Improving Antibiotic Use for Ventilator-Associated Pneumonia Through Diagnostic Stewardship: A Proof-of-Concept Mixed...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Clinical Microbiology

Background:

• Ventilator-associated pneumonia (VAP) is often overtreated due to positive respiratory cultures without clear clinical signs of pneumonia.
• Diagnostic stewardship is crucial to optimize antibiotic use in intensive care units (ICUs).

Purpose of the Study:

• To evaluate the impact of modifying lower respiratory tract (LRT) culture reports on antibiotic prescribing for suspected VAP.
• To assess the effectiveness of diagnostic stewardship at the respiratory culture reporting stage.

Main Methods:

• A mixed-methods study involving baseline evaluation and a nonrandomized intervention in two adult ICUs.
• Intervention: Modified LRT culture reports to indicate potential colonization for cultures not meeting pneumonia criteria, as adjudicated by physician review using a standard algorithm.
• Compared antibiotic prescribing for VAP between baseline and intervention periods.

Main Results:

• At baseline, antibiotic treatment for VAP was more frequent with pathogen identification in inappropriate LRT cultures (46%) compared to no growth (23%).
• During the intervention, modified reports for inappropriate LRT cultures with potential pathogens led to a significantly lower completion rate of antibiotic therapy for VAP (18% vs. 46% in the baseline group).

Conclusions:

• Modifying LRT culture reports, guided by clinical pneumonia features, can facilitate diagnostic stewardship for VAP.
• This approach helps reduce unnecessary antibiotic treatment in intensive care settings.