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Updated: Jun 11, 2025
Author Spotlight: Accelerating Diagnostic Accuracy with Direct Identification of Gram-Negatives from Blood Culture Bottles
Published on: May 24, 2024
Diagnostic stewardship for blood cultures in the pediatric intensive care unit: lessons in implementation from the
Charlotte Z Woods-Hill1, Danielle W Koontz2, Anping Xie3
1Division of Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Insights
Implementing diagnostic stewardship in pediatric intensive care units (PICUs) involves 10 critical tasks. Top-performing sites used distinct strategies to reduce unnecessary blood cultures and antibiotic use.
Area of Science:
- Implementation Science
- Pediatric Critical Care Medicine
- Diagnostic Stewardship
Background:
- Unnecessary blood cultures in pediatric intensive care units (PICUs) contribute to increased antibiotic use and patient harm.
- Diagnostic stewardship programs aim to optimize test utilization and improve patient outcomes.
Purpose of the Study:
- To examine the implementation process of a diagnostic stewardship collaborative (BrighT STAR) in 14 US PICUs.
- To identify critical tasks and site-level strategies for successful blood culture stewardship.
Main Methods:
- A multi-center electronic survey was administered to site leads at 14 PICUs participating in the BrighT STAR collaborative.
- The survey assessed implementation strategies based on qualitative data and guided by implementation science literature.
Main Results:
- Ten specific tasks were identified as critical for implementing blood culture diagnostic stewardship.
- Variability in site-level strategies was observed, with distinct approaches used by top-performing sites.
- Certain strategies may address key drivers of overuse and target clinician behavior change.
Conclusions:
- The BrighT STAR collaborative provides valuable insights into facilitating diagnostic stewardship in PICUs.
- Further research is needed to compare specific strategies and optimize stewardship outcomes in complex pediatric critical care settings.
Objective:
BrighT STAR was a diagnostic stewardship collaborative of 14 pediatric intensive care units (PICUs) across the United States designed to standardize and reduce unnecessary blood cultures and study the impact on patient outcomes and broad-spectrum antibiotic use. We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.
Design:
A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.
Setting:
14 PICUs enrolled in BrighT STAR.
Participants:
Site leads at each enrolled site.
Methods:
An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.
Results:
10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior.
Conclusions:
BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment.
Clinical Trial Registry Information:
Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). NCT03441126. https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1.
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