May 18, 2022
Medical Xpress covers a report by researchers at Johns Hopkins Children’s Center and elsewhere on the practice of blood draws on PICU patients with fevers and fears of sepsis. To promote patient safety practices, the researchers developed a decision support program that appears to reduce the number of blood draws and antibiotic usage without increasing sepsis risks.
Inappropriate antibiotic use is an ongoing threat to the healthcare system. CDC data relay about 30% of antibiotics are unnecessary or incorrectly prescribed in hospital settings. More than half of PICU patients in prior studies often received antibiotics for fevers from noninfectious illnesses or the weaning of other medications.
The researchers led an expert collaborative called BrighT STAR (Testing STewardship to Reduce Antimicrobial Resistance). Fourteen participating sites looked at past studies and practices to draft guidance to reduce blood draws in patients with low suspicion or risk for sepsis, and to measure the impact of an algorithm on blood culture rates, broad-spectrum antibiotic use and other patient outcomes.
The proposed algorithm helps front-line providers evaluate patients with fevers, optimize decisions and consider questions like: ‘How do I think about that patient?’, ‘Do they need a blood culture?’, ‘Did they have a blood culture already?’
Blood culture rates, along with other measures, were tracked and reported monthly. When compared to a previous period, the quality improvement algorithm demonstrated a decrease in blood cultures performed by an average of 34%, and 11 of the 14 sites reported antibiotic use was reduced overall by 13%. At all 14 sites, central line-associated bloodstream infections decreased by 36% and there was no significant change in the rates of Clostridioides difficile.
Researchers believe their concept will help change clinician decision-making and benefit patients. They hope to expand the approach nationwide and explore application in adults. PIDS member Aaron Milstone is senior author of the paper and is quoted in the article, “Repeated blood draws, especially those from venous catheters, along with use of antibiotics while awaiting culture results just in case of a bacterial infection, are practices that contribute to a rise in antibiotic resistance, lead to additional testing and can prolong a child’s hospital length of stay…These findings suggest that multidisciplinary efforts to standardize blood culture collection and avoid unnecessary testing in the PICU can be done successfully and safely in diverse settings, and that reducing blood culture use can, in turn, reduce broad-spectrum antibiotic use.”