Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.
Diagnostic stewardship was associated with a 16% decline in endotracheal aspirate cultures
Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.
IMPORTANCE: Endotracheal aspirate culture (endotracheal aspirate culture) practices for evaluation of ventilator-associated infections (ventilator-associated infections) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for ventilator-associated infections.
To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (pediatric intensive care units).
DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (Quality Improvement) Collaborative involving pediatric intensive care units across the US between 2019 and 2023.
fewer cultures ordered, less unnecessary testing without harming patients
Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106 967 ventilator-days preimplementation and 92 167 ventilator-days postimplementation.
The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11).
There were no significant changes in the rates of bronchoalveolar lavage cultures, pediatric intensive care units length of stay, pediatric intensive care units or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days.
In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced endotracheal aspirate culture use in the pediatric intensive care units without safety concerns.
Future work will determine optimal implementation strategies, assess sustainability and the cost impact of endotracheal aspirate culture stewardship.