Optimizing Respiratory Culture Practices for Mechanically Ventilated Children

优化机械通气儿童的呼吸培养实践

• 批准号: 10349660
• 负责人: Anna Sick-Samuels
• 金额: $ 19.79万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10349660
• 关键词: Address; Adverse event; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Aspirate substance; Attitude; Award; Bacteremia; Bacterial Antibiotic Resistance; Bacterial Infections; Behavior; Biometry; Caring; Child; Childhood; Chronically Ill; Clinical; Clinical Research; Clinical Trials; Collection; Communicable Diseases; Complex; Complication; Consolidated Framework for Implementation Research; Critical Care; Critically ill children; Data; Diagnosis; Diagnostic; Direct Costs; Dissemination and Implementation; Engineering; Environment; Evaluation; Evidence based practice; Faculty; Florida; Focus Groups; Fright; Future; Goals; Gold; Growth; Health Care Costs; Hospital Charges; Hospitals; Human; Infection; Institution; Interdisciplinary Study; International; Interruption; Intervention; Interview; K-Series Research Career Programs; Length of Stay; Lung; Measures; Mechanical ventilation; Medicine; Mentors; Microbiology; Modeling; Modification; Morbidity - disease rate; Outcome; Patients; Pediatric Hospitals; Pediatric Intensive Care Units; Perception; Preparation; Prevention; Process; Provider; Qualitative Methods; Qualitative Research; Quality of Care; Readiness; Reproducibility; Research; Research Methodology; Research Personnel; Resources; Respiratory System; Respiratory Tract Infections; Risk; Safety; Sepsis; Septic Shock; Series; Surveys; Time; Training; Uncertainty; Universities; Variant; Ventilator; Work; care outcomes; career development; clinical decision support; cohort; effectiveness implementation study; effectiveness implementation trial; endotracheal; evidence base; experience; healthcare-associated infections; hospital readmission; implementation barriers; implementation science; implementation strategy; improved; improved outcome; interest; medical schools; member; mortality; patient oriented research; patient safety; pragmatic implementation; programs; public health relevance; research and development; respiratory; respiratory colonization; skills; success; support tools; tool; ventilation

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.

简要摘要 自1990年代以来，机械通风儿童的数量已增长了80倍和呼吸机 - 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 通常获得VAI诊断和气管气管抽吸培养物（EAC）的不确定性 作为评估VAI的工具。尽管EAC结果不是特定于感染与定殖的特定的，但许多 临床医生将EAC中的细菌生长解释为感染促使治疗的证据。确实，有50％ 小儿重症监护病房（PICU）中使用的抗生素用于VAI。因此，EAC的过度使用有助于 不必要的抗生素治疗，通过促进抗生素抗性，抗生素 - 相关的不良事件，并增加医疗保健成本。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并提高质量的巨大潜力 照顾成千上万的通风儿童。这项研究的目的是（1）定义全国EAC实践 并确定可疑VAI的儿童的最佳EAC实践，（2）评估关键的临床结果 试点计划实施干预措施以改善EAC实践，（3）确定促进者和障碍 EAC诊断管理计划，以告知可重复实施策略。 Sick-Samuels博士是约翰·霍普金斯大学儿科传染病的教职员工 医学院。她致力于进行以患者为导向的研究来开发，实施，衡量 诊断管理计划的影响和传播的影响，以改善复杂住院的护理 患者。在这个职业发展奖中，她寻求（1）发展实施科学方面的专业知识 以及患者的安全和质量研究，（2）分析用于患者安全和质量的临床结果 研究，（3）将定性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（Aaron Milstone）博士很广泛 专门用于预防抗生素抗性和医疗保健的临床研究经验 儿童的相关感染。她的副官员肖恩·贝伦霍兹（Sean Berenholtz）博士是 患者的安全性和质量以及预防呼吸机相关感染，吉尔·马斯泰勒（Jill Marsteller）博士是国家 实施科学研究的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，感染力方面拥有专业知识 疾病，患者安全和质量，实施科学，人为因素工程和生物统计学。这 工作将使她为制定R01提案做好准备，以进行一项多中心有效性试验的试验 EAC诊断管理。通过这项指导的研究，约翰·霍普金斯的资源丰富的环境 大学和受保护的时间完成了她的培训目标，Sick-Samuels博士将成为独立的 研究人员领导诊断管理和实施科学研究。