Shifting the Culture: Tracheitis Guidelines Reduce Overdiagnosis in a Pediatric Hospital

Introduction: There is significant variability in the indications for treatment of tracheitis, as well as the type and course of treatment. Our pediatric specialty care hospital has an average daily census of trach/vent patients (ADCv) of >15, presenting the opportunity to implement meaningful change to reduce antibiotic burden in a quantifiable way. The length of stay for these patients is often at least three months, facilitating follow-up of outcomes. We hypothesize that if tracheitis diagnostic and treatment guidelines are provided, then there will be a 20% decrease in tracheitis-related antibiotic days per ADCv without increase in infection-related pediatric ventilator-associated events (P-VAEs).


Methods: Following literature review and discussion with content experts, a guideline was created and implemented for the inpatient unit in September 2024. Stakeholder education was provided via a grand rounds presentation to complement the guideline. Guideline criteria include increased secretions, increased respiratory support, new temperature instability, as well as lab criteria. The data for the three months pre-implementation (July-September 2024) were compared to the data for the following nine months (October 2024 – June 2025). Data was reviewed for accuracy; data was analyzed with assistance of Julius AI via a Mann-Whitney U test to determine whether there was a statistically significant difference between pre- and post- implementation groups in terms of tracheitis-related antibiotic days per ADCv (calculated as days of therapy in that month divided by the ADCv). P-VAEs were tracked during this time.


Results: Pre-implementation there were 3-8 tracheitis cases per month and 23-93 days of antibiotic therapy per month. Post-implementation, there were 1-3 tracheitis cases per month and 3-13 days of antibiotic therapy per month. There was a significant difference when assessing the number of days of tracheitis antibiotics per ADCv, equivalent to an 84% reduction (2.59 vs 0.41, p= 0.0091). There were zero instances of infection-related P-VAE during this period.


Conclusions: Tracheitis guidelines enhanced antimicrobial stewardship at our institution with successful reduction of tracheitis antibiotic days per ADCv by 84%. There were no associated P-VAEs despite the reduced antimicrobial use.