Limiting blood draws on critically sick children can reduce antibiotic use

A new study found that there was a significant reduction in blood cultures and antibiotic use in pediatric intensive care units (PICU) after they were provided with support to standardize their protocol for when to draw blood from patients. 

The study was published in JAMA Pediatrics  and led by pediatric infectious diseases specialist Aaron Milstone, MD., MHS., who is also a professor of pediatrics at the Johns Hopkins University School of Medicine. The study aimed to provide hospitals with guidelines on when to perform blood cultures in sick children in an effort to reduce the use of blood cultures and antibiotics.

According to Milstone, overuse of blood cultures and antibiotics can have negative consequences for critically ill pediatric patients.

“Patients in the pediatric intensive care unit are usually the sickest of the sick, and you want to do everything you can to help,” said Milstone in a statement. “But when you perform a blood culture, anything can grow — whether it’s the reason behind the concerning symptom or possible contamination of the sample. Collecting a blood culture when it’s not needed can lead to unnecessary antibiotic use, unwanted side effects from additional medications, and additional blood tests.”

With the help of Milstone and her team, over the course of three years, 14 medical institutions standardized their practices involving blood cultures and antibiotic use. The hospitals’ blood culture rates, along with antibiotic use and other measures were tracked monthly.

After the hospitals implemented guidelines for blood cultures, there was a significant reduction in overall antibiotic use and blood culture rates. Thirteen out of 14 hospitals reduced their blood culture rates between 15 and 58 percent. Across all the institutions, blood culture rates decreased by an average of 34 percent. In addition, the study found that antibiotic use was reduced by an average of 13 percent across the 11 medical institutions that reported on antibiotic prescription rates.

“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,” Milstone said.