Respiratory Culture Stewardship to Reduce Antibiotic Use in Critically Ill Children

呼吸培养管理减少危重儿童抗生素的使用

• 批准号: 10341374
• 负责人: AARON M MILSTONE
• 金额: $ 47.01万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10341374
• 关键词: Respiratory; Culture; Stewardship; Reduce; Antibiotic

Project Summary In the U.S. over 150,000 patients die annually from multidrug-resistant infections, and resistant infections are associated with over $20 billion in healthcare costs. Healthcare-associated infections (HAI) highlight the impact of antibiotic resistance, as more than 40% of HAIs are due to antibiotic-resistant organisms. Children requiring mechanical ventilation are at risk for developing ventilator-associated infections (VAI). VAIs are responsible for 23-53% of all HAIs among children. Up to 87% of pediatric intensive care unit (PICU) patients are treated with antibiotics and treatment for suspected VAIs accounts for 50% of antibiotic use in the PICU. In an effort to inform the diagnosis of VAIs, clinicians often obtain respiratory cultures from mechanically ventilated patients. However, these cultures are obtained from a non-sterile site and more than 50% of endotracheal cultures will grow a potentially pathogenic organism within 3 days of intubation regardless of clinical symptoms. Respiratory cultures cannot distinguish between bacterial colonization and infection, and despite the low specificity to indicate infection, positive cultures prompt clinicians to treat with antibiotics. Safely reducing testing, referred to as diagnostic stewardship, is an emerging strategy to reduce testing overuse and potentially antibiotic overuse. Recently, a novel clinical practice guideline designed at the Johns Hopkins Children’s Center to standardize approach to respiratory cultures in critically ill children safely reduced respiratory culture use by 41%. The long- term objective of this proposal is to develop a customizable diagnostic stewardship program that can improve antibiotic use and prevent antibiotic resistance among vulnerable children. The specific aims are Aim 1) evaluate whether diagnostic stewardship of respiratory cultures among mechanically ventilated children decreases respiratory culture use and antibiotic use without leading to unintended patient harm, Aim 2) identify barriers and facilitators to implementation of diagnostic stewardship quality improvement programs to reduce respiratory culture use among mechanically ventilated patients in 14 pediatric intensive care units, and Aim 3) use a Delphi method, including a panel with nationwide representation, to develop consensus recommendations informing when to obtain respiratory cultures in mechanically ventilated children. Fourteen hospitals participating in a multicenter quality improvement initiative, the Bright STAR Collaborative, are implementing local quality improvement programs to improve respiratory culture use. This proposal will evaluate the implementation of local diagnostic stewardship programs and determine whether these programs represent an effective and safe strategy to reduce antibiotic use in a vulnerable population. The proposed aims will assemble the tools and evidence to broadly disseminate diagnostic stewardship as a strategy to reduce antibiotic use and deliver high value care, and catalyze similar work in non-ICU pediatric and adult populations.

项目摘要 在美国，每年有15万名患者死于多药耐药感染，耐药感染是 与超过200亿美元的医疗保健费用相关。医疗保健相关感染（HAI）突出了影响 抗生素耐药性，因为超过40％的HAI是由于抗生素抗性生物所致。需要孩子 机械通气有发展与通气相关感染（VAI）的风险。 VAI负责 儿童中所有HAI的23-53％。多达87％的小儿重症监护病房（PICU）患者接受治疗 可疑VAI的抗生素和治疗占PICU中抗生素使用的50％。努力 告知VAI的诊断，临床医生经常从机械通风的患者那里获得呼吸道培养。 但是，这些培养物是从非疾病部位获得的，超过50％的气管培养物将 无论临床症状如何呼吸道 培养物无法区分细菌定植和感染，而dospite的特异性很低 表明感染阳性培养物促使临床医生用抗生素治疗。安全减少测试，提到 作为诊断管理，是一种新兴策略，旨在减少测试过度使用和潜在的抗生素过度使用。 最近，在约翰·霍普金斯儿童中心设计的一项新型临床实践指南以标准化 重症儿童中呼吸道培养的方法将呼吸培养的使用安全降低了41％。长期 该建议的术语目标是制定可自定义的诊断管理计划，以改进 易攻击儿童的抗生素使用并防止抗生素耐药性。具体目的是目标1） 评估机械通风儿童中呼吸培养的诊断管理是否 减少呼吸道培养的使用和抗生素使用而不会导致意外伤害，目标2）确定 实施诊断管理质量改进计划的障碍和促进者 在14个小儿重症监护病房的机械通风患者中使用呼吸道培养，AIM 3） 使用Delphi方法，包括具有国家范围代表的小组来建立共识 建议何时在机械通风儿童中获得呼吸道培养。十四 参加多中心质量改进计划的医院，《明星合作》是 实施本地质量改进计划，以改善呼吸道文化的使用。该提议将 评估本地诊断管理计划的实施，并确定这些程序是否 代表了减少脆弱人群中抗生素使用的有效策略。拟议的目标 将组装工具和证据，以广泛传播诊断管理，以减少 抗生素使用并提供高价值护理，并在非ICU小儿和成人种群中催化类似的工作。