Clinical Report: Diagnostic Stewardship Cuts Testing in Sick Infants

Overview

A diagnostic stewardship program reduced respiratory culture use by 16% in pediatric intensive care units without adverse patient outcomes.

Background

The use of endotracheal aspirate cultures in children with artificial airways is common for diagnosing suspected ventilator-associated infections. However, these cultures often lack specificity, leading to potential overdiagnosis and unnecessary antibiotic treatments. Implementing diagnostic stewardship can help optimize testing practices and improve clinical relevance.

Data Highlights

Key Findings

• 16% reduction in respiratory culture use across 15 PICUs.
• No increase in adverse outcomes such as length of stay or readmissions.
• Standardized clinical decision support tools were used to guide testing.
• Variable effectiveness of the intervention was noted between centers.
• Further research is needed to assess integration into routine workflows.

Clinical Implications

Further research is needed to assess integration into routine workflows.

Conclusion

Further research is needed to determine how best to integrate stewardship into routine workflows and assess its sustainability and cost impact.

Related Resources & Content

1. Dumm RE, The Pathologist, 2025 -- Optimizing Diagnostic Stewardship: The Lab Director’s Perspective
2. MDSpire News, 2025 -- Optimizing Diagnostic Stewardship: The Lab Director’s Perspective
3. MDSpire News, 2025 -- Optimizing Diagnostic Stewardship: The Clinician’s Perspective
4. Dumm RE, The Pathologist, 2025 -- Optimizing Diagnostic Stewardship: The Clinician’s Perspective
5. CDC, PedVAE | PSC | NHSN, 2026 -- Pediatric Ventilator-Associated Events
6. JAMA Network, 2026 -- Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU
7. ASM Journals -- Improving the culture surrounding tracheal aspirates in mechanically ventilated children
8. PedVAE | PSC | NHSN | CDC
9. Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU | Critical Care Medicine | JAMA Network Open | JAMA Network
10. Improving the culture surrounding tracheal aspirates in mechanically ventilated children