Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative
Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative
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DOI：
10.1038/s41372-018-0041-y
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发表时间：
2018-04-01
影响因子：
2.9
通讯作者：
Zayek, Michael
中科院分区：
文献类型：
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作者：
Bhat, Ramachandra;Custodio, Haidee;Zayek, Michael
背景在早产儿中合理使用抗生素治疗是必要的，因为长期和不合理的抗生素使用与不良的短期和长期结果相关。局部问题我们的基线数据回顾发现，尽管败血症的可能性很低，但早产儿过度使用和不必要的长时间抗生素暴露。方法和干预从我们的药房数据库中回顾计算基线总体AUR，在质量改进(QI)倡议(Pre-QI阶段)之前的4个月。主要的QI干预措施包括开发和实施用于评估和管理疑似脓毒症的指导算法，其中包括关键的QI措施，例如强调如果血培养仍为阴性，则在36小时内及早停止使用抗生素，并引入多重聚合酶链式反应分析以早期识别致病微生物。从2016年2月(QI阶段)开始，通过多个计划-研究-法案周期实施了这一QI倡议，目标是在2016年12月之前实现胎龄在25(0/7)周至33(6/7)周之间的早产儿的基线总体AUR降低10%。结果在11个月期间，总的AUR(结果测量)从每千个住院日治疗154.8天下降到138.4天(下降10.6%，p<；0.05)。然而，指导算法(过程测量)的总体依从率仍然低于90%的目标。结论这种多阶段QI举措能够降低我们NICU的总体AUR。这种降低AUR对早产儿的有益影响仍有待确定。
Background Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.Local problem Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.Methods and interventions The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 25(0/7) and 33(6/7) weeks. Data for the QI phase of the study were collected prospectively.Result The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease, p < 0.05) over the 11-month period. However, the overall rate of adherence to guidance algorithm (process measure) remained below the target goal of 90%.Conclusion This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.