儿科重症监护病房血培养的诊断管理：来自BrighT STAR协作组的实施经验教训。
Diagnostic stewardship for blood cultures in the pediatric intensive care unit: lessons in implementation from the BrighT STAR Collaborative.
作者信息
Woods-Hill Charlotte Z, Koontz Danielle W, Xie Anping, Colantuoni Elizabeth A, Sick-Samuels Anna, Miller Marlene R, Arthur Abigail, Aneja Anushree, Kumar Urmi, Milstone Aaron M
机构信息
Division of Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Antimicrob Steward Healthc Epidemiol. 2024 Sep 25;4(1):e148. doi: 10.1017/ash.2024.416. eCollection 2024.
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.
目的
“光明之星”是美国14个儿科重症监护病房（PICU）开展的一项诊断管理协作项目，旨在规范并减少不必要的血培养检查，并研究其对患者预后及广谱抗生素使用的影响。我们现在详细审视实施过程，以了解各机构是如何在其PICU中推动这一诊断管理项目的。
设计
基于“光明之星”第一阶段收集的关于实施过程的定性数据，对14个“光明之星”机构开展多中心电子调查。
地点
14个参与“光明之星”项目的PICU。
参与者
每个参与机构的负责人。
方法
在协作项目第一阶段完成后，对所有14个机构进行了一项基于实施科学文献并依据“光明之星”期间收集的数据的电子调查。
结果
10项特定任务对于实施血培养诊断管理似乎至关重要，各机构在完成这些任务时所采用的策略存在差异。各机构将某些任务和策略评为非常重要。表现最佳的机构所采用的策略与表现较差的机构不同。某些策略可能与血培养过度使用的驱动因素相关，是改变临床医生行为的关键目标。
结论
“光明之星”为在PICU中推动成功的诊断管理所使用的任务和策略提供了重要见解。在这个复杂环境中，需要开展更多工作来比较具体策略并优化管理结果。
临床试验注册信息
《危重症儿童血培养改进指南及抗生素减量诊断管理（光明之星）》。NCT03441126。https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1 。
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