Optimizing Respiratory Culture Practices for Mechanically Ventilated Children

小结 自20世纪90年代以来，使用机械通风的儿童数量增长了80倍，呼吸机-- 相关感染(VAI)是主要的并发症。在没有黄金标准的情况下，有临床 Vais和气管内吸液培养(EACS)诊断的不确定性是常见的。 作为VAI评估的工具。尽管EAC结果并不是感染与定居的特异性结果，但许多 临床医生将EACS中的细菌生长解释为感染促使治疗的证据。事实上，50%的 儿科重症监护病房(PICU)中使用的抗生素是用于静脉感染的。因此，过度使用EAC有助于 不必要的抗生素治疗，通过增加抗生素耐药性而增加患者的发病率，抗生素- 相关的不良事件和增加的医疗成本。诊断管理计划促进 合理使用EAC在减少不必要的抗生素使用和提高质量方面具有重大潜力 为数以千计的呼吸机儿童提供护理。这项研究的目标是(1)定义全国性的EAC实践 和确定疑似Vais儿童的最佳EAC实践，(2)评估关键临床结果 实施干预措施的试点计划，以改进东非共同体的做法，以及(3)确定促进者和障碍 EAC诊断管理计划，为可复制的实施战略提供信息。 西克-塞缪尔博士是约翰·霍普金斯大学儿科传染病教员 医学院。她致力于开展以患者为中心的研究，以开发、实施、测量 影响和传播诊断管理计划，以改善复杂住院患者的护理 病人。在这个职业发展奖期间，她寻求(1)发展实施科学方面的专业知识 和患者安全和质量研究，(2)分析用于患者安全和质量的临床结果 研究，(3)将质的研究方法应用于实施科学，(4)准备进行 多中心混合有效性--实施试验。她的主要导师亚伦·米尔斯通博士拥有广泛的 致力于预防抗生素耐药性和医疗保健的临床研究和试验经验- 儿童中的相关感染。她的合作导师肖恩·贝伦霍尔茨博士是一位国内和国际的领导者 患者的安全和质量以及呼吸机相关感染的预防，而吉尔·马斯特勒博士是一名国家 实施科学专家，研究成功实施和传播的决定因素 循证实践。她的顾问和合作者在重症监护医学、传染病方面拥有专业知识 疾病、患者安全和质量、实施科学、人为因素工程学和生物统计学。这 她将为制定R01提案做好准备，以进行以下方面的多中心有效性-实施试验 EAC诊断管理。有了这项有指导的研究，约翰霍普金斯大学丰富的资源环境 在大学和保护时间内完成她的训练目标，西克-塞缪尔博士将成为一名独立的 调查员领导诊断管理和实施科学研究。

Brief Summary The number of mechanically ventilated children has grown 80-fold since the 1990s and ventilator- associated infections (VAIs) are a leading complication. In the absence of a gold standard, there is clinical uncertainty around the diagnosis of VAIs, and endotracheal aspirate cultures (EACs) are commonly obtained as a tool to assess for VAI. Although EAC results are not specific for infection versus colonization, many clinicians interpret bacterial growth in EACs as evidence of infection prompting treatment. Indeed, 50% of antibiotics used in the pediatric intensive care unit (PICU) are for VAIs. Thus, over-use of EACs contributes to unnecessary antibiotic treatment, compounding patient morbidity by promoting antibiotic resistance, antibiotic- associated adverse events, and increased healthcare costs. Diagnostic stewardship programs promoting the judicious use of EACs have significant potential to reduce unnecessary antibiotic use and improve the quality of care for thousands of ventilated children. The goal of this study is to (1) define nationwide EAC practices and identify optimal EAC practices in children with suspected VAIs, (2) assess key clinical outcomes after a pilot program implementing interventions to improve EAC practices, and (3) identify facilitators and barriers of EAC diagnostic stewardship programs to inform reproducible implementation strategies. Dr. Sick-Samuels is a faculty member in Pediatric Infectious Diseases at the Johns Hopkins University School of Medicine. She is committed to conducting patient-oriented research to develop, implement, measure the impact of, and disseminate diagnostic stewardship programs to improve the care of complex hospitalized patients. During this career-development award, she seeks to (1) develop expertise in implementation science and patient safety and quality research, (2) analyze clinical outcomes used in patient safety and quality research, (3) apply qualitative research methods to implementation science, and (4) prepare to conduct a multicenter hybrid effectiveness-implementation trial. Her primary mentor, Dr. Aaron Milstone, has extensive experience in clinical research and trials dedicated to prevention of antibiotic-resistance and healthcare- associated infections in children. Her co-mentors, Dr. Sean Berenholtz, is a national and international leader in patient safety and quality and prevention of ventilator-associated infections, and Dr. Jill Marsteller is a national expert in implementation science researching determinants of successful implementation and dissemination of evidence-based practices. Her advisors and collaborators have expertise in critical care medicine, infectious diseases, patient safety and quality, implementation science, human factors engineering, and biostatistics. This work will prepare her to develop an R01 proposal to conduct a multicenter effectiveness-implementation trial of EAC diagnostic stewardship. With this mentored research, the resource rich environment of Johns Hopkins University and the protected time to complete her training goals, Dr. Sick-Samuels will become an independent investigator leading diagnostic stewardship and implementation science research.