Practices, perceptions and attitudes of paediatric critical care practitioners in the evaluation of critically ill children for bacteraemia in the United Kingdom and the Republic of Ireland, a BrighT STAR survey

Abstract Background Blood cultures, whilst essential in investigating for sepsis, can, if overused, lead to patient harm through over-investigation, increased antibiotic exposure and antimicrobial resistance development. We aimed to survey current practices and perceptions regarding blood culture use in paediatric critical care (PCC) in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A cross-sectional electronic survey, designed by the Testing STewardship for Antibiotic Reduction (BrighT STAR) collaborative and endorsed by the Paediatric Critical Care Society (PCCS), distributed to all PCCS members between October and November 2024. Results One hundred seventy-eight responses were received from 27/29 UK and ROI PCC sites (unit response rate 93.1%). 85% respondents (150/176) reported a new or persistent fever would trigger a blood culture in their PCC, increasing to 97% (170/176) if a central line were also present. Variability regarding surveillance cultures, triggers to screen for bacteraemia and preferred sites for sampling were reported. Recognition of potential negative consequences of blood cultures differed among roles, reported by 30% nurses, 65% Nurse Practitioners and 75% medical staff. Barriers to changing practice included fear of missing sepsis (77%, 105/137) and, amongst non-consultant respondents, pressure to meet metrics (73%, 58/79) and the opinion of other specialities (78%, 18/23 resident doctors). Facilitators for change included collaborative efforts (73%, 94/128) and consensus recommendations (80%, 102/128). Conclusions To change the “culture of cultures” in a UK or Irish PCC, all stakeholders need to be engaged. Collaborative efforts could facilitate change in practice, reduce unnecessary testing, and increase alignment to consensus recommendations.