Use of antibiotics in pediatric intensive care and potential savings
Use of antibiotics in pediatric intensive care and potential savings
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DOI：
10.1007/s001340051288
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发表时间：
2000-07-01
影响因子：
38.9
通讯作者：
Fanconi, S
中科院分区：
文献类型：
--
作者：
Fischer, JE;Ramser, M;Fanconi, S
目的：最大限度地减少不必要的抗生素处方仍然是一个重要目标。由于各单位之间在患者组合和其他特征方面存在异质性，因此必须确定特定于研究中心的减排目标。在这里，我们提出了一个模型来解决这个问题，通过一个观察性队列study.Setting：一个三级，多学科，新生儿和儿科重症监护病房的一所大学教学hospital.Patients：所有新生儿和儿童目前在单位（n = 456）1998年9月和1999年3月之间。入院的原因包括心脏手术后的术后护理，主要的新生儿或儿科手术，严重的创伤，和医疗条件需要critical care.Methods：每日记录的抗生素和启动的指征。停药后，每个治疗事件进行评估，以存在或不存在infection.Results：在456例患者258（56.6%）接受全身抗生素，达到1815暴露日（54.6%）在3322住院日。其中，512例（28%）为预防性用药，1303例为疑似感染用药。疑似呼吸机相关肺炎治疗占1303个治疗日的616（47%）天，疑似脓毒症治疗占255天（20%）天。在552（40%）个治疗日期间，患者被分类为无感染或病毒感染。在29周研究期间，该单位的平均每周暴露率变化很大（范围：40 - 77/100住院日）。病人的特点并没有解释这种variation.Conclusion：在这个单位的抗生素治疗的最大减少将导致措施协助疑似呼吸机相关性肺炎被排除，并从削减延长预防。
Objective: Minimizing unwarranted prescription of antibiotics remains an important objective. