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Repeat tracheal aspirate cultures in pediatric intensive care patients: Frequency, resistance, and antimicrobial use
Edward Lyon1, Jennifer Goldman1,2, Brian Lee2,3
1Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA.
Insights
Repeat tracheal aspirate (TA) cultures in pediatric intensive care units often yield the same pathogens and rarely change antibiotic treatment. However, these repeat cultures can identify the development of multidrug-resistant organisms (MDROs).
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Antimicrobial stewardship
Background:
- Repeat tracheal aspirate (TA) cultures are common in pediatric intensive care units (PICUs).
- Understanding the clinical utility and impact of these repeat cultures is crucial for optimizing patient care and antibiotic use.
Purpose of the Study:
- To evaluate the clinical impact of repeat tracheal aspirate (TA) cultures.
- To identify features associated with repeat TA cultures in critically ill children.
Main Methods:
- Retrospective cohort study of children (≤18 years) admitted to PICU or CICU with ≥2 TA cultures.
- Data collected included demographics, clinical status, antibiotic usage, and microbiology.
- Descriptive statistics analyzed culture frequency, timing, rationale, antibiotic exposure, and multidrug-resistant organism (MDRO) development.
Main Results:
- Sixty-three patients underwent 252 repeat TA cultures; 71% were in the PICU.
- A median of 3 cultures per patient were obtained, with 50% within 7 days.
- 66% of patients had the same organism identified on multiple cultures; antibiotic management was infrequently altered.
Conclusions:
- Repeat TA cultures in critically ill children often identify persistent pathogens without guiding antibiotic changes.
- These cultures are valuable for detecting the emergence of multidrug-resistant organisms (MDROs).
Objective:
To evaluate the clinical impact and features associated with repeat tracheal aspirate (TA) cultures in children admitted to the intensive care unit.
Design:
Retrospective cohort study.
Setting:
A 338-bed freestanding, tertiary pediatric academic medical center with pediatric medical intensive care unit (PICU) and cardiac intensive care units (CICU).
Patients:
Children ≤18 years of age who were admitted to either the PICU or CICU who had ≥2 TA cultures in a single intensive care admission.
Methods:
Patients with ≥2 TA cultures between 2018 and 2019 were included in this study. The following information was collected: patient demographics, clinical data summarizing patient condition at the time of culture collection, number of TA cultures per patient, antibiotic usage, and microbiologic data. Descriptive statistics established the frequency of TA collection, time between culturing, clinical reasoning for collection, antibiotic exposure, and development of multidrug-resistant organisms (MDRO).
Results:
Sixty-three patients had repeat TA cultures and accounted for 252 TA cultures during the study period. Most patients with repeat TA cultures were admitted to the PICU (71%) and were male (65%). A median of 3 TA cultures per patient were obtained with 50% of repeat cultures occurring within 7 days from the previous culture. Sixty-six percent of patients had the same organism cultured on ≥2 TA cultures. Most antibiotics were not modified or continued to treat the results of the TA culture.
Conclusions:
Repeat TA cultures frequently show the same pathogens, and results do not often influence antibiotic selection or usage. Repeat TA cultures did demonstrate the development of MDROs.
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