{"id":31480,"date":"2026-11-02T04:10:00","date_gmt":"2026-11-01T20:10:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=31480"},"modified":"2026-11-02T05:43:47","modified_gmt":"2026-11-01T21:43:47","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9apicu%e4%b8%ad%e9%87%87%e7%94%a8%e4%b8%b4%e5%ba%8a%e5%86%b3%e7%ad%96%e6%94%af%e6%8c%81%e7%b3%bb%e7%bb%9f%e4%bc%98%e5%8c%96%e5%91%bc%e5%90%b8","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=31480","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1aPICU\u4e2d\u91c7\u7528\u4e34\u5e8a\u51b3\u7b56\u652f\u6301\u7cfb\u7edf\u4f18\u5316\u547c\u5438\u9053\u57f9\u517b\u7684\u8bca\u65ad\u7ba1\u7406"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Critical Care Medicine<\/p>\n\n\n\n

Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU<\/h1>\n\n\n\n

Anna C. Sick-Samuels, Charlotte Z. Woods-Hill, Daniel P. Kelly, et al<\/h3>\n\n\n\n

JAMA Netw Open 2026;9;(7):e2626547. doi:10.1001\/jamanetworkopen.2026.26547<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the association of diagnostic stewardship of endotracheal aspirate cultures using clinical decision support with culture rates, antibiotic use, and patient outcomes in the pediatric intensive care unit (PICU)?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study, a collaborative of 15 PICUs observed a statistically significant reduction in endotracheal aspirate culture rates. There were no significant changes in antibiotic utilization or balancing measures such as bronchoalveolar lavage culture rates, length of stay, readmissions, and ventilation duration, nor was patient harm detected.<\/p>\n\n\n\n

Meaning<\/strong>  These findings suggest that diagnostic stewardship using clinical decision support to standardize testing indications and optimize endotracheal aspirate culture practices in patients without suspected ventilator-associated infection may reduce culture use in critically ill children without safety concerns.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Endotracheal aspirate culture (EAC) practices for evaluation of ventilator-associated infections (VAI) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for VAI. Diagnostic stewardship strategies to optimize EAC testing practices may reduce overtesting and unnecessary antibiotic treatment.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (PICUs).<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (QI) Collaborative involving PICUs across the US between 2019 and 2023. Data were collected from the participating sites and from the Children\u2019s Hospital Association Pediatric Health Information System and were analyzed from August to December 2025.<\/p>\n\n\n\n

Exposure<\/strong>  Participating PICUs conducted local QI programs focused on optimizing EAC practices, facilitated by the BrighT STAR collaborative.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was the monthly rate of EACs per 100 ventilator-days. Secondary outcomes included rates of antibiotic initiations and antibiotic days of therapy, bronchoalveolar lavage cultures, readmissions, length of stay, ventilation duration, ventilation-free days, sepsis, and septic shock. Analysis included adjustment for seasonality.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106\u202f967 ventilator-days preimplementation and 92\u202f167 ventilator-days postimplementation. Comparing 24 months in the preimplementation period with the 18 months in the postimplementation period, the mean monthly EAC rate declined by 16% from a preimplementation to postimplementation rate of 7.80 to 6.55 cultures per 100 ventilator-days (relative rate [RR], 0.84; 95% CI, 0.78-0.90). The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11). There were no significant changes in the rates of bronchoalveolar lavage cultures, PICU length of stay, PICU or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced EAC use in the PICU without safety concerns. Future work will determine optimal implementation strategies, assess sustainability and the cost impact of EAC stewardship.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Critical Care Medicine Dia […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31480"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31480"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31480\/revisions"}],"predecessor-version":[{"id":32021,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31480\/revisions\/32021"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}