Diagnostic Stewardship Cuts Blood Cultures, Antibiotic Use in PICU

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In the pediatric intensive care unit (PICU), multidisciplinary diagnostic stewardship interventions can reduce blood culture and antibiotic use.

HealthDay News — In the pediatric intensive care unit (PICU), multidisciplinary diagnostic stewardship interventions can reduce blood culture and antibiotic use, according to a study published online May 2 in JAMA Pediatrics.

Charlotte Z. Woods-Hill, M.D., from the Children’s Hospital of Philadelphia, and colleagues examined the association of a 14-site multidisciplinary PICU blood culture collaborative with culture rate, antibiotic use, and patient outcomes in a prospective quality improvement (QI) study. The QI program focused on blood culture practices in the PICU.

The researchers found that the blood culture rate was 149.4 per 1,000 patient-days/month preimplementation and 100.5 per 1,000 patient-days/month postimplementation across the 14 PICUs, representing a relative reduction of 33%. The rate of broad-spectrum antibiotic use decreased from 506 to 440 days per 1,000 patient-days/month (13% relative reduction) comparing the periods before and after implementation. The rate of broad-spectrum antibiotic initiation decreased from 58.1 to 53.6 initiations/1,000 patient-days/month, which was an 8% relative reduction. In addition, there was a 36% relative reduction in the rates of central line-associated bloodstream infection, from 1.8 to 1.1 per 1,000 central venous line days/month. Before and after implementation, mortality, length of stay, readmission, sepsis, and severe sepsis/septic shock were similar.

“Our study confirms that diagnostic stewardship is a promising strategy to augment antimicrobial stewardship programs and reduce antibiotic overuse,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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