Background: Overtreatment of ventilator-associated pneumonia (VAP) in the intensive care unit is driven by positive respiratory tract cultures in the absence of a clinical picture of pneumonia. We evaluated the potential for diagnostic stewardship at the respiratory culture reporting step.

Methods: In this mixed methods study, we conducted a baseline evaluation of lower respiratory tract (LRT) culture appropriateness and antibiotic prescribing, followed by a nonrandomized intervention in 2 adult intensive care units. The intervention was a comment in the report to indicate potential colonization instead of organism identification when LRT cultures were inappropriate-that is, not meeting criteria for pneumonia as adjudicated by a physician using a standard algorithm.

Results: At baseline, among 66 inappropriate LRT cultures, antibiotic treatment for VAP was more frequent with identification of potential pathogens in the index culture when compared with no growth/normal flora (16/35 [46%] vs 7/31 [23%], = .049). In the intervention period, 28 inappropriate cultures with growth of potential pathogens underwent report modification. The proportion of episodes for which antibiotic therapy for VAP was completed was significantly lower in the intervention group vs the baseline group (5/28 [18%] vs 16/35 [46%], = .02).

Conclusions: Diagnostic stewardship for VAP could be facilitated by modification of LRT culture reporting guided by clinical features of pneumonia.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420684PMC
http://dx.doi.org/10.1093/ofid/ofae500DOI Listing

Publication Analysis

Top Keywords

diagnostic stewardship
12
ventilator-associated pneumonia
8
mixed methods
8
methods study
8
intensive care
8
respiratory tract
8
culture reporting
8
lrt culture
8
lrt cultures
8
potential pathogens
8

Similar Publications

Purpose Of Review: The management of thoracic empyema is often complicated by diagnostic delays, recurrence, treatment failures and infections with antibiotic resistant bacteria. The emergence of artificial intelligence (AI) in healthcare, particularly in clinical decision support, imaging, and diagnostic microbiology raises great expectations in addressing these challenges.

Recent Findings: Machine learning (ML) and AI models have been applied to CT scans and chest X-rays to identify and classify pleural effusions and empyema with greater accuracy.

View Article and Find Full Text PDF

Recent updates of interferon-derived myxovirus resistance protein A as a biomarker for acute viral infection.

Eur J Med Res

December 2024

Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, 269, Debre Markos, Ethiopia.

Background: Antibiotic resistance (AMR) remains a global public health threat with a high burden in sub-Saharan countries. The overuse of antimicrobials in the clinical setting is the main factor for the spread of antibiotic resistance. Diagnostic uncertainty in differentiating between bacterial and viral infections is the major contributor to antimicrobial overuse.

View Article and Find Full Text PDF

Background: The World Health Organization (WHO) has identified carbapenem-resistant Pseudomonas aeruginosa (CRPA) as one of the three critical priority pathogens. There is scarce literature evaluating the treatment outcomes in patients with CRPA infections treated with traditional non-carbapenem β-lactam (NCBL) agents. Thus, this study aims to assess the effectiveness of traditional NCBL compared to novel β-lactam agents (NVL) for treating non-carbapenem β-lactam -susceptible CRPA.

View Article and Find Full Text PDF

Background: Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance.

View Article and Find Full Text PDF

Colistin is a last-resort treatment for multidrug-resistant Gram-negative bacterial infections, particularly in critically ill patients. Nevertheless, it remains a major threat to public health. We assessed the proportion of colistin-resistant Gram-negative isolates from intensive care unit (ICU) infections in different years, areas, pathogens, and antimicrobial susceptibility tests (AST).

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!