{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:50:05Z","timestamp":1791809405199,"version":"4.3.4"},"reference-count":38,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26105224_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To reduce frequency of endotracheal aspirate culture (EAC) collection and decrease antibiotic days of therapy (DOT) for ventilator-associated tracheitis (VAT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Quality improvement intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Tertiary-care pediatric intensive care unit (PICU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as4\">\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Admitted to the PICU with an endotracheal tube (ETT) or tracheostomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as5\">\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>A clinical decision-support tool was implemented to provide clinical criteria for culture collection and microbiologic criteria for diagnosis, and to reduce treatment duration to 3 days. Key stakeholders were engaged, a nurse champion was identified, and a protocol was implemented. Culture rates (overall and serially repeated) and antibiotic DOT for VAT, each per 100 ETT\/tracheostomy days, were analyzed. The proportion of VAT episodes treated for 3 days was also evaluated. Balancing measures included PICU mortality, ventilator-associated events, ventilator days, and length of stay. Statistical process control methods were used to analyze the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as6\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Across 1072 EACs sent and 213 VAT cases diagnosed, interventions led to a 23% reduction in monthly cultures (9.2 to 7.1 per 100 ETT\/tracheostomy days) and a 53% reduction in serial culture use (1.5 to 0.7 per 100 ETT\/tracheostomy days). There was a 53% reduction in monthly antibiotic DOT for VAT (10.8 to 5.1 per 100 ETT\/tracheostomy days) and a 13-fold increase in the proportion of 3-day antibiotic prescriptions (5 to 65%). There was no increase in mortality, ventilator-associated events, ventilator days, or length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105224_as7\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Standardized VAT guidelines in critically ill children can safely and effectively decrease culture and antibiotic use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10522","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:07:21Z","timestamp":1786439241000},"page":"999-1006","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["A quality improvement initiative to optimize diagnostic and antimicrobial stewardship of ventilator-associated tracheitis in the pediatric intensive care unit"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9896-2405","authenticated-orcid":false,"given":"Evin","family":"Feldman","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/026n33e29","id-type":"ROR","asserted-by":"publisher"}],"name":"Cohen Children\u2019s Medical Center, Northwell Health, Zucker School of Medicine, Hofstra University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9126-2098","authenticated-orcid":false,"given":"Aidan","family":"Doona","sequence":"additional","affiliation":[{"name":"Cohen Children\u2019s Medical Center, Northwell Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8720-9051","authenticated-orcid":false,"given":"Denise","family":"Iacono","sequence":"additional","affiliation":[{"name":"Cohen Children\u2019s Medical Center, Northwell Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2015-9495","authenticated-orcid":false,"given":"Jesse","family":"Honig","sequence":"additional","affiliation":[{"name":"Zucker School of Medicine, Hofstra University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9256-6447","authenticated-orcid":false,"given":"Anupama","family":"Subramony","sequence":"additional","affiliation":[{"name":"Zucker School of Medicine, Hofstra University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3419-6083","authenticated-orcid":false,"given":"Todd","family":"Sweberg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/026n33e29","id-type":"ROR","asserted-by":"publisher"}],"name":"Cohen Children\u2019s Medical Center, Northwell Health, Zucker School of Medicine, Hofstra University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1061-3698","authenticated-orcid":false,"given":"Mundeep K.","family":"Kainth","sequence":"additional","affiliation":[{"name":"Northwell Health, Zucker School of Medicine, Hofstra University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"S0899823X26105224_ref18","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00930-22"},{"key":"S0899823X26105224_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac698"},{"key":"S0899823X26105224_ref6","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31828a897f"},{"key":"S0899823X26105224_ref21","doi-asserted-by":"publisher","DOI":"10.1086\/675279"},{"key":"S0899823X26105224_ref25","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics9020051"},{"key":"S0899823X26105224_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.299"},{"key":"S0899823X26105224_ref27","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz360.1369"},{"key":"S0899823X26105224_ref26","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir203"},{"key":"S0899823X26105224_ref14","first-page":"240","article-title":"Understanding reasons clinicians obtained endotracheal aspirate cultures and impact on patient management to inform diagnostic stewardship initiatives","volume":"41","author":"Sick-Samuels","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X26105224_ref17","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000106"},{"key":"S0899823X26105224_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000213"},{"key":"S0899823X26105224_ref4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2343"},{"key":"S0899823X26105224_ref36","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26152"},{"key":"S0899823X26105224_ref2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.122499"},{"key":"S0899823X26105224_ref29","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-022-01399-1"},{"key":"S0899823X26105224_ref32","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003259"},{"key":"S0899823X26105224_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.21536"},{"key":"S0899823X26105224_ref33","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003695"},{"key":"S0899823X26105224_ref16","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181fe2ffb"},{"key":"S0899823X26105224_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23716"},{"key":"S0899823X26105224_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00326-4"},{"key":"S0899823X26105224_ref37","doi-asserted-by":"publisher","DOI":"10.1186\/2047-2994-3-32"},{"key":"S0899823X26105224_ref24","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"S0899823X26105224_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.22588"},{"key":"S0899823X26105224_ref5","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.155.1.9001306"},{"key":"S0899823X26105224_ref28","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000368"},{"key":"S0899823X26105224_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25873"},{"key":"S0899823X26105224_ref30","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1634"},{"key":"S0899823X26105224_ref20","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001001"},{"key":"S0899823X26105224_ref31","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2024.105"},{"key":"S0899823X26105224_ref19","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002761"},{"key":"S0899823X26105224_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25814"},{"key":"S0899823X26105224_ref23","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002014"},{"key":"S0899823X26105224_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2011.06.001"},{"key":"S0899823X26105224_ref11","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000569"},{"key":"S0899823X26105224_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2013.12.009"},{"key":"S0899823X26105224_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"S0899823X26105224_ref1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27114"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X26105224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:37:33Z","timestamp":1791808653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X26105224\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":38,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["S0899823X26105224"],"URL":"https:\/\/doi.org\/10.1017\/ice.2026.10522","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}