{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:03:28Z","timestamp":1786482208512,"version":"build-2736575974"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"unspecified","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X24001053_as1\"><jats:title>Objective:<\/jats:title><jats:p>To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as2\"><jats:title>Design:<\/jats:title><jats:p>Quality improvement intervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as3\"><jats:title>Setting:<\/jats:title><jats:p>Tertiary care pediatric intensive care unit (PICU).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as4\"><jats:title>Patients:<\/jats:title><jats:p>Mechanically ventilated children admitted between 9\/2018 and 8\/2022.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as5\"><jats:title>Methods:<\/jats:title><jats:p>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\u20138\/2020) to the postintervention period (9\/2020\u20138\/2021) was performed using Poisson regression.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as6\"><jats:title>Results:<\/jats:title><jats:p>The monthly tracheal aspirate culture rate prior to the COVID-19 pandemic (9\/2018\u20133\/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\u20138\/2020) to 2.3 cultures per 100 ventilator days postintervention (9\/2020\u20138\/2021) (IRR 0.52, 95% CI 0.47\u20130.59, <jats:italic>P<\/jats:italic> &lt; 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 (<jats:italic>P<\/jats:italic> = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001053_as7\"><jats:title>Conclusion:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2024.105","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T09:16:31Z","timestamp":1725441391000},"page":"943-951","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":6,"title":["Impact of a tracheal aspirate culture diagnostic test stewardship intervention in a tertiary care PICU"],"prefix":"10.1017","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-8708","authenticated-orcid":false,"given":"Kathleen","family":"Chiotos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giyoung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Sydney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Woods-Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Wolfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah R.","family":"Stinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0691-3551","authenticated-orcid":false,"given":"Joseph","family":"Piccione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Blumenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7054-8798","authenticated-orcid":false,"given":"Garrett","family":"Keim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Traynor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaditya","family":"Dudhia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlee","family":"Doll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1944-3747","authenticated-orcid":false,"given":"Rebecca","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-3186","authenticated-orcid":false,"given":"Jeffrey","family":"Gerber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"S0899823X24001053_ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.8531"},{"key":"S0899823X24001053_ref29","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03779-z"},{"key":"S0899823X24001053_ref8","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2016-0104"},{"key":"S0899823X24001053_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s001340051288"},{"key":"S0899823X24001053_ref16","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.152.3.7663779"},{"key":"S0899823X24001053_ref19","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1634"},{"key":"S0899823X24001053_ref22","first-page":"238","article-title":"Technical aids","volume":"16","author":"Nelson","year":"1984","journal-title":"J Qual Technol"},{"key":"S0899823X24001053_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw118"},{"key":"S0899823X24001053_ref28","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003259"},{"key":"S0899823X24001053_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"S0899823X24001053_ref17","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000213"},{"key":"S0899823X24001053_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2022.1024"},{"key":"S0899823X24001053_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001001"},{"key":"S0899823X24001053_ref20","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000368"},{"key":"S0899823X24001053_ref21","unstructured":"21. 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