# Diagnosis and management of pediatric tracheostomy-associated infections

> **NIH AHRQ R01** · CHILDREN'S HOSPITAL OF LOS ANGELES · 2021 · $500,000

## Abstract

PROJECT SUMMARY/ABSTRACT: In children with tracheostomy (an artificial airway placed for upper airway
abnormalities or chronic illness progression), bacterial respiratory infections are the most common reason for
hospital admission, accounting for over 4600 hospitalizations and $300 million in U.S. hospital charges each
year. Despite being the most common reason for hospital admission, there is limited evidence for the treatment
of bacterial tracheostomy-associated infections (bTRAINs; bacterial pneumonia and/or tracheitis) in children.
The overall objective of the current application is to evaluate what factors influence clinicians to diagnose and
treat suspected bTRAINs with antibiotics. Pseudomonas aeruginosa (Pa), a bacterium with limited oral
antibiotic options, is a common cause of bTRAINs. Because Pa causes 60% of bTRAINs, some clinicians
presumptively treat for Pa while awaiting test results. However, because Pa growth is also common in
respiratory cultures from patients with tracheostomy without clinical bTRAIN symptoms, some clinicians do not
use Pa-targeted antibiotics when Pa is recovered on respiratory culture. Our preliminary data demonstrates
wide variations in hospital-level diagnostic testing and treatment care practices in this population that are not
associated with clinical outcomes, common use of empiric Pa-targeted antibiotics, and absence of differential
outcomes when Pa is detected, regardless of receiving Pa-targeted antibiotics. Through development of a
consortium of five freestanding children's hospitals, we will prospectively collect data on 1500 hospitalizations
in children with tracheostomy and complete the following specific aims: 1) To determine the impact of rapid
respiratory viral testing on continued antibiotic treatment in children with suspected bTRAINs; 2) To identify
clinical and laboratory factors associated with antibiotic overuse in children with tracheostomy treated for
bTRAINs; and 3) To define the association between bacteria-discordant antibiotic coverage, culture results and
clinical outcomes in children hospitalized with bTRAINs and Pa-positive respiratory cultures. This will be the
first multicenter prospective study in respiratory infections in children with tracheostomy. Findings will provide
the necessary groundwork to design and implement targeted intervention trials to address heterogeneity in
bTRAIN diagnosis and management, which may lead to decreased broad-spectrum antibiotic exposure and
better long-term outcomes in a vulnerable population with high healthcare utilization. The proposal is
responsive to the current program announcement (PA-16-423) and the AHRQ's mission to promote
appropriate antibiotic use by “improv[ing] the appropriateness of antibiotic selection” through identifying “factors
influencing prescriber decisions about the use and choice of antibiotics” and by examining “the role of rapid
diagnostics in improving antibiotic use, including how rapid diagnostics should be integ...

## Key facts

- **NIH application ID:** 10211599
- **Project number:** 1R01HS027619-01A1
- **Recipient organization:** CHILDREN'S HOSPITAL OF LOS ANGELES
- **Principal Investigator:** Christopher John Russell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $500,000
- **Award type:** 1
- **Project period:** 2021-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10211599

## Citation

> US National Institutes of Health, RePORTER application 10211599, Diagnosis and management of pediatric tracheostomy-associated infections (1R01HS027619-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10211599. Licensed CC0.

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