Optimizing Respiratory Culture Practices for Mechanically Ventilated Children

简要总结 自20世纪90年代以来，机械通气儿童的数量增长了80倍， 相关感染（VAIs）是主要的并发症。在没有金标准的情况下， VAIs诊断的不确定性，通常获得气管内抽吸物培养（EAC） 作为奥钢联的评估工具虽然EAC结果对于感染与定植没有特异性，但许多 临床医生将EAC中的细菌生长解释为感染的证据，从而促使治疗。事实上，50%的 儿科重症监护病房（PICU）中使用的抗生素用于VAIs。因此，过度使用EAC有助于 不必要的抗生素治疗，通过促进抗生素耐药性，抗生素- 相关的不良事件和增加的医疗费用。诊断管理计划，促进 明智地使用EAC具有减少不必要的抗生素使用和提高质量的巨大潜力， 为成千上万的通风儿童提供护理。本研究的目的是（1）确定全国范围内的EAC实践 并确定疑似VAIs儿童的最佳EAC实践，（2）评估治疗后的关键临床结局， 实施干预措施以改善EAC实践的试点计划，以及（3）确定促进因素和障碍， EAC诊断管理计划，以告知可重复的实施策略。 Sick-Samuels博士是约翰霍普金斯大学儿科传染病系的一名教员 医学院。她致力于开展以患者为导向的研究，以开发，实施，测量 的影响，并传播诊断管理计划，以改善复杂的住院病人的护理 患者在这个职业发展奖，她寻求（1）发展在实施科学的专业知识 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局 研究，（3）将定性研究方法应用于实施科学，（4）准备进行一项 多中心混合有效性-实施试验。她的主要导师亚伦·米尔斯顿博士， 致力于预防抗药性和医疗保健的临床研究和试验经验- 儿童相关感染。她的共同导师，肖恩Berenholtz博士，是一个国家和国际领导人， 患者安全和质量以及呼吸机相关感染的预防，Jill Marsteller博士是一位全国性的 执行科学专家，研究成功执行和传播《公约》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， 疾病，病人安全和质量，实施科学，人因工程和生物统计学。这 她的工作将准备制定一项R 01提案，以进行多中心的有效性实施试验， EAC诊断管理。通过这项指导性研究，约翰霍普金斯大学资源丰富的环境 大学和受保护的时间来完成她的训练目标，生病的塞缪尔博士将成为一个独立的 领导诊断管理和实施科学研究的调查员。

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.