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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Diagnostic Stewardship of Endotracheal Aspirate Cultures in a PICU
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Diagnostic Stewardship of Endotracheal Aspirate Cultures in a PICU

机译：在PICU中的气管插气候文化的诊断管理

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BACKGROUND: Clinicians commonly obtain endotracheal aspirate cultures (EACs) in the evaluation of suspected ventilator-associated infections. However, bacterial growth in EACs does not distinguish bacterial colonization from infection and may lead to overtreatment with antibiotics. We describe the development and impact of a clinical decision support algorithm to standardize the use of EACs from ventilated PICU patients. METHODS: We monitored EAC use using a statistical process control chart. We compared the rate of EACs using Poisson regression and a quasi-experimental interrupted time series model and assessed clinical outcomes 1 year before and after introduction of the algorithm. RESULTS: In the preintervention year, there were 557 EACs over 5092 ventilator days; after introduction of the algorithm, there were 234 EACs over 3654 ventilator days (an incident rate of 10.9 vs 6.5 per 100 ventilator days). There was a 41% decrease in the monthly rate of EACs (incidence rate ratio [IRR]: 0.59; 95% confidence interval [CI] 0.51–0.67; P < .001). The interrupted time series model revealed a preexisting 2% decline in the monthly culture rate (IRR: 0.98; 95% CI 0.97–1.0; P = .01), immediate 44% drop (IRR: 0.56; 95% CI 0.45–0.70; P = .02), and stable rate in the postintervention year (IRR: 1.03; 95% CI 0.99–1.07; P = .09). In-hospital mortality, hospital length of stay, 7-day readmissions, and All Patients Refined Diagnosis Related Group severity and mortality scores were stable. The estimated direct cost savings was $26?000 per year. CONCLUSIONS: A clinical decision support algorithm standardizing EAC obtainment from ventilated PICU patients was associated with a sustained decline in the rate of EACs, without changes in mortality, readmissions, or length of stay.
机译：背景：临床医生在评估疑似呼吸机相关感染时通常会获得气管内抽吸培养物（EAC）。然而，EAC中的细菌生长并不能区分细菌定植和感染，并可能导致抗生素过度治疗。我们描述了临床决策支持算法的发展和影响，该算法用于标准化通气PICU患者的EAC使用。方法：我们使用统计过程控制图监测EAC的使用。我们使用泊松回归和准实验中断时间序列模型比较了EAC的发生率，并评估了引入该算法前后1年的临床结果。结果：在干预前一年，共有557例EAC患者超过5092个呼吸机日；引入该算法后，3654个呼吸机日内共有234个EAC（每100个呼吸机日的事件率分别为10.9和6.5）。EAC的月发病率下降了41%（发病率比[IRR]：0.59；95%可信区间[CI]0.51–0.67；P<0.001）。中断时间序列模型显示，月培养率（IRR:0.98；95%CI 0.97–1.0；P=0.01）先前存在2%的下降，立即下降44%（IRR:0.56；95%CI 0.45–0.70；P=0.02），以及干预后一年的稳定率（IRR:1.03；95%CI 0.99–1.07；P=0.09）。住院死亡率、住院时间、7天再入院率、所有患者与诊断相关的严重程度和死亡率评分均稳定。估计直接成本节约是26美元？每年1000美元。结论：标准化通气PICU患者获得EAC的临床决策支持算法与EAC发生率的持续下降相关，死亡率、再入院率或住院时间没有变化。

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