Neonatal Intensive Care Unit Antibiotic Use
Neonatal Intensive Care Unit Antibiotic Use
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DOI：
10.1542/peds.2014-3409
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发表时间：
2015-05-01
期刊：
影响因子：
8
通讯作者：
Gould, Jeffrey B.
中科院分区：
文献类型：
--
作者：
Schulman, Joseph;Dimand, Robert J.;Gould, Jeffrey B.
背景与目的：治疗疑似感染是新生儿重症监护室日常工作的主要内容。我们假设NICU抗生素处方实践的变化与已证实的感染率、坏死性小肠结肠炎（NEC）、死亡率、出生入院率以及NICU手术量和平均住院时间相关。方法：在2013年对加利福尼亚州127个新生儿重症监护病房的52061名婴儿进行回顾性队列研究中，我们比较了样本均值，并按新生儿重症监护病房护理水平和最低/最高抗生素使用率四分位数分层，探讨了线性和非参数相关性。结果：总体抗生素使用变化了40倍，从2.4%到97.1%不等；中位数= 24.5%。在所有级别的护理中，它与已证实的感染、NEC、手术量或死亡率无关。50%的中级新生儿重症监护病房处于抗生素使用最高的四分位数，但大多数这些单位报告的感染率为零。抗生素最高四分位数的地区新生儿重症监护病房报告的出生住院率比最低四分位数的地区新生儿重症监护病房高218% (0.24 vs 0.11, P = 0.03)，住院时间长35%（90.2天vs 66.9天，P = 0.03）。结论：在127个新生儿重症监护病房中，证实感染、NEC、手术量和死亡率负担相似的新生儿重症监护病房中，抗生素处方实践存在40倍的差异，这表明相当一部分抗生素使用缺乏明确的依据；在一些新生儿重症监护病房，抗生素被过度使用。需要进一步的研究来确定适当的使用范围，并阐明抗生素与其他资源使用之间关系的决定因素和方向性。
BACKGROUND AND OBJECTIVES: Treatment of suspected infection is a mainstay of the daily work in the NICU. We hypothesized that NICU antibiotic prescribing practice variation correlates with rates of proven infection, necrotizing enterocolitis (NEC), mortality, inborn admission, and with NICU surgical volume and average length of stay.METHODS: In a retrospective cohort study of 52 061 infants in 127 NICUs across California during 2013, we compared sample means and explored linear and nonparametric correlations, stratified by NICU level of care and lowest/highest antibiotic use rate quartiles.RESULTS: Overall antibiotic use varied 40-fold, from 2.4% to 97.1% of patient-days; median = 24.5%. At all levels of care, it was independent of proven infection, NEC, surgical volume, or mortality. Fifty percent of intermediate level NICUs were in the highest antibiotic use quartile, yet most of these units reported infection rates of zero. Regional NICUs in the highest antibiotic quartile reported inborn admission rate 218% higher (0.24 vs 0.11, P = .03), and length of stay 35% longer (90.2 days vs 66.9 days, P = .03) than regional NICUs in the lowest quartile.CONCLUSIONS: Forty-fold variation in NICU antibiotic prescribing practice across 127 NICUs with similar burdens of proven infection, NEC, surgical volume, and mortality indicates that a considerable portion of antibiotic use lacks clear warrant; in some NICUs, antibiotics are overused. Additional study is needed to establish appropriate use ranges and elucidate the determinants and directionality of relationships between antibiotic and other resource use.