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Impact of a tracheal aspirate culture diagnostic test stewardship intervention in a tertiary care PICU

Published online by Cambridge University Press:  04 September 2024

Kathleen Chiotos Open the ORCID record for Kathleen Chiotos [Opens in a new window] ,
Giyoung Lee ,
Guy Sydney ,
Charlotte Woods-Hill ,
Heather Wolfe ,
Hannah R. Stinson ,
Joseph Piccione Open the ORCID record for Joseph Piccione [Opens in a new window] ,
Jennifer Blumenthal ,
Garrett Keim Open the ORCID record for Garrett Keim [Opens in a new window]  and
Yun Li
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Kathleen Chiotos*
Affiliation:
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 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Giyoung Lee
Affiliation:
Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
Guy Sydney
Affiliation:
Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
Charlotte Woods-Hill
Affiliation:
Division of Critical Care Medicine and Anesthesiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
Heather Wolfe
Affiliation:
Division of Critical Care Medicine and Anesthesiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Hannah R. Stinson
Affiliation:
Division of Critical Care Medicine and Anesthesiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Joseph Piccione
Affiliation:
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Jennifer Blumenthal
Affiliation:
Division of Critical Care Medicine and Anesthesiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Garrett Keim
Affiliation:
Division of Critical Care Medicine and Anesthesiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
Yun Li
Affiliation:
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
Danielle Traynor
Affiliation:
Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Aaditya Dudhia
Affiliation:
Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Ashlee Doll
Affiliation:
Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Rebecca Harris
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Jeffrey Gerber
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
*
Corresponding author: Kathleen Chiotos; Email: chiotosk@chop.edu
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Abstract

Objective:

To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures.

Design:

Quality improvement intervention.

Setting:

Tertiary care pediatric intensive care unit (PICU).

Patients:

Mechanically ventilated children admitted between 9/2018 and 8/2022.

Methods:

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.

Results:

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, P < 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 (P = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention.

Conclusion:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 9
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: Preliminary results from this study were published in abstract form at IDWeek 2021 (virtual).

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