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Diagnostic Stewardship Cuts Testing in Sick Infants

Clinical decision support reduced potentially unnecessary respiratory cultures in critically ill children without evidence of patient harm

09/02/2026 News 3 min read

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Objective:

To evaluate the impact of a diagnostic stewardship program on respiratory culture use in pediatric intensive care units (PICUs).

Approach:

Study Design: A multicenter cohort study conducted across 15 US PICUs from 2019 to 2023.
Intervention: Implementation of clinical decision support tools, including checklists and algorithms, to standardize endotracheal aspirate culture collection.

Key Findings:

Respiratory culture use decreased by 16% from 7.80 to 6.55 cultures per 100 ventilator-days.
Cultures repeated within 3 days declined from approximately 13% to 10%.
No increase in adverse outcomes such as length of stay, readmissions, sepsis, or antibiotic use was observed.

Limitations:

Variable reductions in culture rates between centers indicate local practice influences effectiveness.
Patient-level data were unavailable, and rare safety events may have been missed.

Conclusion:

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

Sources:

Critical Care Medicine