scholarly journals Results of a Multicenter Diagnostic Stewardship Collaborative to Optimize Blood Culture Use in Critically Ill Children

2021 ◽  
Vol 1 (S1) ◽  
pp. s27-s27
Author(s):  
Danielle Koontz ◽  
Charlotte Woods-Hill ◽  
Annie Voskertchian ◽  
Anping Xie ◽  
Marlene Miller ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Critically Ill ◽  
Blood Cultures ◽  
Bright Star ◽  
Critically Ill Children ◽  
Site Specific ◽  
Rate Range ◽  
Study Team ◽  
The Mean

Group Name: Bright STAR Authorship GroupBackground: 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 describe the implementation of a multisite quality improvement collaborative to reduce unnecessary blood cultures in pediatric intensive care unit (PICU) patients, and its 18-month impact on blood culture rates and safety metrics. Methods: In 2018, 14 PICUs joined the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, designed to understand and improve blood culture practices in critically ill children. Guided by a centralized multidisciplinary study team, sites first reviewed existing evidence for safe reduction of unnecessary blood cultures and assessed local practices and barriers to change. Subsequently, local champions developed and implemented clinical decision-support tools informed by local patient needs to guide new blood-culture practices. The coordinating study team facilitated regular evaluations and discussions of project progress through monthly phone calls, site visits if requested by sites or the study team, and collaborative-wide teleconferences. The study team collected monthly blood culture rates and monitored for possible delays in obtaining blood cultures using a standardized review process as a safety balancing metric. We compared 24 months of baseline data to 18 months of postimplementation using a Poisson regression model accounting for the site-specific patient days and correlation of culture use within a site over time. Results: Across the 14 sites, before implementation, 41,768 blood cultures were collected over 259,701 PICU patient days. The mean preimplementation site-specific blood culture rate was 15.7 cultures per 100 patient days (rate range, 9.6–48.2 cultures per 100 patient days). After implementation, 22,397 blood cultures were collected over 208,171 PICU patient days. The mean postimplementation rate was 10.4 cultures per 100 patient days (rate range, 4.7–28.3 cultures per 100 patient days), which was 33.6% lower than the preimplementation (relative rate 0.66; 95% CI, 0.65–0.68 p <0.01). In 18 months post-implementation, sites reviewed 793 positive blood cultures, and identified only one suspected delay in culture collection possibly attributable to the site’s blood culture reduction program. Conclusions: Multidisciplinary quality improvement teams safely facilitated a 33.6% average reduction in blood culture use in critically ill children at 14 hospitals. Future collaborative work will determine the impact of blood culture diagnostic stewardship on antibiotic use and other important patient safety outcomes.Funding: NoDisclosures: None

scholarly journals 1350. Optimizing Blood Culture Use in Critically Ill Children: Year One of a Multi-Center Diagnostic Stewardship Collaborative

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S685-S686
Author(s):  
Charlotte Z Woods-Hill ◽  
Danielle W Koontz ◽  
Annie Voskertchian MPH ◽  
Anping Xie PhD ◽  
Marlene R Miller ◽  
...  
Keyword(s):  
Blood Culture ◽  
Critically Ill ◽  
Culture Collection ◽  
Blood Cultures ◽  
Bright Star ◽  
Critically Ill Children ◽  
Site Specific ◽  
Phone Calls ◽  
The Mean ◽  
The Impact

Abstract Background Overuse of blood cultures can lead to false positives and unnecessary antibiotics. Our objective was to describe the implementation and 12-month impact of a multi-site quality improvement collaborative to reduce unnecessary blood cultures in pediatric intensive care unit (PICU) patients. Methods In 2018, 14 PICUs joined the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, designed to understand and improve blood culture practices in PICUs. Guided by a multidisciplinary study team, sites 1) reviewed existing evidence for safe blood culture reduction, 2) assessed local practices and barriers to change, and 3) developed and implemented new blood culture practices informed by local context. We facilitated and monitored project progress through phone calls, site visits, and collaborative-wide teleconferences. We collected monthly blood culture rates and monitored for delays in culture collection as a safety balancing metric. We compared 24 months of baseline data to post-implementation data (2-14 months) using a Poisson regression model accounting for the site-specific patient days and correlation of culture use within a site over time. Results Across 14 sites, there were 41,986 pre-implementation blood cultures collected over 238,182 PICU patient days. The mean pre-implementation site-specific blood culture rate was 19.42 cultures/100 patient days (range 9.59 to 48.18 cultures/100 patient days). Post-implementation, there were 12,909 blood cultures collected over 118,600 PICU patient days. The mean post-implementation rate was 14.02 cultures/100 patient days (range 5.40 to 37.57 cultures/100 patient days), a 23% decrease (relative rate 0.77, 95% CI: 0.60, 0.99, p = 0.04). In 12 months post-implementation, sites reviewed 463 positive blood cultures, and identified only one suspected delay in culture collection possibly attributable to the site’s culture reduction program. Bright STAR Collaborative Site Blood Culture Rate 100 Patient Days Conclusion Multidisciplinary teams facilitated a 23% average reduction in blood culture use in 14 PICUs. Future work will determine the impact of blood culture diagnostic stewardship on antibiotic use and other important patient safety outcomes. Disclosures James C. Fackler MD, MD, Rubicon Health LLC (Other Financial or Material Support, Founder)

