In the absence of evidence-based laboratory guidelines, the workup and interpretation of tracheal aspirate (TA) cultures remains controversial and confusing within the fields of clinical microbiology, infectious diseases, and critical care. Between 22 January and 24 February 2020, we conducted a national, web-based survey of microbiology laboratory personnel in free-standing pediatric hospitals and adult hospitals containing pediatric facilities regarding the laboratory practices used for TA specimens. We hypothesized there would be substantial center-level variability in laboratory processing of TA cultures. The response rate for the survey was 48% (73/153). There was a high level of variability in the criteria used for all processes, including specimen receipt, Gram staining, and culture reporting. Most respondents (77%) reported they do not reject TA specimens based on Gram stain criteria, and 44% of labs do not require that a minimum number of Gram stain fields be reviewed prior to reporting results. Overall, nonacademic hospital laboratories and pediatric-only laboratories are more likely to identify, report, and perform susceptibility testing on organisms from TA cultures, regardless of organism quantity or predominance. There is a substantial amount of process variability among pediatric microbiology laboratories that affects TA culture reporting, and which guides treatment decisions. This variation within and among labs makes clinical outcome studies related to TA cultures difficult to interpret. This study serves as a pragmatic step in informing the development of robust clinical guidelines. Clinical outcome and implementation studies are necessary to determine the effectiveness of guidelines for TA cultures.

中文翻译：

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儿科气管内吸出物培养调查 (PETACS)：检查美国儿科微生物实验室的实践差异

在缺乏循证实验室指南的情况下，气管抽吸物 (TA) 培养物的检查和解释在临床微生物学、传染病和重症监护领域仍然存在争议和混乱。2020 年 1 月 22 日至 2 月 24 日期间，我们对独立儿科医院和包含儿科设施的成人医院的微生物实验室人员进行了一项全国性的网络调查，调查涉及用于 TA 标本的实验室实践。我们假设在 TA 培养物的实验室处理中会有很大的中心级变异。调查的回应率为 48% (73/153)。用于所有流程的标准存在很大差异，包括样本接收、革兰氏染色和培养报告。大多数受访者 (77%) 表示他们不拒绝基于革兰氏染色标准的 TA 标本，44% 的实验室不要求在报告结果之前审查最低数量的革兰氏染色区域。总体而言，非学术医院实验室和仅限儿科的实验室更有可能对来自 TA 培养物的微生物进行识别、报告和药敏试验，而不管微生物数量或优势如何。儿科微生物实验室之间存在大量的过程变异，影响 TA 培养报告，并指导治疗决策。实验室内部和实验室之间的这种差异使得与 TA 培养相关的临床结果研究难以解释。这项研究是为制定稳健的临床指南提供信息的务实步骤。