Christopher Babbitt, MD
Pediatric Intensivist
MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach
Long Beach, California
Disclosure information not submitted.
Susan Adams, Pharm.D., BCPS
Lead Clinical Pharmacist
MemorialCare Miller Children's Hospital and Women's Hospital Long Beach
Long Beach, California, United States
Disclosure information not submitted.
Inderpal Randhawa, MD
Medical Director of the Children's Pulmonary Institute and Program Director of the Cystic Fibrosis
MemorialCare Miller Children's Hospital and Women's Hospital Long Beach
Long Beach, California, United States
Disclosure information not submitted.
Title: The Impact of Pneumonia PCR Testing on Antibiotic Therapy for Ventilated PICU Patients
Introduction: According to the U.S. Centers for Disease Control and Prevention, 30–50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Inappropriate usage can lead to further antibiotic resistance. An adult ICU study utilizing pneumonia PCR panel testing found that it altered antibiotic prescriptions in 41% of patients.
Methods: A performance improvement (PI) project was conducted at our center utilizing pneumonia PCR panel testing to forecast the impact of early microbial results on prescribing antibiotic therapy in ventilated PICU patients. The study design was a pre- and post-implementation analysis. A PDSA format was used for the project. Pneumonia PCR testing was implemented over a 5-month period in respiratory failure patients with suspected pneumonia or tracheitis. The post implementation study cohort was compared with a pre-implementation cohort without PCR testing during an identical prior 5-month period. The primary outcome measure was duration of antibiotic therapy for the suspected infection.
Results: A total of 41 patients were identified pre-implementation and 21 patients post-implementation from a database query. Baseline data indicated that pre-implementation patients were younger (56 vs 132 months, p=0.04), but there was no difference in PRISM 3 scores, worst oxygenation saturation index at 24 or 48 hours or the number of patients meeting severe PARDS criteria, diagnosed with pneumonia, or chronically ventilated. There was also no difference in the following outcome measures: mortality, PICU LOS, hospital LOS, or ventilator free days. Post implementation patient’s median duration of antibiotics was lower compared to pre-implementation patients (6 vs 9 days, p=0.003). The time to PCR results was shorter compared to time to culture results in the pre-cohort (5 vs 67 hours, p< 0.0001). Overall, 81% of the organisms found on culture were identified on PCR. The medical team altered antibiotic therapy (escalated, de-escalated or stopped) 57% of the time based on the early PCR result.
Conclusion: Early pneumonia PCR testing in pediatric respiratory failure patients reduced the time to identify respiratory organisms and was associated with changes in antibiotic prescribing behavior and shorter duration of antibiotic therapy.