CONCLUSION
Among children with tracheostomies at our institution, respiratory
culture testing demonstrates limited utility as a testing tool to screen
for, diagnose, or treat, ARI. ARI diagnosis is only associated with
isolation of organisms commonly seen in and empirically treated during
routine bacterial respiratory infections, without better odds of
identifying uncommon or treatment-modifying organisms. Despite frequent
isolation, P. aeruginosa was not associated with ARI and may not
represent acute infection. Both TA and BAL respiratory cultures have
poor sensitivity, moderate specificity, and low likelihood ratios to
screen for ARI in clinical practice. Future guidelines for respiratory
culture ordering and clinical interpretation should consider the limited
value of this diagnostic test.