Diagnostic Stewardship in the Pediatric Intensive Care Unit: Results of the Bright STAR Collaborative
Back to course
Video Transcription
Video Summary
Asset Subtitle
Pharmacology, Quality and Patient Safety, Pediatrics, 2022
Asset Caption
INTRODUCTION/HYPOTHESIS: Blood cultures are fundamental in the diagnosis and treatment of sepsis. Culture practices vary widely and overuse can lead to false positive results and unnecessary antibiotics. Our objective was to evaluate the impact of a multi-site quality improvement collaborative focused on blood culture practices in pediatric intensive care units (PICUs) on blood culture rates, antibiotic use, and balancing measures. We hypothesized that decreased blood cultures would be associated with decreased antibiotic use. METHODS: In 2018, 14 PICUs joined the Bright STAR (Testing STewardship to reduce Antibiotic Use and Resistance) Collaborative. Sites assessed local practices, developed and implemented clinical decision support tools to guide new blood culture practices, and audited post-implementation cultures for compliance and safety. We compared 24 months of baseline data to 18 months of post-implementation data using a Poisson regression model accounting for the site-specific patient days and correlation within a site over time. RESULTS: Across the 14 sites, there were 41,731 pre-implementation blood cultures and 22,408 post-implementation blood cultures. Per 1000 patient days/month, there were an estimated 156.9 blood cultures pre-implementation and 104.1 blood cultures post-implementation, a 34% reduction in the relative rate and an absolute reduction of 52.78 blood cultures (p < .001). Per 1000 patient days/month, there were 505.99 total days of broad-spectrum antibiotic use pre-implementation and 440.34 days of broad-spectrum antibiotic use post-implementation, a 13% relative reduction in antibiotic use, and an absolute reduction of 65.65 days of antibiotic therapy  (p < .001). Balancing metrics of PICU mortality rates, length of stay, readmission, and sepsis/septic shock were unchanged. In addition, 793 episodes of post-implementation bacteremia were reviewed in detail, and in 99.9%, no concern for delay in obtaining blood cultures was identified.     CONCLUSIONS: Multidisciplinary diagnostic stewardship work can reduce blood culture and antibiotic use in critically ill children. Future work will determine optimal strategies for wider-scale dissemination of blood culture diagnostic stewardship in the PICU setting, while monitoring for patient safety and unintended consequences.
Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Quality and Patient Safety
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Antibiotics
Tag Evidence Based Medicine
Tag Pediatrics
Tag Guidelines
Year 2022
medical overuse
pediatric intensive care unit
Bright Star Collaborative
diagnostic stewardship


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By