Implementing Diagnostic Stewardship to Reduce Antibiotic Use and Resistance in Critically Ill Children

实施诊断管理以减少危重儿童的抗生素使用和耐药性

• 批准号: 9980915
• 负责人: AARON M MILSTONE
• 金额: $ 43.45万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980915
• 关键词: Implementing; Diagnostic; Stewardship; Reduce; Antibiotic

PROJECT SUMMARY Sepsis accounts for approximately 8% of pediatric intensive care unit (PICU) admissions, with an in-hospital mortality of 25% and an estimated annual cost of $4-5 billion in the United States. Delayed antimicrobial therapy is associated with worse outcomes for pediatric sepsis, but initial signs of sepsis can be non-specific and subtle. Clinicians frequently order blood cultures to aid in diagnosing bacterial sepsis, but universally accepted standards or guidelines to guide decisions around when to obtain blood cultures are not available. Weighed against the potentially disastrous consequences of failing to diagnose sepsis in a timely fashion, blood cultures are generally perceived to be a low-risk screening test. The yield of blood cultures, however, is low (5-15%) and up to half are falsely positive. False positive cultures contribute to patient harm via additional hospital days, unnecessary antibiotics, and increased costs. Unnecessary antibiotic use is a primary driver of antibiotic resistance, which is emerging as a grave threat to human health worldwide. Recently, a novel clinical practice guideline designed to standardize approach to blood cultures in critically ill children safely reduced blood culture use by 46%. In addition, there was a 15% reduction in broad spectrum antibiotic use post- intervention. Subsequent implementation of this program in two other PICUs yielded reductions in blood culture use. The long term objective of this proposal is to determine whether diagnostic stewardship, specifically the appropriate use of blood cultures, can safely reduce antibiotic use and antibiotic resistance in a large and diverse group of hospitals. The specific aims are Aim 1) to implement an evidence-based, clinical practice guideline for evaluation of patients with signs and symptoms of sepsis to decrease blood culture use in PICUs, Aim 2) to evaluate whether a clinical practice will reduce antibiotic use, antibiotic resistance, and Clostridium difficile infection, and Aim 3) to determine whether this clinical practice guideline has an unintended consequence of patient harm. A prospective multicenter quality improvement program will be implemented at 10 hospitals, and will be evaluated using a quasi-experimental design comparing outcome data in pre- and post-periods. The findings could provide evidence that diagnostic stewardship around blood cultures can decrease harm to patients by reducing unnecessary antibiotic use and antibiotic resistance.

项目摘要 败血症约占小儿重症监护病房（PICU）入院的8％ 在美国，死亡率为25％，估计年度成本为4-5亿美元。延迟的抗菌素 治疗与儿科败血症的结局差有关，但败血症的初始迹象可能是非特异性的 和微妙。临床医生经常下令血液培养以帮助诊断细菌败血症，但普遍 无法获得何时获得血液培养的决定的公认标准或指南。 权衡与未能及时诊断败血症的潜在灾难性后果 通常认为血液培养物是低风险筛查测试。然而，血液培养的产量是 低（5-15％）和最多一半是错误的阳性。假阳性培养通过额外 医院的日子，不必要的抗生素和成本增加。不必要的抗生素使用是 抗生素耐药性，正成为对全世界人类健康的严重威胁。最近，一种新颖的临床 实践指南旨在标准化重症儿童的血液培养方法安全减少 血液培养使用46％。此外，在 - 干涉。随后在另外两个PICU中实施该程序，导致血液培养的降低 使用。该提案的长期目标是确定诊断管理是否，特别是 适当使用血液培养物，可以安全地降低抗生素的使用和抗生素耐药性 多样化的医院。具体目的是目的1）实施基于证据的临床实践 评估脓毒症症状和症状的患者的指南，以减少Picus的血液培养用途， 目标2）评估临床实践是否会减少抗生素使用，抗生素耐药性和梭状芽胞杆菌 艰难梭菌感染，目标3）确定该临床实践指南是否有意外 患者伤害的结果。预期的多中心质量改进计划将在 10家医院，并将使用准实验设计进行评估，以比较前后的结果数据 周期后。这些发现可以提供证据表明围绕血液培养的诊断管理可以 通过减少不必要的抗生素使用和抗生素耐药性来减少对患者的伤害。