scholarly journals Bright STAR Collaborative Consensus Guidelines for Blood Culture Use in Critically Ill Children

2020 ◽  
Vol 41 (S1) ◽  
pp. s22-s23
Author(s):  
Charlotte Woods-Hill ◽  
Danielle Koontz ◽  
Annie Voskertchian ◽  
Marlene Miller ◽  
James Fackler ◽  
...  
Keyword(s):  
Blood Culture ◽  
Critically Ill ◽  
Bloodstream Infections ◽  
Healthcare Research ◽  
Blood Cultures ◽  
Delphi Process ◽  
Bright Star ◽  
Critically Ill Children ◽  
Diagnostic Tools ◽  
Modified Delphi

Background: Blood cultures are essential diagnostic tools used to identify bloodstream infections and to guide antimicrobial therapy. However, collecting cultures without clear indications or that do not inform management can lead to false-positive results and unnecessary use of antibiotics. Blood culture practices vary significantly in critically ill children. Our objective was to create a consensus guideline focusing on when to safely avoid blood cultures in pediatric intensive care unit (PICU) patients. Methods: A panel of multidisciplinary experts, many participating in the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, engaged in a 2-part modified Delphi process. Round 1 consisted of a preparatory literature summary and an electronic survey sent to subject matter experts (SMEs). In the survey, SMEs rated a series of recommendations about when to avoid blood cultures on a 5-point Likert scale, 1 being the lowest score and 5 being the highest score. Consensus was achieved for each recommendation if 75% of respondents chose a score of 4 or 5, and these were included in the final guideline. Any recommendations that did not meet these a priori criteria for consensus were set aside for discussion during the in-person expert panel review (round 2). An outside expert in consensus methodology facilitated round 2. After a review of the survey results and comments from round 1 and group discussion, the SMEs voted on these recommendations in real time. Voting was blinded. Participants included Bright STAR site leads, national content experts, and representatives from relevant national societies. Results: We received 29 completed surveys from 34 invited participants for an 85% response rate. Of the 27 round 1 recommendations, 18 met predetermined criteria for consensus. Round 2 included 26 in-person voting participants who (1) discussed and modified the 9 recommendations that had not met round 1 consensus, and (2) modified for clarity or condensed from multiple into single recommendations the 18 recommendations that had met the round 1 consensus. The final document contains 19 recommendations that provide guidance on how to safely improve blood culture use in PICU patients (Table 1). Also, 8 recommendations discussed did not reach consensus for inclusion. Conclusions: Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in critically ill children. These guidelines are a critical step in disseminating diagnostic stewardship and reducing unnecessary testing on a wider scale.Funding: Agency for Healthcare Research and Quality, R18 HS025642-01, 9/2017 – 9/2020 (Aaron Milstone, PI)Disclosures: None

scholarly journals Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children

2019 ◽  
Vol 08 (03) ◽  
pp. 144-147
Author(s):  
Christine Anh-Thu Tran ◽  
Jenna Verena Zschaebitz ◽  
Michael Campbell Spaeder
Keyword(s):  
Decision Making ◽  
Blood Culture ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Clinical Status ◽  
Blood Cultures ◽  
Systemic Inflammatory Response ◽  
Critically Ill Children ◽  
Culture Acquisition

AbstractBlood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.

