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.

中文翻译：

---

危重儿童血培养诊断管理与培养率、抗生素使用和患者结果的关联：Bright STAR 合作的结果。

重要性 儿科重症监护病房 (PICU) 中过度使用血培养会导致不必要的抗生素使用并导致抗生素耐药性。通过诊断管理优化血培养实践可以减少不必要的血培养和抗生素。目的 评估 14 个地点的多学科 PICU 血培养协作与培养率、抗生素使用和患者预后的关系。设计、设置和参与者 这项前瞻性质量改进 (QI) 合作涉及 2017 年至 2020 年期间美国各地的 14 个 PICU，以进行 Bright STAR（抗生素减少测试管理）合作。从每个参与的 PICU 和儿童医院协会儿科健康信息系统收集数据，以了解预先指定的主要和次要结局。暴露 当地的 QI 计划重点关注 PICU 中的血培养实践（由更大的 QI 合作组织推动）。主要结果和措施 主要结果是血培养率（每 1000 名患者日/月）。次要结局包括广谱抗生素的使用（治疗总天数和入院后 ≥3 天新开始广谱抗生素）和 PICU 中枢导管相关血流感染 (CLABSI) 率、艰难梭菌感染、死亡率、再入院率、住院时间、败血症和严重败血症/败血性休克。结果 在 14 个 PICU 中，实施前的血培养率为每 1000 个患者天/月 149.4 个，实施后的血培养率为每 1000 个患者天/月 100.5 个，相对降低了 33%（95% CI，26%-39%）。比较实施前后，广谱抗生素的使用率从每1000患者天/月的506天减少到440天，相对减少13%（95% CI，7%-19%）。广谱抗生素起始使用率从 58.1 次/1000 患者天/月下降至 53.6 次/1000 患者天/月，相对减少 8%（95% CI，4%-11%）。CLABSI 发生率从每 1000 个中心静脉线日/月 1.8 次下降至 1.1 次，相对降低了 36%（95% CI，20%-49%）。实施前后的死亡率、住院时间、再入院、败血症和严重败血症/败血性休克相似。结论和相关性 多学科诊断管理干预措施可以减少 PICU 中的血培养和抗生素使用。未来的工作将确定在这种情况下更广泛地传播诊断管理的最佳策略，同时监测患者安全和平衡措施。