Chiotos Kathleen, Lee Giyoung, Sydney Guy, Woods-Hill Charlotte, Wolfe Heather, Stinson Hannah R, Piccione Joseph, Blumenthal Jennifer, Keim Garrett, Li Yun, Traynor Danielle, Dudhia Aaditya, Doll Ashlee, Harris Rebecca, Gerber Jeffrey
Division of Critical Care Medicine and Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Infect Control Hosp Epidemiol. 2024 Aug;45(8):943-951. doi: 10.1017/ice.2024.105. Epub 2024 Sep 4.
To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures.
Quality improvement intervention.
Tertiary care pediatric intensive care unit (PICU).
Mechanically ventilated children admitted between 9/2018 and 8/2022.
We developed and implemented a consensus guideline for obtaining tracheal aspirate cultures through a series of Plan-Do-Study-Act cycles. Change in culture rates and broad-spectrum antibiotic days of therapy (DOT) per 100 ventilator days were analyzed using statistical process control charts. A secondary analysis comparing the preintervention baseline (9/2018-8/2020) to the postintervention period (9/2020-8/2021) was performed using Poisson regression.
The monthly tracheal aspirate culture rate prior to the COVID-19 pandemic (9/2018-3/2020) was 4.6 per 100 ventilator days. A centerline shift to 3.1 cultures per 100 ventilator days occurred in 4/2020, followed by a second shift to 2.0 cultures per 100 ventilator days in 12/2020 after guideline implementation. In our secondary analysis, the monthly tracheal aspirate culture rate decreased from 4.3 cultures preintervention (9/2018-8/2020) to 2.3 cultures per 100 ventilator days postintervention (9/2020-8/2021) (IRR 0.52, 95% CI 0.47-0.59, < 0.01). Decreases in tracheal aspirate culture use were driven by decreases in inappropriate cultures. Treatment of ventilator-associated infections decreased from 1.0 to 0.7 antibiotic courses per 100 ventilator days ( = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention.
A diagnostic test stewardship intervention was both safe and effective in reducing the rate of tracheal aspirate cultures and treatment of ventilator-associated infections in a tertiary PICU.
评估一项以气管抽吸物培养为重点的诊断检测管理干预措施的影响。
质量改进干预措施。
三级医疗儿科重症监护病房（PICU）。
2018年9月至2022年8月期间入院的机械通气儿童。
我们通过一系列计划-实施-研究-改进循环，制定并实施了获取气管抽吸物培养的共识指南。使用统计过程控制图分析每100个通气日的培养率变化和广谱抗生素治疗天数（DOT）。使用泊松回归对干预前基线（2018年9月至2020年8月）与干预后时期（2020年9月至2021年8月）进行二次分析。
在2019年冠状病毒病大流行之前（2018年9月至2020年3月），每月气管抽吸物培养率为每100个通气日4.6次。2020年4月中心线转移至每100个通气日3.1次培养，随后在2020年12月指南实施后第二次转移至每100个通气日2.0次培养。在我们的二次分析中，每月气管抽吸物培养率从干预前（2018年9月至2020年8月）的每100个通气日4.3次培养降至干预后（2020年9月至2021年8月）的每100个通气日2.3次培养（发病率比0.52，95%置信区间0.47-0.59，P<0.01）。气管抽吸物培养使用的减少是由不适当培养的减少驱动的。呼吸机相关感染的治疗从每100个通气日1.0个抗生素疗程降至0.7个抗生素疗程（P=0.03）。干预后死亡率、住院时间、再入院率或呼吸机相关性肺炎均未增加。
在三级儿科重症监护病房，诊断检测管理干预措施在降低气管抽吸物培养率和呼吸机相关感染治疗方面既安全又有效。
