiotic treatment and prevention requires further clinical trials.
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