Diagnostic Stewardship in the Pediatric Intensive Care Unit

Sick-Samuels, Anna; Woods-Hill, Charlotte

doi:10.1016/j.idc.2021.11.003

Cited by 9 publications

(4 citation statements)

References 107 publications

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“…28 Diagnostic stewardship is fundamental to antimicrobial stewardship within pediatric intensive care units. 29 Judicious blood culture practices have decreased broad-spectrum antibiotic use in critically ill children. 30 Additionally, Prinzi et al found significant variability in ETT culture rates and increased antibiotic usage associated with ETT culturing.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Hillyer,

Jaggi,

Chanani

et al. 2024

Pediatric Quality &Amp; Safety

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Background: We developed a multidisciplinary antimicrobial stewardship team to optimize antimicrobial use within the Pediatric Cardiac Intensive Care Unit. A quality improvement initiative was conducted to decrease unnecessary broad-spectrum antibiotic use by 20%, with sustained change over 12 months. Methods: We conducted this quality improvement initiative within a quaternary care center. PDSA cycles focused on antibiotic overuse, provider education, and practice standardization. The primary outcome measure was days of therapy (DOT)/1000 patient days. Process measures included electronic medical record order-set use. Balancing measures focused on alternative antibiotic use, overall mortality, and sepsis-related mortality. Data were analyzed using statistical process control charts. Results: A significant and sustained decrease in DOT was observed for vancomycin and meropenem. Vancomycin use decreased from a baseline of 198 DOT to 137 DOT, a 31% reduction. Meropenem use decreased from 103 DOT to 34 DOT, a 67% reduction. These changes were sustained over 24 months. The collective use of gram-negative antibiotics, including meropenem, cefepime, and piperacillin-tazobactam, decreased from a baseline of 323 DOT to 239 DOT, a reduction of 26%. There was no reciprocal increase in cefepime or piperacillin-tazobactam use. Key interventions involved electronic medical record changes, including automatic stop times and empiric antibiotic standardization. All-cause mortality remained unchanged. Conclusions: The initiation of a dedicated antimicrobial stewardship initiative resulted in a sustained reduction in meropenem and vancomycin usage. Interventions did not lead to increased utilization of alternative broad-spectrum antimicrobials or increased mortality. Future interventions will target additional broad-spectrum antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Hillyer,

Jaggi,

Chanani

et al. 2024

Pediatric Quality &Amp; Safety

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“…Interventions related to reducing unnecessary blood culturing have been studied in critically ill paediatric patients and more recently in adult patients. Much of the initial research on diagnostic stewardship for blood culturing has been completed in the paediatric population [32]. Recently, the Bright STAR Collaborative published their multicentre experience implementing diagnostic stewardship across 14 paediatric ICUs [33].…”

Section: Blood Stream Infectionsmentioning

confidence: 99%

Diagnostic stewardship: what impacts antibiotics use?

Coffey

Morgan

Claeys

2023

Current Opinion in Infectious Diseases

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Purpose of review The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing. Recent findings Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use. Summary Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.

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“…It is more obvious than ever that it is important and essential to find and establish a gold standard diagnostic tool with clearly objective and repetitive criteria for diagnosis and appropriate decision-making regarding management of antibiotic use in the pediatric population [4,5,[73][74][75][76][77]. A distinction between infectious VARIs, (VAP and VAT included) and non-infectious VAEs is useful and should be clear so as to prevent the inappropriate administration of antibiotics [78][79][80][81]. This issue of both infective and noninfective events included in the VAE surveillance as is redefined by the CDC is challenging.…”

Section: Definitions Of Vap and Vaesmentioning

confidence: 99%

Ventilator associated pneumonia (VAP) in children: a diagnostic challenge

2023

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Respiratory support in critically ill children is crucial and often mechanical ventilation (MV) is needed for lifesaving intervention. MV can lead to complications with, ventilator associated pneumonia (VAP) being one of the most serious and has been associated with prolonged length of mechanical ventilation (LOV) and length of stay in hospital (LOS), morbidity and mortality. Despite the importance of VAP, the definition (both clinically and epidemiologically) is limited. Some of the criteria used for the definition of VAP are subjective. In addition, the use of different diagnostic parameters in VAP definition has resulted in major limitations in terms of surveillance and prevention. Pediatric VAP as well as other pediatric medical conditions are based on a number of different criteria in adult studies. The various challenges and different approaches to defining VAP, especially in children, are obvious in the most recent literature. During the last decade, there has been an attempt to overcome some of these previous challenges and limitations. With this historical context in mind, a new surveillance definition of VAP was proposed for adults in 2013, ventilator-associated events (VAEs). In 2020, the pediatric definition of VAE (pedVAE) was introduced by centers for disease control and prevention (CDC) with adjusted criteria for the pediatric population. One of the clinical definitions, clinical pulmonary infection score (CPIS), has been modified (mCPIS) and adjusted to pediatric VAP. This narrative review describes the different definitions that are currently available for epidemiological as well as clinical purposes. We target to summarize the differences and similarities in all proposed definitions in order to help clinicians and investigators better evaluate this complicated medical condition that presents in their patients.

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Diagnostic Stewardship in the Pediatric Intensive Care Unit

Cited by 9 publications

References 107 publications

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Diagnostic stewardship: what impacts antibiotics use?

Ventilator associated pneumonia (VAP) in children: a diagnostic challenge

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