Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations
Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations
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DOI：
10.1542/peds.2017-4322
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发表时间：
2018-12-01
期刊：
影响因子：
8
通讯作者：
Horbar, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Ho, Timmy;Buus-Frank, Madge E.;Horbar, Jeffrey D.
背景技术背景：美国疾病控制与预防中心（CDC）发布了医院抗生素管理计划（ASP）的核心要素，而新生儿医学明智选择前5名名单将抗生素治疗确定为过度使用的领域。我们确定了基线患病率和构成的新生儿特异性ASP和评估的变异性NICU抗生素使用率（AURs）：数据收集使用佛蒙特州牛津网络成员在2016年2月的横截面审计。单位措施来自CDC的医院ASP的核心要素的7个领域，包括领导承诺，问责制，药物专业知识，行动，跟踪，报告和教育。患者水平测量包括患者人口统计学、适应症和治疗原因。AUR的定义是接受抗生素治疗的婴儿人数除以当天的人口普查，计算每个单元的AUR。没有一个中心涉及所有7个核心要素。在这7项中，只有问责制（55%）和药物专业知识（62%）的依从性> 50%。中心审查了4127名婴儿目前的抗生素暴露。有725名婴儿接受了抗生素治疗，医院AUR中位数为17%（四分位数间距为10%-26%）。412例患者> 48小时的抗生素，只有26%（107 412）有积极的文化results.CONCLUSIONS：CDC的建议，以改善抗生素的使用和抗生素的做法在新生儿期之间存在显着的差距。点患病率AUR存在很大差异。接受抗生素治疗超过48小时的婴儿中，有四分之三没有通过培养证实感染。
BACKGROUND: The Centers for Disease Control and Prevention (CDC) published the Core Elements of Hospital Antibiotic Stewardship Programs (ASPs), while the Choosing Wisely for Newborn Medicine Top 5 list identified antibiotic therapy as an area of overuse. We identify the baseline prevalence and makeup of newborn-specific ASPs and assess the variability of NICU antibiotic use rates (AURs).METHODS: Data were collected using a cross-sectional audit of Vermont Oxford Network members in February 2016. Unit measures were derived from the 7 domains of the CDC's Core Elements of Hospital ASPs, including leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Patient-level measures included patient demographics, indications, and reasons for therapy. An AUR, defined as the number of infants who are on antibiotic therapy divided by the census that day, was calculated for each unit.RESULTS: Overall, 143 centers completed structured self-assessments. No center addressed all 7 core elements. Of the 7, only accountability (55%) and drug expertise (62%) had compliance > 50%. Centers audited 4127 infants for current antibiotic exposure. There were 725 infants who received antibiotics, for a hospital median AUR of 17% (interquartile range 10%-26%). Of the 412 patients on > 48 hours of antibiotics, only 26% (107 out of 412) had positive culture results.CONCLUSIONS: Significant gaps exist between CDC recommendations to improve antibiotic use and antibiotic practices during the newborn period. There is wide variation in point prevalence AURs. Three-quarters of infants who received antibiotics for > 48 hours did not have infections proven by using cultures.