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Updated: May 18, 2026

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases
03:22

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases

Published on: March 1, 2024

Early Antibiotic Discontinuation for Children With a Positive Rapid Respiratory Viral Test Hospitalized for Suspected

Christopher J Russell1, Naoko Kono2, Margaret Rush3,4

  • 1Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA.

Pediatric Pulmonology
|May 16, 2026
PubMed

Insights

Early antibiotic discontinuation in children with tracheostomies and positive respiratory viral PCR tests for suspected bacterial TRacheostomy-Associated INfections (bTRAINs) did not increase serious outcomes. This suggests clinicians can consider stopping antibiotics early in these pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Critical Care Medicine
  • Antimicrobial Stewardship

Background:

  • Children with tracheostomies are susceptible to respiratory infections.
  • Bacterial TRacheostomy-Associated INfections (bTRAINs) require careful management.
  • Distinguishing viral from bacterial infections is crucial for appropriate antibiotic use.

Purpose of the Study:

  • To evaluate the association between early antibiotic discontinuation and clinical outcomes in children with tracheostomies hospitalized for suspected bTRAINs.
  • To determine if early antibiotic cessation impacts length of stay, ICU transfer, mortality, or rehospitalization.
  • To inform antibiotic stewardship practices in this vulnerable pediatric population.

Main Methods:

  • A multicenter cohort study included children with tracheostomies, positive respiratory viral PCR, and suspected bTRAINs.
  • Mixed-effects regression models and inverse probability treatment weighting were used to analyze data.
  • Outcomes assessed included length of stay, late ICU transfer, in-hospital mortality, and 30-day bTRAIN rehospitalization.

Main Results:

  • Early antibiotic discontinuation occurred in 28% of hospitalizations.
  • Full antibiotic treatment was associated with a 23% increased length of stay.
  • Rates of late ICU transfer, in-hospital mortality, and 30-day rehospitalization were similar between early discontinuation and full treatment groups.

Conclusions:

  • Early discontinuation of antibiotics in children with suspected bTRAINs and positive viral tests is associated with similar serious outcomes compared to full treatment.
  • Clinicians may consider early antibiotic cessation in these pediatric patients to optimize antimicrobial stewardship.
  • Further research could explore specific viral-bacterial co-infection scenarios.
Abstract

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