What question did this study set out to answer?

To examine outpatient practices for diagnosing and managing bacterial tracheitis in ventilator-dependent children.

January 14, 2026Open Access

P-402. Current Practices for the Outpatient Diagnosis & Management of Bacterial Tracheitis (BT) in Ventilator-Dependent Children (VC)

GDGeneviève A DonaheyChildren's Hospital of Pittsburgh GRGlenn J. RapsinskiChildren's Hospital of Pittsburgh JRJessica Reyes-AngelChildren's Hospital of Pittsburgh

Key Points

To examine outpatient practices for diagnosing and managing bacterial tracheitis in ventilator-dependent children.
Self-reported surveys from outpatient providers
Chart review of respiratory illness events
Analysis of endotracheal culture ordering patterns
Review of antibiotic treatment regimens
Assessment of outcomes including emergency department visits and hospitalizations.
78% response rate from baseline practice surveys among 18 outpatient providers
Significant practice variation in obtaining endotracheal cultures for diagnosis
Antibiotic treatment duration ranged from 5 to 14 days
100 cultures were associated with respiratory illness events
Findings suggest a need for standardized care in managing bacterial tracheitis.

Abstract

Abstract Background There are no nationally recognized guidelines for the diagnosis & management of ventilator-associated BT. Guidelines for pediatric inpatient ordering of endotracheal cultures (EC) have reduced unnecessary cultures, but there are no studies examining outpatient practices & management of BT. We propose to extrapolate this work to the outpatient setting for VC.Table 1.OP survey responses regarding diagnosis and management of BT.Table 2.RIEs from a sample of 60 patients from 1/1/2022-10/1/2024. Methods This project examines outpatient provider (OP) practices via self-reported survey responses & chart review of respiratory illness events (RIE) in VC. OP RIEs were characterized using standardized definitions. Medical records were reviewed from 1/1/2022-10/1/2024 to examine the number of & reason for ordering ECs, specific antibiotic treatment, both prescribed & actual days of therapy (DOT), & outcomes including ED visits & hospitalization. Results 18 OPs were identified in the pulmonology & complex care departments. Baseline practice surveys distributed with a 78% response rate. 11/14 of OPs report routinely obtaining ECs to assist with diagnosis and management of BT & 4/14 obtain routine surveillance cultures (Table 1). Antibiotic DOT had a large range, 5-14 days (Table 1). Survey responses were compared with data obtained from 145 VC, including 220 ECs obtained from 1/1/2022-10/1/2024, & 174 RIEs from a subset of 60 VC (Table 2). 100 ECs were associated with RIEs. 33/220 were surveillance cultures, ordered by Pulmonology only. 9 cultures had no indication documented. The highest proportion of cultures ordered in assessment of RIEs were ordered by Pulmonology & the ED, while ENT had the lowest. Pulmonology & ENT had the highest rates of antibiotic prescriptions. Conclusion Survey data and chart review indicates that there is significant practice variation regarding diagnosis & treatment of bacterial tracheitis & the use of ECs. These results reflect the known lack of diagnostic & treatment data regarding BT in VC, thus presenting an opportunity for meaningful intervention to standardize care. Disclosures Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant

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