Diagnosis of Bacterial Tracheostomy-Associated Respiratory Tract Infections in Pediatric Patients

OBJECTIVES To identify demographic and clinical characteristics of children with fever and/or respiratory illness associated with a diagnosis of bacterial tracheostomy-associated respiratory tract infections (bTARTI). Secondary objectives included comparison of diagnostic testing, length of stay (LOS), and readmission rates between children diagnosed with bTARTI and others. METHODS We performed a retrospective chart review of encounters over 1 year for fever and/or respiratory illness at a single academic children’s hospital for children with tracheostomy dependence. Patient characteristics, features of presenting illness, and laboratory and imaging results were collected. Generalized linear mixed models were employed to study associations between patient characteristics, diagnosis of bTARTI, and impact on LOS or readmission rates. RESULTS Among 145 children with tracheostomies identified, 79 children contributed 208 encounters. bTARTI was diagnosed in 66 (31.7%) encounters. Significant associations with bTARTI diagnosis included chest radiograph consistent with bacterial pneumonia (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.50–2.08), positive tracheal aspirate culture (OR, 1.3; 95% CI, 1.05–1.61), higher white blood cell count (16.4 vs 13.1 × 103/µ; P = .03), change in oxygen requirement (OR, 1.14; 95% CI, 1.00–1.31), telephone encounter (OR, 1.41; 95% CI, 1.09–1.81), and living at home with family (OR, 1.42; 95% CI, 1.06–1.92). LOS for admitted patients with bTARTI was 2.19 times longer (CI, 1.23–3.88). CONCLUSIONS In our single-center study, we identified several clinical and nonclinical factors associated with a diagnosis of bTARTI. Despite widespread use, few laboratory tests were predictive of a diagnosis of bTARTI. There is need for standardization in diagnosis.