TOP 68 - Identifying Risk Factors for Outpatient Treatment Failure of Tracheostomy-Associated Respiratory Infections in Pediatric Patients: A Retrospective Study

Publication Number: 2821.TOP 68

Samuel J. Pouncey, University of Louisville School of Medicine, Jeffersonville, IN, United States; Vicki Montgomery, Norton Children’s Hospital, Louisville, KY, United States; Jamie M. Furlong-Dillard, Norton Children’s Hospital, Louisville, KY, United States; Kelly A. Lyons, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, United States

Background: There are approximately 4,500 pediatric tracheostomies performed in the United States each year. Despite improving outcomes overall, pediatric tracheostomy patients frequently experience tracheostomy-associated respiratory infections (TARIs), contributing to >20,000 annual hospitalizations and $1.4 billion in healthcare costs. This is the most common reason for hospitalization among the pediatric tracheostomy population. Little is known currently about outpatient treatment failure rates and predictors of hospital admission to treat TARIs.

Objective: Our primary aim is to identify factors associated with outpatient treatment failure of TARIs and, secondarily, to determine predictors of prolonged hospital or ICU stay among admitted patients. We defined a TARI as: the presence of two or more of the following in a patient with a tracheostomy: 1) Temperature < 36 C or >38.3 C, 2) Leukocytes < 5,000 or >10,000/mm^3 or 3) onset or increase in purulent tracheal secretions with or without any radiologic pulmonary infiltrate.

Design/Methods: To accomplish these objectives, we conducted a single center, retrospective chart review of pediatric tracheostomy patients treated for TARI within the Norton Children’s Hospital system and ambulatory setting from July 1st, 2021 to June 30th, 2024. We included patient aged 0-18 years with tracheostomy both with and without need for mechanical ventilation. Demographic, clinical, and treatment variables were extracted. There were no exclusion criteria. The primary outcome was outpatient treatment failure, defined as hospital admission for TARI within 15 days of initiation of outpatient antibiotic therapy for TARI. Bivariate tests and multivariate logistic regression with forward stepwise selection will identify independent predictors. Findings will guide criteria for early admission and inform management strategies for outpatient TARIs.