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

> **NIH AHRQ R18** · JOHNS HOPKINS UNIVERSITY · 2020 · $434,458

## Abstract

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.

## Key facts

- **NIH application ID:** 9980915
- **Project number:** 5R18HS025642-04
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** AARON M MILSTONE
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $434,458
- **Award type:** 5
- **Project period:** 2017-09-30 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9980915

## Citation

> US National Institutes of Health, RePORTER application 9980915, Implementing Diagnostic Stewardship to Reduce Antibiotic Use and Resistance in Critically Ill Children (5R18HS025642-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9980915. Licensed CC0.

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