EAC Use, Process Measures, and Secondary Outcomes 1 Year Before and After Initiation of a Diagnostic Stewardship Program in the PICU
| Outcomes . | Year Preintervention . | Year Postintervention . | P . |
|---|---|---|---|
| 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,b n (%) | 465 (83.5) | 199 (85.0) | .59 |
| Antibiotic treatment of a new episode of VAI after EAC,c n (%) | 148 (26.6) | 60 (25.6) | .79 |
| Outcomes . | Year Preintervention . | Year Postintervention . | P . |
|---|---|---|---|
| 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,b n (%) | 465 (83.5) | 199 (85.0) | .59 |
| Antibiotic treatment of a new episode of VAI after EAC,c n (%) | 148 (26.6) | 60 (25.6) | .79 |
IQR, interquartile range; —, not applicable.
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).
Antibiotic treatment included ongoing or newly initiated antibiotics within 2 d of EAC obtainment. Antibiotics given for prophylaxis were excluded.
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.