Diagnostic Stewardship in the Pediatric Intensive Care Unit

Anna C Sick-Samuels; Charlotte Woods-Hill

doi:10.1016/j.idc.2021.11.003

Diagnostic Stewardship in the Pediatric Intensive Care Unit

Infect Dis Clin North Am. 2022 Mar;36(1):203-218. doi: 10.1016/j.idc.2021.11.003.

Authors

Anna C Sick-Samuels¹, Charlotte Woods-Hill²

Affiliations

¹ Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: asick1@jhmi.edu.
² Division of Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

In the pediatric intensive care unit (PICU), clinicians encounter complex decision making, balancing the need to treat infections promptly against the potential harms of antibiotics. Diagnostic stewardship is an approach to optimize microbiology diagnostic test practices to reduce unnecessary antibiotic treatment. We review the evidence for diagnostic stewardship of blood, endotracheal, and urine cultures in the PICU. Clinicians should consider 3 questions applying diagnostic stewardship: (1) Does the patient have signs or symptoms of an infectious process? (2) What is the optimal diagnostic test available to evaluate for this infection? (3) How should the diagnostic specimen be collected to optimize results?

Keywords: Diagnostic stewardship; Pediatric intensive care; Sepsis; Urinary tract infection; Ventilator-associated infection.

Publication types

Review

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Child
Humans
Intensive Care Units, Pediatric*

Substances

Anti-Bacterial Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding