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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1743178
Original Article

The Impact of Pneumonia PCR Panel Testing in the PICU: A Quality Improvement Study

Yaron Fireizen
1   Department of Pediatric Pulmonology, Miller Children's and Women's Hospital of Long Beach, University of California, Irvine School of Medicine, Irvine, California, United States
,
Christopher J. Babbitt 
2   Department of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
,
Susan Adams
3   Department of Pediatric Pharmacy, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
,
Tricia Morphew
4   Morphew Consulting LLC, Bothell, Washington, United States
5   MemorialCare Health System, Fountain Valley, California, United States
,
Emanuel T. Ferro
6   Department of Pathology, Long Beach Memorial Medical Center, Long Beach, California, United States
,
Inderpal Randhawa
1   Department of Pediatric Pulmonology, Miller Children's and Women's Hospital of Long Beach, University of California, Irvine School of Medicine, Irvine, California, United States
› Author Affiliations Financial Support All of the work in this study is the original work of the authors. Dr. Babbitt received internal funding from the Memorial Medical Foundation at Miller Children's and Women's Hospital of Long Beach that was used to pay for a statistician for this project. Morphew Consulting, LLC has an ongoing consultancy arrangement with MHS to provide biostatistical support to research conducted at Miller Children's and Women's Hospital.
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Abstract

Inappropriate antibiotic usage can contribute to the promotion of resistant bacteria. In an effort to reduce antibiotic length of therapy (LOT), we initiated a performance improvement project utilizing pneumonia polymerase chain reaction (PCR) testing in ventilated pediatric intensive care unit (PICU) patients suspected of tracheitis or pneumonia. This is a single-center cohort intervention study that compared pre- and postimplementation patients. The intervention was the use of a pneumonia PCR panel on all PICU patients undergoing an evaluation for acute tracheitis or pneumonia during the postimplementation period. The inclusion criteria were either acute or acute on chronic respiratory failure. After an 8-month period, the charts were reviewed from both cohorts and baseline data, and outcome data were compared by statistical analysis. A total of 41 preimplementation and 30 postimplementation patients were compared, and no baseline differences were found except postimplementation patients being slightly older (133 vs. 56 months, p-value = 0.040). Analysis of the primary outcome measures found that the time to identification of organism (5 vs. 67 hours) and LOT (5 vs. 9 days, p < 0.001) were shorter in postimplementation patients compared with preimplementation patients. Antibiotics were changed based on the results of the pneumonia PCR on 18 of 30 patients (60%). There was no difference in ventilator-free days, PICU length of stay, or mortality. In conclusion, pneumonia PCR panel testing leads to more rapid results and is associated with reduced antibiotic LOT.

Keywords

antibiotics - pneumonia - ventilator


Publication History

Received: 09 November 2021

Accepted: 15 January 2022

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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