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Antibiotic Use and Infection Patterns in Pediatric Tracheostomy Patients During Index Hospitalization

Romaine F Johnson1,2, Saudamini Lele1,2, Alyssa C Chapel1,2

  • 1Department of Otolaryngology-Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA.

OTO Open
|August 18, 2026
PubMed

Insights

Antibiotic use in pediatric tracheostomy patients varies widely by diagnosis, not infection risk. Stewardship efforts should focus on individual patient factors and standardized viral testing to reduce unnecessary antibiotic exposure.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease epidemiology
  • Antimicrobial stewardship

Background:

  • Antibiotic utilization is a key process measure in healthcare settings.
  • Pediatric tracheostomy patients represent a vulnerable population with complex medical needs.
  • Understanding antibiotic use patterns is crucial for quality improvement initiatives.

Purpose of the Study:

  • To evaluate antibiotic utilization as a process measure in pediatric tracheostomy patients.
  • To establish baseline variation in antibiotic use across diagnostic categories.
  • To inform quality improvement and antimicrobial stewardship initiatives.

Main Methods:

  • Retrospective study of pediatric tracheostomy patients (2015-2024) at a tertiary children's hospital.
  • Quantified antibiotic use across diagnostic categories; defined prophylactic courses (≤2 days).
  • Modeled infection risk using mixed-effects logistic regression, accounting for patient clustering.

Main Results:

  • Respiratory conditions were most common (43.8%), followed by cardiac (19.3%).
  • Cardiac patients had high antibiotic exposure (mean 52.1 days) with low infection rates (17.8%).
  • Trauma patients had the highest infection rates (31.5%); only 19.6% of cultures showed true bacterial infection.

Conclusions:

  • Antibiotic prescribing patterns often reflect institutional preferences over true infection risk.
  • Individual patient factors, not diagnostic category, more strongly predict infection.
  • Highlights the need for personalized stewardship and standardized viral detection protocols.
Abstract

Keywords:
antibiotic utilizationantimicrobial stewardshipbacterial infectionspediatric tracheostomy

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