To order or not to order, that is the question… so how can we guide improved diagnostic stewardship interventions for respiratory cultures?

Reviewed by Jennifer Cihlar, DO, Vanderbilt University Medical Center

In this mixed methods process study, Chiotos et al., evaluates behaviors and perceptions of multiple specialties and levels of training regarding respiratory cultures for diagnosis of ventilator associated infections in a tertiary care PICU. Many providers felt respiratory cultures were overutilized however, multiple survey respondents noted that ordering them by “default” was still a common group practice especially in response to fever and influenced by a common concern of “fear of missing something”. Interestingly, actual, or perceived opinions of the PICU attendings influenced decision-making of PICU hospitalists, NPs and fellows, in that many felt overruled by an attending even when they did not feel respiratory culture was indicated. Barriers to standardization included tension around the perceived loss of autonomy that came from this implementation and a large concern that the overreliance on standardized guidelines would lead to missed diagnoses in more nuanced scenarios.

Chiotos K, Marshall D, Kellom K, et al. Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention. Infection Control & Hospital Epidemiology. 2023:1-9.

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