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Diagnosis and management of pediatric tracheostomy-associated infections

Award Number: R01HS027619
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2021
PERIOD OF PERFORMANCE END DATE: 07/31/2026

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Diagnosis and management of pediatric tracheostomy-associated infections - PROJECT SUMMARY/ABSTRACT: In children with tracheostomy (an artificial airway placed for upper airway abnormalities or chronic illness progression), bacterial respiratory infections are the most common reason for hospital admission, accounting for over 4600 hospitalizations and $300 million in U.S. hospital charges each year. Despite being the most common reason for hospital admission, there is limited evidence for the treatment of bacterial tracheostomy-associated infections (bTRAINs; bacterial pneumonia and/or tracheitis) in children. The overall objective of the current application is to evaluate what factors influence clinicians to diagnose and treat suspected bTRAINs with antibiotics. Pseudomonas aeruginosa (Pa), a bacterium with limited oral antibiotic options, is a common cause of bTRAINs. Because Pa causes 60% of bTRAINs, some clinicians presumptively treat for Pa while awaiting test results. However, because Pa growth is also common in respiratory cultures from patients with tracheostomy without clinical bTRAIN symptoms, some clinicians do not use Pa-targeted antibiotics when Pa is recovered on respiratory culture. Our preliminary data demonstrates wide variations in hospital-level diagnostic testing and treatment care practices in this population that are not associated with clinical outcomes, common use of empiric Pa-targeted antibiotics, and absence of differential outcomes when Pa is detected, regardless of receiving Pa-targeted antibiotics. Through development of a consortium of five freestanding children's hospitals, we will prospectively collect data on 1500 hospitalizations in children with tracheostomy and complete the following specific aims: 1) To determine the impact of rapid respiratory viral testing on continued antibiotic treatment in children with suspected bTRAINs; 2) To identify clinical and laboratory factors associated with antibiotic overuse in children with tracheostomy treated for bTRAINs; and 3) To define the association between bacteria-discordant antibiotic coverage, culture results and clinical outcomes in children hospitalized with bTRAINs and Pa-positive respiratory cultures. This will be the first multicenter prospective study in respiratory infections in children with tracheostomy. Findings will provide the necessary groundwork to design and implement targeted intervention trials to address heterogeneity in bTRAIN diagnosis and management, which may lead to decreased broad-spectrum antibiotic exposure and better long-term outcomes in a vulnerable population with high healthcare utilization. The proposal is responsive to the current program announcement (PA-16-423) and the AHRQ's mission to promote appropriate antibiotic use by “improv[ing] the appropriateness of antibiotic selection” through identifying “factors influencing prescriber decisions about the use and choice of antibiotics” and by examining “the role of rapid diagnostics in improving antibiotic use, including how rapid diagnostics should be integrated into clinicians' decision making about antibiotic use.” This proposal also studies several AHRQ priority populations, including children, low income populations, individuals with disabilities, and individuals who need chronic health care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $442,201 )
2024	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	003	4	7/10/2024	NON-COMPETING CONTINUATION	$442,202
2024	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	4/24/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2024	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	002	3	5/1/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$144,017
2024	2022	CHILDREN'S HOSPITAL LOS ANGELES	4650 W SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	5/1/2024	NON-COMPETING CONTINUATION	-$144,018
														Subtotal = $442,201

Issue Date FY: 2023 ( Subtotal = $448,527 )
2023	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	001	3	9/14/2023	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$448,527
2023	2022	CHILDRENS HOSPITAL LOS ANGELES	4650 W SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	9/14/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $448,527

Issue Date FY: 2022 ( Subtotal = $495,987 )
2022	2022	CHILDRENS HOSPITAL LOS ANGELES	4650 W SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	7/25/2022	NON-COMPETING CONTINUATION	$495,987
														Subtotal = $495,987

Issue Date FY: 2021 ( Subtotal = $500,000 )
2021	2021	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	7/20/2021	NEW	$500,000
														Subtotal = $500,000

Grand Total All Awards = $1,886,715

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Diagnosis and management of pediatric tracheostomy-associated infections

Award Number: R01HS027619

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/01/2021

PERIOD OF PERFORMANCE END DATE: 07/31/2026

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