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Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentations 2 - Care Equity, Quality, and Safety

Antibiotic Use and Infection Patterns in Pediatric Tracheostomy Patients During Index Hospitalization

Monday, October 13, 2025

8:36 AM - 8:42 AM EDT

Location: 107-108

Disclosure(s):

Alyssa C. Chapel, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Romaine F. Johnson, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pediatric tracheostomy patients are at high risk for infections and antibiotic overuse, making them a critical population for antimicrobial stewardship.

Methods: This retrospective cohort study was conducted at a tertiary care children’s hospital between January 2015 and December 2024. Data were collected on pediatric patients (aged 0–18 years) who underwent tracheostomy, including demographics, primary diagnoses, antibiotic usage, and infection patterns. Antibiotic utilization was categorized as prophylactic or therapeutic. Cultures were analyzed to determine infection timing and pathogen profiles. Independent variables included age, primary diagnosis, and infection timing, while outcome measures included antibiotic duration, infection rates, and culture positivity. Statistical comparisons were performed to identify patterns in antibiotic use across diagnostic categories and assess potential misalignments between antibiotic exposure and infection risks.

Results: The cohort included 429 patients (median age: 0.57 years, IQR: 0.36–4.66), with primary diagnoses of respiratory (43.8%), cardiac (19.4%), congenital (8.6%), and neuromuscular conditions (7.9%). Prophylactic antibiotic durations varied significantly across diagnostic categories (range: 0.63–1.08 days, p< 0.0001), with neuromuscular patients receiving the longest courses. Post-surgical infections occurred in 82.4% of patients, with a median time to the first positive culture of 52.5 days (IQR: 20.8–102.5). Cardiac patients had significantly higher antibiotic exposure compared to respiratory patients (adjusted difference: 10.6 days, 95% CI: 9.1–12.2, p< 0.001), despite a lower infection rate (76.0% vs 85.1%). Respiratory and cardiac patients accounted for 71.3% of MRSA and Pseudomonas isolates.

Conclusions: Misalignment between antibiotic use and infection rates highlights opportunities for antimicrobial stewardship, particularly in cardiac patients. Diagnosis-specific risks and timing of infections should guide future antibiotic use guidelines to optimize care for pediatric tracheostomy patients.

Presenting Author(s)

SL

Saudamini Lele, MD

LSU Health - Shreveport, United States

Disclosure information not submitted.

Co-Author(s)

Alyssa C. Chapel, MD

Resident
University of Texas Southwestern Medical School
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Cynthia S. Wang, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure information not submitted.
Yann-Fuu Kou, MD

Assistant Professor
University of Texas Southwestern Medical Center, Department of Otolaryngology
Dallas, TX, United States

Disclosure information not submitted.
Stephen R. Chorney, MD, MPH

Assistant Professor, Department of Otolaryngology - Head & Neck Surgery
University of Texas Southwestern
Dallas, TX, United States

Disclosure information not submitted.
RJ

Romaine F. Johnson, MD, MPH

Professor
Univ of Texas Southwestern Med Ctr
Dallas, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

RJ

Romaine F. Johnson, MD, MPH

Professor
Univ of Texas Southwestern Med Ctr
Dallas, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.