In children with pre-existing tracheostomy (an artificial airway placed for upper airway abnormalities or chronic illness progression), acute respiratory infections are the most common reason for hospital admission. These admissions account for over 4600 hospitalizations and $300 million in U.S. hospital charges each year. There is limited evidence regarding the diagnosis and management of bacterial tracheostomy-associated infections (bTRAINs), such as bacterial pneumonia and/or tracheitis. In children, Pseudomonas aeruginosa (Pa) accounts for 60% of bTRAIN hospitalizations; thus, many clinicians treat with broad-spectrum Pa-targeted antibiotics while awaiting test results. The FDA recently approved the BioFire Rapid Pneumonia Panel, a bacterial semi-quantitative PCR test which evaluates for 22 pneumonia-causing pathogens, including Pa. Results return in 1-2 hours, compared to 2-3 days for routine bacterial respiratory cultures. We propose to fill one current knowledge gap in bTRAIN diagnosis by evaluating how clinicians use rapid pneumonia testing to choose antibiotics for suspected bTRAINs.

Our central hypothesis is that rapid pneumonia testing decreases broad-spectrum antibiotic use. This hypothesis has been formulated based upon our preliminary data demonstrating: (1) high use of empiric Pa-targeted antibiotics in this population, (2) that many patients who receive Pa-targeted antibiotics ultimately do not grow Pa; and (3) high sensitivity and specificity of the BioFire Rapid Pneumonia Panel. In preparation for a future randomized controlled trial examining the utility of rapid pneumonia testing in bTRAIN evaluation and management, we propose a prospective, observational cohort study of 50 children with tracheostomy undergoing new evaluation for a suspected bTRAIN to test the feasibility and impact of this new test on antibiotic prescribing practices. We will compare our outcomes to contemporary controls not receiving the BioFire Rapid Pneumonia Panel test. Through this pilot project and subsequent trials, our long-term goal is to improve diagnosis and treatment of acute respiratory infections in children with tracheostomy.

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