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- Title
Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes: Results of the Bright STAR Collaborative.
- Authors
Woods-Hill, Charlotte Z.; Colantuoni, Elizabeth A.; Koontz, Danielle W.; Voskertchian, Annie; Xie, Anping; Thurm, Cary; Miller, Marlene R.; Fackler, James C.; Milstone, Aaron M.; Agulnik, Asya; Albert, J. Elaine-Marie; Auth, Michael J.; Bradley, Erin; Clayton, Jason A.; Coffin, Susan E.; Dallefeld, Samantha; Ezetendu, Chidiebere P.; Fainberg, Nina A.; Flaherty, Brian F.; Foster, Charles B.
- Abstract
This quality improvement study examines data for blood culture rates, antibiotic use, and patient outcomes from 14 pediatric intensive care units that implemented a program intended to reduce overuse of blood cultures. Key Points: Question: What is the association of diagnostic stewardship for blood cultures with culture rates, antibiotic use, and patient outcomes in the pediatric intensive care unit? Findings: In this quality improvement study, a collaborative of 14 pediatric intensive care units found significant decreases in blood culture utilization and broad-spectrum antibiotic use. Balancing measures (mortality, readmission, length of stay, sepsis, and severe sepsis/septic shock) remained stable. Meaning: Multidisciplinary diagnostic stewardship to optimize blood culture practices in patients without suspected sepsis can safely decrease blood cultures and antibiotic use in critically ill children. Importance: Blood culture overuse in the pediatric intensive care unit (PICU) can lead to unnecessary antibiotic use and contribute to antibiotic resistance. Optimizing blood culture practices through diagnostic stewardship may reduce unnecessary blood cultures and antibiotics. Objective: To evaluate the association of a 14-site multidisciplinary PICU blood culture collaborative with culture rates, antibiotic use, and patient outcomes. Design, Setting, and Participants: This prospective quality improvement (QI) collaborative involved 14 PICUs across the United States from 2017 to 2020 for the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative. Data were collected from each participating PICU and from the Children's Hospital Association Pediatric Health Information System for prespecified primary and secondary outcomes. Exposures: A local QI program focusing on blood culture practices in the PICU (facilitated by a larger QI collaborative). Main Outcomes and Measures: The primary outcome was blood culture rates (per 1000 patient-days/mo). Secondary outcomes included broad-spectrum antibiotic use (total days of therapy and new initiations of broad-spectrum antibiotics ≥3 days after PICU admission) and PICU rates of central line–associated bloodstream infection (CLABSI), Clostridioides difficile infection, mortality, readmission, length of stay, sepsis, and severe sepsis/septic shock. Results: Across the 14 PICUs, the blood culture rate was 149.4 per 1000 patient-days/mo preimplementation and 100.5 per 1000 patient-days/mo postimplementation, for a 33% relative reduction (95% CI, 26%-39%). Comparing the periods before and after implementation, the rate of broad-spectrum antibiotic use decreased from 506 days to 440 days per 1000 patient-days/mo, respectively, a 13% relative reduction (95% CI, 7%-19%). The broad-spectrum antibiotic initiation rate decreased from 58.1 to 53.6 initiations/1000 patient-days/mo, an 8% relative reduction (95% CI, 4%-11%). Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days/mo, a 36% relative reduction (95% CI, 20%-49%). Mortality, length of stay, readmission, sepsis, and severe sepsis/septic shock were similar before and after implementation. Conclusions and Relevance: Multidisciplinary diagnostic stewardship interventions can reduce blood culture and antibiotic use in the PICU. Future work will determine optimal strategies for wider-scale dissemination of diagnostic stewardship in this setting while monitoring patient safety and balancing measures.
- Subjects
UNITED States; ANTIBIOTICS; BLOOD; ANTIMICROBIAL stewardship; EVALUATION of medical care; RESEARCH; INTENSIVE care units; LENGTH of stay in hospitals; CELL culture; CONFIDENCE intervals; CATHETER-related infections; CRITICALLY ill; MORTALITY; PATIENTS; PEDIATRICS; CATASTROPHIC illness; SEPSIS; INTERPROFESSIONAL relations; QUALITY assurance; DESCRIPTIVE statistics; LONGITUDINAL method; BLOODBORNE infections; SEPTIC shock; CHILDREN
- Publication
JAMA Pediatrics, 2022, Vol 176, Issue 7, p690
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2022.1024