ArticleClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2024
A quasi-experimental study of a bundled diagnostic stewardship intervention for ventilator-associated pneumonia.
Article in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT05176353 (Implementation of a Diagnostic Stewardship Bundle for Ventilator-associated Pneumonia Among Mechanically-ventilated Patients), which is not on this map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementation of a Diagnostic Stewardship Bundle for Ventilator-associated Pneumonia Among Mechanically-ventilated Patients
Who cites it
12 citing papers in PubMed, 11 citations in OpenAlex.
- Improving the culture surrounding tracheal aspirates in mechanically ventilated children.Journal of clinical microbiology · 2026Article
- Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.JAMA network open · 2026Article
- Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- A diagnostic stewardship bundle approach to facilitate same-day optimal antimicrobial therapy in gram-negative sepsis: a quasi-experimental study.Scientific reports · 2026Article
- Reductions in ventilator-associated events following implementation of a ventilator-associated pneumonia diagnostic stewardship intervention: A difference-in-difference study.Infection control and hospital epidemiology · 2026Article
- Antimicrobial stewardship programs in sepsis treatment: principles, impact, and future directions.The Korean journal of internal medicine · 2026Review
- Ventilator-associated pneumonia biomarker evaluation (VIBE) study: protocol for a prospective, observational, case-cohort study.BMJ open · 2025Article
- Opportunities for collaboration: the synergy between antimicrobial and diagnostic stewardship in pediatrics.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Review
- Potential role of report nudging on diagnosis and treatment of ventilator-associated pneumonia: a quantitative survey.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Reduced antimicrobial consumption through enhanced pneumonia management in critically ill patients: outcomes of an antibiotic stewardship program in the intensive care unit.Frontiers in medicine · 2025Article
- Improving Antibiotic Use for Ventilator-Associated Pneumonia Through Diagnostic Stewardship: A Proof-of-Concept Mixed Methods Study.Open forum infectious diseases · 2024Article
- Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR.Diagnostics (Basel, Switzerland) · 2024Review
Corrections and comments
- Erratum issued
Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesDiagnostic error in the use of respiratory cultures for ventilator-associated pneumonia (VAP) fuels misdiagnosis and antibiotic overuse within intensive care units. In this prospective quasi-experimental study (NCT05176353), we aimed to evaluate the safety, feasibility, and efficacy of a novel VAP-specific bundled diagnostic stewardship intervention (VAP-DSI) to mitigate VAP over-diagnosis/overtreatment.
methodsWe developed and implemented a VAP-DSI using an interruptive clinical decision support tool and modifications to clinical laboratory workflows. Interventions included gatekeeping access to respiratory culture ordering, preferential use of non-bronchoscopic bronchoalveolar lavage for culture collection, and suppression of culture results for samples with minimal alveolar neutrophilia. Rates of adverse safety outcomes, positive respiratory cultures, and antimicrobial utilization were compared between mechanically ventilated patients (MVPs) in the 1-year post-intervention study cohort (2022-2023) and 5-year pre-intervention MVP controls (2017-2022).
resultsVAP-DSI implementation did not associate with increases in adverse safety outcomes but did associate with a 20% rate reduction in positive respiratory cultures per 1000 MVP days (pre-intervention rate 127 [95% CI: 122-131], post-intervention rate 102 [95% CI: 92-112], p < 0.01). Significant reductions in broad-spectrum antibiotic days of therapy per 1000 MVP days were noted after VAP-DSI implementation (pre-intervention rate 1199 [95% CI: 1177-1205], post-intervention rate 1149 [95% CI: 1116-1184], p 0.03). DISCUSSION: Implementation of a VAP-DSI was safe and associated with significant reductions in rates of positive respiratory cultures and broad-spectrum antimicrobial use. This innovative trial of a VAP-DSI represents a novel avenue for intensive care unit antimicrobial stewardship. Multicentre trials of VAP-DSIs are warranted.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.