Diagnostic Stewardship of Cultures Obtained via Tracheal Tube in Mechanically-Ventilated Critically-Ill Children

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Publication Date

11-9-2023

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Presentation: 46:15

Abstract

Stewardship in medicine describes the practice of responsible use of medical resources and tools without compromising quality of care. Antibiotic stewardship has been a focus for decades to prevent overuse of antibiotics while ensuring those used are appropriate for the patient and infection. Diagnostic stewardship, the practice of optimizing testing and limiting it to those that will yield useful results, has proven to be helpful in reducing inappropriate antibiotic use. A high percentage of children in pediatric intensive care units (PICU) are exposed to antibiotics. When antibiotics are not optimized or given at the appropriate time, risk of harm ensues. Antibiotics for suspected pneumonia in mechanically ventilated children comprise a large portion of use in PICU patients. These antibiotics are often given in response to cultures of secretions obtained via tracheal tubes. Such culture results have been shown to be unreliable predictors of pathogenic infection. Upstream prevention of excessive antibiotic use by diagnostic stewardship of culturing practices has been proven safe and effective. In this quality improvement project in a single PICU, the effect of implementation of a clinical decision support algorithm for indications for tracheal cultures is explored. Focus groups of stakeholders were interviewed regarding use of tracheal cultures in the PICU. Data about baseline use were collected and analyzed. Using review of key drivers as well as literature, a clinical decision support algorithm was developed. Education was provided and the algorithm became adopted into routine clinical care. Results demonstrate that after implementation, the rate of tracheal cultures per 100 ventilator days decreased to 4.2 over a four-month period compared to 10.6 for the same four-month period the year prior. There was no significant difference in mortality or length of stay suggesting that adoption of the clinical decision support algorithm was safe and effective in reduction of cultures.

Language

English

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