OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.METHODSControls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.RESULTSOverall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.CONCLUSIONSVentilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.Infect Control Hosp Epidemiol 2018;39:637-643.

Objective: To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants. Design: Before-and-after intervention study. Setting: Tertiary-care children’s hospital. Patients: Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED). Methods: The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis. Results: Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29–60 days old being managed without antibiotics. Conclusions: Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.

BackgroundThe clinical benefits of multiplex polymerase chain reaction panels are not well defined. We evaluated outcomes among infants before and after implementation of the BioFire® FilmArray® Respiratory Panel 2 (RP2) and Meningitis Encephalitis Panel (MEP).MethodsThis single-center study compared outcomes among infants ≤ 90 days presenting to the Emergency Department with fever (T ≥ 38.0°C) or hypothermia (T < 35.8°C) during 3 time periods. P1 (January 1, 2011–December 31, 2014) had batch testing using a Genmark Dx® respiratory viral panel (RVP) and no standardized clinical practice guideline (CPG); P2 (January 1, 2015–April 30, 2018) had the RVP and a CPG; and P3 (May 1, 2018–March 31, 2019) had on-demand RP2 and MEP testing and a CPG. Clinical data were collected from medical records. Statistical analyses were performed using Kruskal–Wallis and Pearson tests.ResultsThere were 5195 total patients: 2514 in P1, 2082 in P2, 599 in P3. Groups did not differ in pathogens or antimicrobials used. Testing was faster and performed more commonly in P3 than P1 or P2 (P1, 10%; P2, 6.9%; P3, 71%; Table 1). From P1 to P3 there were significant decreases in length of stay (LOS), % receiving antimicrobials, antibiotic durations, ancillary test use, lumbar punctures (LPs), and chest X-rays (Table 1). In P3 compared with P2, infants more commonly received no antimicrobials (43.1% vs. 32.4%, P < 0.001; Figure 1), had fewer median (IQR) number of ancillary tests (5 (5–8) vs. 7 (3–10); P < 0.001), and shorter median (IQR) days of antibiotics (2.0 (1.0–2.7) vs. 2.4 (1.1–3.4); P < 0.001; Table 1). Among P3 infants, those with positive RP2 and/or MEP results were less likely to receive antimicrobials, be hospitalized or readmitted, had fewer ancillary tests and LPs, and shorter LOS and antibiotic durations than those with negative tests (Table 2).ConclusionIn this large pre-post intervention study among infants ≤ 90 days with fever or hypothermia, a clinical guideline plus rapid testing with RP2 and MEP was associated with less antimicrobial use and ancillary testing than a clinical guideline alone. Infants with positive RP2 and/or MEP results had fewer admissions, shorter LOS, and less antimicrobial and ancillary test use than those with negative tests. Rapid pathogen testing has benefit for infants. DisclosuresRitu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.