Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients

Prinzi, Andrea; Parker, Sarah K.; Thurm, Cary; Birkholz, Meghan; Sick-Samuels, Anna

doi:10.1001/jamanetworkopen.2021.40378

Cited by 28 publications

(31 citation statements)

References 51 publications

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“…Increased respira-tory culture acquisition has been associated with increased antibiotic use among children's hospitals. 32,33 In our study only 4 species remained associated with ARI on adjusted, multinomial analysis. These species,H.…”

Section: Discussionmentioning

confidence: 46%

“…5,7,39 Variability in sample quality and lab processing may also contribute, as has been documented in endotracheal tube cultures. 39 The consequence of this variability is clinical inconsistency in diagnosing ARI, 5 use of and types of antibiotic treatment, 32 and probably also patient outcomes including severity, length of illness, and respiratory support needs, all of which limit research and improvement efforts.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory Culture Organism Isolation and Test Characteristics in Children with Tracheostomies with and without Acute Respiratory Infection

Steuart

Ale

Woolums

et al. 2022

Preprint

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Background: Among children with tracheostomies, little is known about how respiratory culture results differ between states with and without acute respiratory infections (ARI), or the overall test performance of respiratory cultures. Objective: To determine the association of respiratory culture organism isolation with diagnosis of ARI in children with tracheostomies, and assess test characteristics of respiratory cultures in the diagnosis of bacterial ARI (bARI). Methods: This single-center, retrospective cohort study included respiratory cultures of children with tracheostomies obtained between 2010-2018. The primary predictor was ARI diagnosis code at the time of culture; the primary outcomes were respiratory culture organism isolation and species identified. Generalized estimating equations were used to assess for association between ARI diagnosis and isolation of any organism while controlling for potential confounders and accounting for within-patient clustering. A multinomial logistic regression equation assessed for association with specific species. Test characteristics were calculated using bARI diagnosis as the reference standard. Results: Among 3,578 respiratory cultures from 533 children (median 4 cultures/child, IQR: 1-9), 25.9% were obtained during ARI and 17.2% had ≥1 organism. Children with ARI diagnosis had higher odds of organism identification (aOR 1.29, 95% CI 1.16–1.44). When controlling for covariates, ARI was associated with isolation of H. influenzae, M. catarrhalis, S. pneumoniae, and S. pyogenes. Test characteristics revealed a 24.3% sensitivity, 85.2% specificity, 36.5% positive predictive value, and 76.3% negative predictive value in screening for bARI. Conclusion: The utility of respiratory culture testing to screen for, diagnose, and direct treatment of ARI in children with tracheostomies is limited.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Respiratory Culture Organism Isolation and Test Characteristics in Children with Tracheostomies with and without Acute Respiratory Infection

Steuart

Ale

Woolums

et al. 2022

Preprint

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“…This study design is unique in that data were collected at the organism level and focused on the influence of microbiology practices on clinician decision-making (to target the organism for therapy) and patient antibiotic exposure. Previous studies demonstrate that higher rates of EAC use in hospitals are associated with higher rates of antimicrobial use ( 1 ). While the reason for this is likely multifaceted, this study supports the hypothesis that laboratory reporting practices for EACs influence prescribing choices.…”

Section: Discussionmentioning

confidence: 99%

“…Endotracheal aspirate cultures (EACs) are commonly obtained from mechanically ventilated pediatric patients ( 1 ). A positive culture alone is not diagnostic of lower respiratory tract infection (LRTI) due to contamination with normal oropharyngeal microbiota, frequent respiratory tract colonization in mechanically ventilated patients, and poor correlation of EAC results with clinical LRTI ( 2 – 4 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of Organism Reporting from Endotracheal Aspirate Cultures on Antimicrobial Prescribing Practices in Mechanically Ventilated Pediatric Patients

et al. 2022

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Endotracheal aspirate cultures (EACs) help diagnose lower respiratory tract infections in mechanically ventilated patients but are limited by contamination with normal microbiota and variation in laboratory reporting. Increased use of EACs is associated with increased antimicrobial prescribing, but the impact of microbiology reporting on prescribing practices is unclear. This study was a retrospective analysis of EACs from mechanically ventilated patients at Children’s Hospital Colorado (CHCO) admitted between 1 January 2019 and 31 December 2019. Chart review was performed to collect all culture and Gram stain components, as well as antibiotic use directed to organisms in culture. Reporting concordance was determined for each organism using American Society for Microbiology guidelines.

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“…However, some authors have proposed the use of TA samples for the diagnosis of VAP. 15 Notwithstanding, BALF is a highly reliable technique that may be more helpful in yielding potential VAP pathogens than tracheal aspirates. 5 In this context, it is important to establish the difference between contamination and infection.…”

Section: Discussionmentioning

confidence: 99%

Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants

et al. 2022

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Introduction Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants. Methods Two cohorts were enrolled, one to select candidates and the other for validation. In both, we included preterms with suspected VAP, according to BALF culture, they were classified into confirmed VAP and no VAP. Concentration of 16 cytokines and 8 oxidative stress/inflammation biomarkers in BALF and TA was determined in all patients. Results In the first batch, IL-17A and TNF-α in BALF, and in the second one IL-10, IL-6, and TNF-α in BALF were significantly higher in VAP patients. BALF TNF-α AUC in both cohorts was 0.86 (sensitivity 0.83, specificity 0.88). No cytokine was shown to be predictive of VAP in TA. A statistically significant increase in the VAP group was found for glutathione sulfonamide (GSA) in BALF and TA. Conclusions TNF-α in BALF and GSA in BALF and TA were associated with VAP in preterm newborns; thus, they could be used as early biomarkers of VAP. Further studies with an increased number of patients are needed to confirm these results. Impact We found that TNF-α BALF and GSA in both BALF and TA are capable of discriminating preterm infants with VAP from those with pulmonary pathology without infection. This is the first study in preterm infants aiming to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in BALF and TA as early diagnostic markers of VAP. We have validated these results in two independent cohorts of patients. Previously studies have focused on full-term neonates and toddlers and determined biomarkers mostly in TA, but none was exclusively conducted in preterm infants.

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Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients

Cited by 28 publications

References 51 publications

Respiratory Culture Organism Isolation and Test Characteristics in Children with Tracheostomies with and without Acute Respiratory Infection

Respiratory Culture Organism Isolation and Test Characteristics in Children with Tracheostomies with and without Acute Respiratory Infection

Impact of Organism Reporting from Endotracheal Aspirate Cultures on Antimicrobial Prescribing Practices in Mechanically Ventilated Pediatric Patients

Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants

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