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Background Respiratory cultures are often obtained as part of a “pan-culture” in mechanically ventilated patients in response to new fevers or leukocytosis, despite an absence of clinical or radiographic evidence suggestive of pneumonia. Methods This was a propensity score-stratified cohort study of hospitalized mechanically-ventilated adult patients between 2014-2019, with new abnormal temperature or serum white blood cell count (NATW), but without radiographic evidence of pneumonia, change in ventilator requirements or documentation of purulent secretions. Two patient groups were compared: those with respiratory cultures performed within 36 hours following NATW, and those without respiratory cultures performed. The co-primary outcomes were the proportion of patients receiving &amp;gt;2 days of total antibiotic therapy and &amp;gt;2 days of broad-spectrum antibiotic therapy within 1 week following NATW. Results Of 534 included patients, 113 (21.2%) had respiratory cultures obtained and 421 (78.8%) did not. Patients with respiratory cultures performed were significantly more likely to receive antibiotics for &amp;gt;2 days within 1 week following NATW than those without respiratory cultures performed (total antibiotic adjusted odds ratio 2.57, 95% confidence interval 1.39-4.75; broad-spectrum antibiotic adjusted odds ratio 2.47, 95% confidence interval 1.46-4.20). Discussion Performance of respiratory cultures for fever/leukocytosis in mechanically-ventilated patients without increasing ventilator requirements, secretion burden or radiographic evidence of pneumonia was associated with increased antibiotic use within one week following incident abnormal temperature and/or WBC. Diagnostic stewardship interventions targeting performance of unnecessary respiratory cultures in mechanically-ventilated patients may reduce antibiotic overuse within intensive care units.

Rethinking the “Pan-Culture”: Clinical Impact of Respiratory Culturing in Patients With Low Pretest Probability of Ventilator-Associated Pneumonia