# NIH grant: BrighT STAR SIRIUS: a hybrid trial evaluating the impact of a comprehensive diagnostic stewardship toolkit on blood culture overuse in critically ill children (1R01HL183352-01A1) — retained record

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NIH grant 1R01HL183352-01A1: BrighT STAR SIRIUS: a hybrid trial evaluating the impact of a comprehensive diagnostic stewardship toolkit on blood culture overuse in critically ill children
Institute: {'code': 'HL', 'abbreviation': 'NHLBI', 'name': 'National Heart Lung and Blood Institute', 'admin_org_id': '12500068', 'admin_funding_url': ''}. PI: Charlotte Z Woods-Hill. Award: $1125256.
Start: 2026-09-18T00:00:00.
Project Abstract
Medical overuse is a significant source of harm to patients and burden on healthcare resource use. In critically
ill children, overuse of blood cultures can lead to a cascade of downstream overtreatment and associated harm
– repeat testing, unnecessary antibiotic exposure, adverse events from those antibiotics, and driving antibiotic
resistance.
Diagnostic stewardship is an important emerging strategy to reduce overuse of diagnostic tests in patients, and
improved testing decisions can also positively impact downstream treatment decisions. We have demonstrated
in our prior work that diagnostic stewardship for blood cultures can safely and sustainably reduce overuse of
blood cultures in critically ill children in the Pediatric Intensive Care Unit (PICU) setting. We have also
demonstrated that blood culture reduction is associated with reduced use of broad-spectrum antibiotic use in
PICU patients, and reduced rates of central-line associated bloodstream infections (CLABSI). We have not,
however, determined optimal strategies for how to most effectively implement or sustain our diagnostic
stewardship intervention, nor have we determined the impact of this intervention on cost, an important outcome
considering how unnecessary testing can impact healthcare resources.
Our proposal now seeks to address this important knowledge gap. In a stepped wedge type 3 hybrid multi-center
trial, we will for the first time directly evaluate a promising comprehensive toolkit strategy for implementing a
blood culture stewardship intervention in a large number of new PICU sites; as well as test a novel additional
sustainability boost strategy. We will focus on reach and sustainability as the primary implementation outcomes.
We will also obtain much-needed data on the cost required to implement this intervention, as well as model the
cost effectiveness of blood culture stewardship. This work will provide evidence, currently lacking, for optimal
implementation strategies as well as the cost impact of our intervention.
This work is significant for multiple reasons: decreasing unnecessary diagnostic testing and the consequent
unnecessary broad-spectrum antibiotics will reduce harm to critically ill pediatric patients from adverse drug
events or drug toxicity and help make children healthier; will decrease burden on the health care system from
repeated lab tests, longer hospital stays and excess costs; and augment antibiotic stewardship efforts to stem
population harm from antibiotic resistance. This work is innovative for multiple reasons: in its leveraging of
implementation science methods to rigorously test strategies for how to reduce testing overuse in critically ill
children; in its effort to demonstrate that diagnostic stewardship can itself be a way to reduce downstream
antibiotic use in children; and in its exploration of the cost effectiveness of a stewardship intervention in the PICU
setting.
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