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.