ABSTRACT Objective Test the association between early antibiotic discontinuation and outcomes for children with a tracheostomy and positive respiratory viral PCR (RVP) hospitalized with suspected bTRAIN (bacterial TRacheostomy‐Associated INfection; pneumonia/tracheitis). Methods We conducted a multicenter cohort study between September 1, 2021 and August 31, 2024 of children with pre‐existing tracheostomy hospitalized for suspected bTRAIN (tracheal aspirate bacterial culture sent and bTRAIN antibiotics started) at six children's hospitals with: (1) a positive RVP test; (2) no antibiotic pre‐treatment; and (3) length of stay (LOS) < 37 days (outlier). Mixed‐effects regression models identified independent associations between early antibiotic discontinuation and our primary outcome, LOS (in days). Inverse probability treatment weighting based on propensity scoring adjusted for measured confounding. We explored the association between early antibiotic discontinuation and 3 secondary outcomes: late ICU transfer, in‐hospital mortality, and 30‐day bTRAIN rehospitalization rates. Results Of 542 hospitalizations in 365 children, the median admission age was 4 years (interquartile range IQR: 2–8 years). Common viruses included rhinovirus ( n = 282; 52%), SARS‐CoV‐2 ( n = 63; 12%), and respiratory syncytial virus ( n = 61; 11%). The median LOS was 7 days (IQR: 5–11 days). Only 28% ( n = 152) had early antibiotic discontinuation; full bTRAIN treatment was associated with a 23% (5%–45%) increased LOS, with estimated LOS means (95% CI) of 7.0 (5.8–8.4) days for early antibiotic discontinuation and 8.6 (7.8–9.4) days in the bTRAIN‐treated group. Secondary outcome rates (late ICU transfer = 14.6%; in‐hospital mortality = 0.9%; 30‐day bTRAIN rehospitalization rate = 8.3%) were similar rates between both groups. Conclusions Given similar rates of serious outcomes in both groups, clinicians could consider early discontinuation of antibiotic treatment in children with suspected bTRAINs who have a positive RVP test.
Russell et al. (Fri,) studied this question.
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