Research Project
10211599
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 integrated into clinicians' decision making about antibiotic use.? This proposal also studies several AHRQ priority populations, including children, low income populations, individuals with disabilities, and individuals who need chronic health care.
