{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:24:49Z","timestamp":1790025889946,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001130","name":"Gerber Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize factors that influence the decision to treat suspected pediatric bacterial tracheostomy\u2010associated respiratory infections (bTRAINs; e.g., pneumonia, tracheitis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a multicenter, prospective cohort study of children with pre\u2010existing tracheostomy hospitalized at six children's hospitals for a suspected bTRAIN (receipt of respiratory culture plus \u22651 doses of an antibiotic within 48\u2009h). The primary predictor was respiratory culture growth categorized as\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      ,\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      \u2009+\u2009\u22651 other bacterium, other bacteria alone, or normal flora\/no growth. Our primary outcome was bTRAIN treatment with a complete course of antibiotics as documented by the discharge team. We used logistic regression with generalized estimating equations to identify the association between our primary predictor and outcome and to identify demographic, clinical, and diagnostic testing factors associated with treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 440 admissions among 289 patients meeting inclusion criteria, 307 (69.8%) had positive respiratory culture growth. Overall, 237 (53.9%) of admissions resulted in bTRAIN treatment. Relative to a negative culture, a culture positive for\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      plus \u22651 other organism (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.02\u20135.0)] or \u22651 other organism alone (aOR: 2.8; 95% CI: 1.4\u20135.6)] was associated with treatment. Several clinical and diagnostic testing (respiratory Gram\u2010stain and chest radiograph) findings were also associated with treatment. Positive respiratory viral testing was associated with reduced odds of treatment (aOR: 0.5; 95% CI: 0.2\u20130.9).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Positive respiratory cultures as well as clinical indicators of acute illness and nonculture test results were associated with bTRAIN treatment. Clinicians may be more comfortable withholding antibiotics when a virus is identified during testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.27117","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T13:09:00Z","timestamp":1718111340000},"page":"2761-2771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Factors associated with tracheostomy\u2010associated infection treatment: A multicenter observational study"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2882-8849","authenticated-orcid":false,"given":"John M.","family":"Morrison","sequence":"first","affiliation":[{"name":"Division of Pediatric Hospital Medicine Johns Hopkins All Children's Hospital St. Petersburg Florida USA"},{"name":"Department of Pediatrics Johns Hopkins University School of Medicine Baltimore Maryland 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USA"},{"name":"Division of Infectious Diseases Children's National Hospital Washington District Columbia USA"},{"name":"Center for Genetic Medicine Research Children's National Research Institute Washington District Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine S.","family":"Forster","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Hospital Medicine and Pediatric Nephrology University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0382-6858","authenticated-orcid":false,"given":"Jonathan D.","family":"Cogen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Department of Pediatrics Seattle Children's Hospital\/University of Washington Seattle Washington USA"},{"name":"Department of Pediatrics University of Washington\/Seattle Children's Hospital Seattle Washington 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