Evidence map›Paper›PMID 42536370›Full record

ArticleJAMA network open2026

Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.

Anna C Sick-Samuels, Charlotte Z Woods-Hill, Daniel P Kelly, Danielle W Koontz, Nora Elhaissouni, Urmi Kumar, Anping Xie, Troy Richardson, Sreejata Dutta, Jill A Marsteller and 34 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

44 authors.

Anna C Sick-SamuelsDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Charlotte Z Woods-HillDivision of Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Daniel P KellyDivision of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Danielle W KoontzDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Nora ElhaissouniDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Urmi KumarDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Anping XieDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Troy RichardsonChildren's Hospital Association, Lenexa, Kansas.
Sreejata DuttaChildren's Hospital Association, Lenexa, Kansas.
Jill A MarstellerArmstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Elizabeth ColantuoniDepartment of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Aaron M MilstoneDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
BrighT STAR Respiratory Authorship Group
Zachary AldewereldDivision of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Michael J AuthDivision of Pediatric Critical Care, Department of Pediatrics, Dell Medical School, Austin, Texas.
Ritu BanerjeeDivision of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Jennifer A BlumenthalDivision of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Katharine BoyleDivision of Critical Care Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Cara CecilDivision of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Samantha DallefeldDivision of Pediatric Critical Care, Department of Pediatrics, Dell Medical School, Austin, Texas.
Brian F FlahertyDivision of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City.
Charles B FosterSection of Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
Keshava M N GowdaDepartment of Pediatric Critical Care Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
Kelly A HardyDivision of Pediatric Critical Care, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Vanderbilt School of Nursing, Nashville, Tennessee.
Sarmistha B HaugerDivision of Pediatric Infectious Disease, Dell Medical School, University of Texas at Austin.
Andrea Green HinesDivision of Infectious Diseases, Department of Pediatrics, Children's Nebraska, University of Nebraska Medical Center, Omaha.
Sue J HongDivision of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Nicholas D HysmithDepartment of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
Andrew KiraguDivision of Critical Care Medicine, Department of Pediatrics, Children's Minnesota, Children's Respiratory and Critical Care Specialist's P.A., Minneapolis.
Aileen L KirbyDivision of Pediatric Critical Care, Doernbecher Children's Hospital, Oregon Health & Science University, Portland.
Christina KoutsariDepartment of Pharmacy, Antimicrobial Stewardship Program, Children's Minnesota, Minneapolis.
Gitte Y LarsenDivision of Critical Care Medicine, Department of Pediatrics, Intermountain Primary Children's Hospital and University of Utah, Salt Lake City.
Caitlin Naureckas LiDivision of Infectious Diseases, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
John C LinDivision of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri.
Matthew H M MarxDivision of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Bridget M NortonDivision of Pediatric Critical Care Medicine, Children's Nebraska, University of Nebraska College of Medicine, Omaha.
Gregory P PriebeDivision of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Glenn J RapsinskiDivision of Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Rebecca G SameDivision of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri.
Hayden T SchwenkDivision of Infectious Diseases, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California.
Katherine M SteffenDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Stanford, California.
Sachin D TadphaleDivision of Pediatric Critical Care & Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis.
Philip ToltzisDivision of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Lorne WalkerDivision of Infectious Diseases, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Endotracheal aspirate culture (EAC) practices for evaluation of ventilator-associated infections (VAI) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for VAI. Diagnostic stewardship strategies to optimize EAC testing practices may reduce overtesting and unnecessary antibiotic treatment. Objective: To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (PICUs). Design, Setting, and Participants: This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (QI) Collaborative involving PICUs across the US between 2019 and 2023. Data were collected from the participating sites and from the Children's Hospital Association Pediatric Health Information System and were analyzed from August to December 2025. Exposure: Participating PICUs conducted local QI programs focused on optimizing EAC practices, facilitated by the BrighT STAR collaborative. Main Outcomes and Measures: The primary outcome was the monthly rate of EACs per 100 ventilator-days. Secondary outcomes included rates of antibiotic initiations and antibiotic days of therapy, bronchoalveolar lavage cultures, readmissions, length of stay, ventilation duration, ventilation-free days, sepsis, and septic shock. Analysis included adjustment for seasonality. Results: Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106 967 ventilator-days preimplementation and 92 167 ventilator-days postimplementation. Comparing 24 months in the preimplementation period with the 18 months in the postimplementation period, the mean monthly EAC rate declined by 16% from a preimplementation to postimplementation rate of 7.80 to 6.55 cultures per 100 ventilator-days (relative rate [RR], 0.84; 95% CI, 0.78-0.90). The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11). There were no significant changes in the rates of bronchoalveolar lavage cultures, PICU length of stay, PICU or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days. Conclusions and Relevance: In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced EAC use in the PICU without safety concerns. Future work will determine optimal implementation strategies, assess sustainability and the cost impact of EAC stewardship.

Indexed as

Antimicrobial StewardshipDecision Support Systems, ClinicalIntensive Care Units, PediatricPneumonia, Ventilator-AssociatedAnti-Bacterial AgentsChildChild, PreschoolCohort StudiesFemaleHumansInfantMaleQuality ImprovementUnited StatesAnti-Bacterial Agents

Identifiers

PMID42536370
PMCPMC13428280

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.