In this episode of the ICHE podcast, we explore the theme of respiratory culturing appropriateness in pediatric patients, emphasizing diagnostic stewardship's role in optimizing patient outcomes. Host David Calfee, MD, MS and guest experts, Kathleen Chiotos, MD, MSCE and Edward Lyon, DO, MA, share insights on how stewardship practices can refine respiratory testing in pediatric intensive care units (PICUs), where evidence suggests these tests are often overused without clinical benefit. They examine challenges in implementing stewardship, including barriers like resistance to change and logistical issues, and discuss practical strategies to overcome these obstacles.

The conversation highlights two recent studies published in ICHE: Dr. Lyon's work on repeat tracheal aspirate cultures in PICUs, which analyzes their frequency, resistance patterns, and impact on antimicrobial use, and Dr. Chiotos's study on a tracheal aspirate culture stewardship intervention, examining its effect in a tertiary PICU. Both authors discuss their studies' methodologies, findings, limitations, and implications for future practice.

To wrap up, each expert offers actionable recommendations for healthcare professionals interested in improving respiratory culturing practices at their institutions, providing practical steps to enhance safety and care efficiency. Full versions of the articles discussed in this episode are available in the September issue of ICHE.