Auditing use of antibiotics in Zimbabwean neonates.
Auditing use of antibiotics in Zimbabwean neonates.
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DOI：
10.1016/j.infpip.2020.100046
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发表时间：
2020-06
影响因子：
--
通讯作者：
Fitzgerald FC
中科院分区：
文献类型：
--
作者：
Chimhini G;Chimhuya S;Madzudzo L;Heys M;Crehan C;Robertson V;Ferrand RA;Sado B;Sharland M;Walker AS;Klein N;Fitzgerald FC
新生儿败血症是低收入地区发病和死亡的主要原因。由于脓毒症的症状不具有特异性且恶化迅速，因此在这些可能不易进行诊断的环境中经常大量使用抗生素。津巴布韦哈拉雷中心医院每年接生 12000 名婴儿，其中约 4800 名婴儿被送入新生儿科。过度拥挤、人手不足和人员流动过快是一贯存在的问题。疑似败血症非常普遍，抗生素也被广泛使用。我们使用世界卫生组织衍生的当地指南作为标准，审核了培训和基准干预对合理化抗生素处方的影响。按照审核周期，2018 年 5 月 8 日至 6 月 6 日期间对入院诊断和抗生素使用进行了初步审核。初步审核后制定了一项实习生培训计划，重点关注抗菌药物管理以及区分“有风险”和“患有”临床疑似败血症的婴儿。 5个月后进行了重新审核。脓毒症是实习生在这两个时间点最常见的入院诊断，但在重复审核时有所减少（81% 对比 59%，P<0.0001）。 5 个月后的重新审核表明，入院和出院时抗生素处方量有所减少。入院时服用抗生素的婴儿从 449 例 (98%) 减少到 96 例 (51%)，P<0.0001。住院治疗天数 (DOT) 从 1243 减少至 1110/1000 患者天。出院时口服阿莫西林处方从 349/354 (99%) 减少至 1% 1/161 (P<0.0001)。尽管持续的绩效审查将是确保安全性和可持续性的关键，但通过绩效反馈、培训和领导，抗生素使用量大幅减少。
Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies ‘at risk of’ versus ‘with’ clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001). A substantial decrease in antibiotic use was achieved by performance feedback, training and leadership, although ongoing performance review will be key to ensuring safety and sustainability.
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影响因子：
2.7
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Banerjee S