Prospective audit and feedback on antibiotic use in neonatal intensive care: a retrospective cohort study
Prospective audit and feedback on antibiotic use in neonatal intensive care: a retrospective cohort study
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DOI：
10.1186/s12887-019-1481-z
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发表时间：
2019-04-11
期刊：
影响因子：
2.4
通讯作者：
Morris, Andrew M.
中科院分区：
文献类型：
--
作者：
Thampi, Nisha;Shah, Prakesh S.;Morris, Andrew M.
背景：抗菌药物管理计划可能导致适当的抗生素使用，但新生儿的最佳方法尚不确定。2012年10月，在三级护理新生儿重症监护室实施了这样的计划。我们评估了这一计划对抗菌药物的使用及其与临床outcomes.Methods：在一项回顾性队列研究中，我们检查了1580名新生儿谁收到抗菌药物在13个月前和13个月期间计划实施的影响。每周5天对接受抗生素治疗的每例患者进行前瞻性稽查和反馈。药学和微生物学数据与当地加拿大新生儿网络数据库的临床数据相关联。主要结局是每1000患者-天的抗生素治疗天数;次要结局包括死亡率、坏死性小肠结肠炎以及培养阳性和培养阴性迟发性脓毒症的抗生素治疗时间。抗生素暴露的广度进行了比较，使用抗生素谱Index.Results：总的抗生素使用减少到339天的治疗每1000例患者-天从395（14%，P < 0.001），没有增加死亡率。培养阴性或培养阳性脓毒症的治疗持续时间、坏死性小肠结肠炎的发生率或抗生素暴露的广度没有差异。在项目实施过程中，抗生素使用率更低（63%对59%，P < 0.001）。窄谱药物的使用减少（P < 0.001）而头孢噻肟的使用增加（P = 0.016）。结论：每日前瞻性审计和反馈与抗生素持续时间或临床结局的变化无关，但开始使用抗生素的婴儿较少，这表明需要额外的干预措施来告知和维持抗生素处方实践的变化。
Background: Antimicrobial stewardship programs potentially lead to appropriate antibiotic use, yet the optimal approach for neonates is uncertain. Such a program was implemented in a tertiary care neonatal intensive care unit in October 2012. We evaluated the impact of this program on antimicrobial use and its association with clinical outcomes.Methods: In a retrospective cohort study, we examined 1580 neonates who received antimicrobials in the 13-months before and 13-months during program implementation. Prospective audit and feedback was given 5 days a week on each patient who was receiving antibiotic. Pharmacy and microbiology data were linked to clinical data from the local Canadian Neonatal Network database. The primary outcome was days of antibiotic therapy per 1000 patient-days; secondary outcomes included mortality, necrotizing enterocolitis, and antibiotic duration for culture-positive and culture-negative late-onset sepsis. The breadth of antibiotic exposure was compared using the Antibiotic Spectrum Index.Results: Overall antibiotic use decreased to 339 days of therapy per 1000 patient-days from 395 (14%, P < 0.001), without an increase in mortality. There was no difference in duration of therapy in culture-negative or culture-positive sepsis, rates of necrotizing enterocolitis, or breadth of antibiotic exposure. Fewer antibiotic starts occurred during program implementation (63% versus 59%, P < 0.001). The use of narrow-spectrum agents decreased (P < 0.001) whereas the use of cefotaxime increased (P = 0.016) during program implementation.Conclusions: Daily prospective audit and feedback was not associated with a change in antibiotic duration or clinical outcomes, however there were fewer babies started on antibiotics, suggesting that additional interventions are required to inform and sustain changes in antibiotic prescribing practices.