scholarly journals 57: DIAGNOSTIC STEWARDSHIP FOR BLOOD CULTURES IN CRITICALLY ILL CHILDREN: THE BRIGHT STAR COLLABORATIVE

2021 ◽  
Vol 50 (1) ◽  
pp. 29-29
Author(s):  
Charlotte Woods-Hill ◽  
Elizabeth Colantuoni ◽  
Danielle Koontz ◽  
Annie Voskertchian ◽  
Anping Xie ◽  
...  
Keyword(s):  
Critically Ill ◽  
Blood Cultures ◽  
Bright Star ◽  
Critically Ill Children

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

Obtaining Blood Cultures in Critically Ill Children

2020 ◽  
Vol 21 (1) ◽  
pp. 107-108
Author(s):  
Thyyar M. Ravindranath ◽  
John S. Baird
Keyword(s):  
Critically Ill ◽  
Blood Cultures ◽  
Critically Ill Children

scholarly journals Utility of A Single Widal Test in The Diagnosis of Typhoid Fever

2012 ◽  
Vol 35 (2) ◽  
pp. 53-58 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Fahim Ahmed Rupam ◽  
Farhana Chaiti
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Predictive Value ◽  
Salmonella Typhi ◽  
Definitive Diagnosis ◽  
Blood Cultures ◽  
Widal Test ◽  
Female Ratio ◽  
The Mean ◽  
Agglutinin Titer

Background & objectives: The clinical diagnosis of typhoid fever is difficult, as the presenting symptoms are often diverse and similar to those observed with other febrile illnesses. The definitive diagnosis of typhoid fever requires the isolation of Salmonella typhi or paratyphi from the patient concerned. Since patients often receive antibiotics prior to a confirmatory diagnosis, there is uncertainty that bacteria can be isolated from the blood cultures. Besides this, the facilities for blood culture are not always available or feasible. All these limitations have made Widal test the most utilized diagnostic test for typhoid fever. Many studies have produced data which had cast serious doubts on the value of the Widal Test and thus reappraisal of the role of a single Widal test is needed.Methods & materials: This study was carried out to determine the changes in clinical pattern of enteric fever. A total of 153 children, aged 0 to 14 years, diagnosed as typhoid fever (either positive blood culture for Salmonella typhi or paratyphi) were induced in the study. Of them, 86 children were with a definitive diagnosis of typhoid or paratyphoid fever as indicated by the isolation of S. typhi or S. paratyphi from the blood and 17 had negative blood culture but were clinically suspected of having typhoid fever. The control group was comprised of 50 children with non-typhoidal fevers The Widal test was carried out using rapid slide agglutination method and its accuracy was assessed by comparing the findings with that obtained through blood culture.Result: The mean age of the patients was 5.2 ± 2.8 years and the youngest and oldest patients were 0.7 and 14 years respectively and male to female ratio was roughly 1:1. Nearly one-quarter (24.6%) of the patients had been suffering from the disease for >10 days and the mean duration of illness was 8.2 ± 3.3 days. Widal Test result showed that an ‘O’ agglutinin titer of cut-off value e”1:40 gave a sensitivity of 87.2%, a specificity of 47.1%, a positive predictive value (PPV) of 89.2% and a negative predictive value (NPV) of 42.1%. The sensitivity and NPV decreased with the increase in titer levels and were 56.9% and 31.5% at cut-off value of e” 1:320, while the specificity and PPV increased with the increase in titer levels from 47.1% and 89.2% respectively at a titer of e”1:40 to 100% at a titer of e” 1:320. The ‘titer behaved in the same way as did the ‘O’ agglutinin titer. Similarly when H’ agglutinin was used the sensitivity and NPV decreased from 65% and 31.7% at a titer of e”1:40 to only 25% and 20% respectively at a titer of > 1:320, while specificity and PPV increased from 76.4% and 81.1% at >1:40 to 94.1% and 95.6% respectively at e” 1:320. When either ‘O’ or ‘H’ antibody titer of e”1:160 was used, a good sensitivity (71%), specificity (70.6%) and PPV (92.4%) resulted, though NPV decreased to 32.4%.Conclusion: The Widal test can be of diagnostic value when blood cultures are not available nor practically feasible.DOI: http://dx.doi.org/10.3329/bjch.v35i2.10377  Bangladesh J Child Health 2011; Vol 35 (2): 53-58

scholarly journals Assessment of the Value of Routine Blood Cultures in the Evaluation and Treatment of Patients With Chorioamnionitis

