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TABLE 3

EAC Use, Process Measures, and Secondary Outcomes 1 Year Before and After Initiation of a Diagnostic Stewardship Program in the PICU

OutcomesYear PreinterventionYear PostinterventionP
Primary outcome, culture rates    
 EACs, n 557 234 — 
 Monthly EACs, mean (SD) 46.4 (10.1) 19.5 (4.3) <.001 
 Ventilator days, n 5092 3654 — 
 Monthly EAC rate per 100 ventilator days, mean (SD) 10.9 (1.4) 6.5 (1.5) <.001 
 Patient days, n 11 442 10 763 — 
 Monthly EAC rate per 1000 patient days, mean (SD) 48.9 (11.4) 21.8 (5.0) <.001 
Process measures    
 EAC repeated within 3 d, n (%) 108 (19.4) 21 (9.0) <.001 
 Time since previous EAC, d, median (IQR) 7.0 (3.0–14.0) 13.0 (5.0–37.0) <.001 
Secondary outcomes    
 EAC collected reflexive with blood and urine cultures, n (%) 197 (35.4) 90 (38.5) .41 
 Ventilator support at time of EACa    
  Intubated ≥48 h, n (%) 255 (46.6) 90 (40.9) .06 
  Tracheostomy, n (%) 207 (37.8) 64 (29.1) .008 
 Antibiotic treatment of any condition after EAC,bn (%) 465 (83.5) 199 (85.0) .59 
 Antibiotic treatment of a new episode of VAI after EAC,cn (%) 148 (26.6) 60 (25.6) .79 
OutcomesYear PreinterventionYear PostinterventionP
Primary outcome, culture rates    
 EACs, n 557 234 — 
 Monthly EACs, mean (SD) 46.4 (10.1) 19.5 (4.3) <.001 
 Ventilator days, n 5092 3654 — 
 Monthly EAC rate per 100 ventilator days, mean (SD) 10.9 (1.4) 6.5 (1.5) <.001 
 Patient days, n 11 442 10 763 — 
 Monthly EAC rate per 1000 patient days, mean (SD) 48.9 (11.4) 21.8 (5.0) <.001 
Process measures    
 EAC repeated within 3 d, n (%) 108 (19.4) 21 (9.0) <.001 
 Time since previous EAC, d, median (IQR) 7.0 (3.0–14.0) 13.0 (5.0–37.0) <.001 
Secondary outcomes    
 EAC collected reflexive with blood and urine cultures, n (%) 197 (35.4) 90 (38.5) .41 
 Ventilator support at time of EACa    
  Intubated ≥48 h, n (%) 255 (46.6) 90 (40.9) .06 
  Tracheostomy, n (%) 207 (37.8) 64 (29.1) .008 
 Antibiotic treatment of any condition after EAC,bn (%) 465 (83.5) 199 (85.0) .59 
 Antibiotic treatment of a new episode of VAI after EAC,cn (%) 148 (26.6) 60 (25.6) .79 

IQR, interquartile range; —, not applicable.

a

Proportions do not add up to 100 because if the patient was not intubated ≥48 h or with a tracheostomy, the remaining EACs were obtained from patients intubated <48 h (85 EACs in year 1 and 66 EACs in year 2).

b

Antibiotic treatment included ongoing or newly initiated antibiotics within 2 d of EAC obtainment. Antibiotics given for prophylaxis were excluded.

c

Newly treated VAI episodes included initiation of antibiotic treatment continued >2 d with clinician-documented indication for tracheitis, pneumonia, or treating a positive EAC result.

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