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Research Snapshot Theater: Quality and Patient Safety, Pediatric IV

Reduction of Unnecessary Respiratory Cultures in the Pediatric ICU: A Quality Improvement Initiative

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 10
  • VC

    Victoria Corley, MD

    Arkansas

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • CM

    Caleb McMinn, PharmD

    Pharmacy Clinical Coordinator, Pediatric Infectious Diseases/Antimicrobial Stewardship
    Arkansas Children's Hospital

    Disclosure information not submitted.

  • SP

    Sanjiv Pasala, MD

    Assosciate Professor of Pediatrics
    University of Arkansas for Medical Sciences, Arkansas Children's Hospital

    Disclosure information not submitted.

  • SA

    Salim Aljabari, MD

    Assosciate Professor of Pediatrics
    University of Arkansas for Medical Sciences, Arkansas Children's Hospital

    Disclosure information not submitted.

  • EG

    Ethan L. Gillett, MD

    Assistant Professor of Pediatrics
    University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Arkansas

    Disclosure information not submitted.

Introduction: Ventilator-associated infections (VAI) are a common concern for clinicians in pediatric intensive care units (PICU) and are associated with increased ventilator days and ICU length of stay (LOS). Respiratory cultures are commonly obtained when a VAI is suspected, but repeating these cultures too frequently is of low diagnostic utility and may lead to unnecessary antibiotic exposure. Consensus recommendations are to not obtain repeat respiratory cultures within 72 hours. This study aimed to reduce the amount of repeat respiratory cultures obtained within 72 hours in our PICU through a quality improvement initiative.


Methods: A best practice advisory (BPA) was added to our electronic health record that alerted clinicians attempting to order a repeat respiratory culture within 72 hours and informed them that this practice is not currently recommended. Mechanically ventilated patients with at least two respiratory cultures obtained in the 12 months following this intervention were compared with patients in the 12 months prior. Culture frequency, antibiotic usage, duration of mechanical ventilation, and ICU LOS were examined.


Results: A total of 101 patients met criteria (56 pre-intervention and 45 post-intervention). The number of events in which a repeat culture was obtained within 72 hours decreased from 17 to 4. There was a significant increase in the average time between repeat cultures (4.9 vs. 6.8 days, p=0.004) with a reduction in the number of respiratory cultures obtained per 100 ventilator days (17.8 vs 12.7). There was also a reduction in total antibiotic days from 742 to 542 following the intervention. There was no significant change in average patient ventilator days (4.39 vs. 5.04, p=0.069) or ICU LOS (17 vs. 21.1 days, p=0.15).


Conclusions: While VAI’s are a common concern in mechanically ventilated patients, it is important to maintain good diagnostic stewardship and not obtain unnecessary repeat respiratory cultures that are unlikely to add new diagnostic information and may result in unnecessary antibiotic exposure. Our utilization of a BPA discouraging PICU clinicians from obtaining repeat respiratory cultures within 72 hours was effective in reducing the number of repeat cultures without negatively impacting patient ventilator days or ICU LOS.