Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit
Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit
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转诊新生儿重症监护病房的抗生素管理挑战
DOI：
10.1055/s-0035-1569990
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发表时间：
2015
影响因子：
2
通讯作者：
J. Cantey
中科院分区：
文献类型：
--
作者：
K. Shipp;Tracy Chiang;Stephanie Karasick;Kayla Quick;Sean T. Nguyen;J. Cantey
新生儿抗生素过度使用与不良结局相关。 数据仅限于指导新生儿重症监护室（NICU）的抗生素管理。我们的目标是确定在转诊NICU中抗生素管理的改进领域。方法回顾性分析入住转诊NICU与先天性NICU婴儿的抗生素使用情况。 抗生素使用通过每1,000患者-天（PD）的治疗天数（DOT）进行量化。结果78%的转介新生儿重症监护病房（NICU）患儿接受了≥ 1个疗程的抗生素治疗。 转诊新生儿重症监护病房的婴儿接受抗生素DOT/1,000 PD的比例高于先天性新生儿重症监护病房的婴儿（558.9 vs. 343.2，p <0.001），广谱治疗的比例更高。对于转诊NICU中的婴儿，39%的抗生素疗程是在转院医院开始的;与转院后开始的疗程相比，这些疗程的范围更广（28%比20%，p <0.001），并且在48至72小时内减量或停止的可能性较小（58%比87%，p <0.001）。结论与新生儿重症监护病房相比，转诊新生儿重症监护病房的疑似脓毒症患者使用抗生素的比例更高，且抗菌谱广，抗菌药物的使用率更低。 管理干预措施应包括为有危险因素的婴儿保留广谱治疗，并在获得培养结果后立即降低剂量。
Abstract Background Antibiotic overuse in neonates is associated with adverse outcomes. Data are limited to guide antibiotic stewardship in the neonatal intensive care unit (NICU). Our objective was to identify areas for antibiotic stewardship improvement in a referral NICU. Methods Retrospective review of antibiotic use administered to infants admitted to a referral NICU compared with an inborn NICU. Antibiotic use was quantified by days of therapy (DOT) per 1,000 patient-days (PD). Results A total of 78% of referral NICU infants received ≥ 1 course of antibiotics. Infants in the referral NICU received more antibiotic DOT/1,000 PD than in the inborn NICU (558.9 vs. 343.2, p < 0.001), with a higher proportion of broad-spectrum therapy. For infants in the referral NICU, 39% of antibiotic courses were started at the transferring hospital; these were broader in spectrum (28 vs. 20%, p < 0.001) and less likely to be de-escalated or discontinued at 48 to 72 hours (58 vs. 87%, p < 0.001) than courses started after transfer. Conclusions Compared with the inborn NICU, suspected sepsis in the referral NICU accounted for more antibiotic utilization, which was broad-spectrum and less likely to be de-escalated. Stewardship interventions should include reserving broad-spectrum therapy for infants with risk factors and de-escalating promptly once culture results become available.
影响因子：
5.1
作者：
Kuppala, Venkata S.;Meinzen-Derr, Jareen;Morrow, Ardythe L.;Schibler, Kurt R.
通讯作者：
Schibler, Kurt R.