1994 ◽  
Vol 2 (3) ◽  
pp. 111-114 ◽  
Author(s):  
Gregory J. Locksmith ◽  
Patrick Duff
Keyword(s):  
Blood Culture ◽  
Unknown Origin ◽  
Initial Response ◽  
Blood Cultures ◽  
Response To Therapy ◽  
Initial Assessment ◽  
Study Population ◽  
The Mean ◽  
The Cost ◽  
Febrile Morbidity

Objective: The objective of this investigation was to determine the usefulness of blood cultures in evaluating patients with chorioamnionitis who were treated in accordance with a specific antibiotic protocol.Methods: We reviewed the records of 539 patients with chorioamnionitis who delivered at our facility over a 3 year period (July 1, 1989–June 30, 1992). Patients had one set of aerobic and anaerobic blood cultures at the time of their initial assessment. They were treated initially with ampicillin or vancomycin plus gentamicin. Those who required cesarean delivery also received clindamycin postoperatively. Patients who had a poor initial response to therapy were treated empirically with selected antibiotics targeted against likely resistant organisms until the results of bacteriologic cultures were available. Bacteremic patients had repeat blood cultures while on therapy. We analyzed the medical records to determine the frequency with which blood culture results led to meaningful changes in patient management. We also compared the duration of febrile morbidity in bacteremic vs. nonbacteremic patients.Results: Thirty-nine of 538 patients (7.2%, 95% confidence interval [CI] 5.2–9.2%) had positive blood cultures. In only one patient did the result of the blood culture definitively alter therapy. This patient had a fever of unknown origin, and the finding of a positive blood culture ultimately led to the diagnosis of chorioamnionitis. The mean duration of febrile morbidity was not significantly different in bacteremic vs. nonbacteremic patients (2.03 vs. 1.74 days). None of the repeat blood cultures was positive. The cost of blood cultures in the study population was $72,759.00.Conclusions: The routine use of blood Cultures in the assessment of patients with chorioamnionitis rarely provides information that justifies a change in clinical management when patients are treated in accordance with the specific antibiotic protocol outlined in this investigation.

scholarly journals Role of PSOFA-E Score in Predicting the Clinical Outcome of Critically Ill Children

2020 ◽  
Vol 8 (1) ◽  
pp. 27-31
Author(s):  
Bhaskar Gorla ◽  
Vishwas Rao
Keyword(s):  
Critically Ill ◽  
Characteristic Curve ◽  
Critically Ill Children ◽  
Number Of Children ◽  
Bedside Echocardiography ◽  
Failure Assessment ◽  
Echocardiographic Parameters ◽  
The Mean ◽  
Simple Bedside

Background: Recently pediatric sequential organ failure assessment (pSOFA) score was adapted and validated in critically ill children. This study was aimed to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of SOFA score (pSOFA-E score) and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children.Subjects and Methods:This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka, from November 2017 to November 2019. A total of 74 cases were studied. Result:Most of the children were aged <1 year (41.89%). Majority of the patients (62.16%) improved and 37.84% of the patients expired. The mean and median pSOFA-E scores were 10.53±4.06 and 10 respectively and pSOFA-E score of 5-8 was noted in most of the children (32.43%). Mortality was significantly high in children with pSOFA-E score between 9-12 (39.13%), 13-16 (77.78%), 17-20 (83.33%) (p<0.001). Receiver operating characteristic curve (ROC) yielded area under curve (AUC) of 0.920 and 0.791 with a cut-off value of 11.5 in predicting mortality. Significantly higher number of children with pSOFA-E score of ≥ 11.5 had positive blood culture (30%). Conclusion:The findings of the present study validate and emphasize that, addition of score devised by requirement of ionotropes to maintain adequate ejection fraction defy simple bedside echocardiography to pSOFA score is highly useful and accurate in discrimination of PICU mortality, morbidity and cardiovascular status/ compromise of body.

Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative

2018 ◽  
Vol 27 (3) ◽  
pp. 194-203 ◽  
Author(s):  
Blair R. L. Colwell ◽  
Cydni N. Williams ◽  
Serena P. Kelly ◽  
Laura M. Ibsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Improvement Project

Background Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. Objective To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients. Methods A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater. Results In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P &lt; .001) patients and were less likely to have barriers (P &lt; .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred. Conclusions A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.

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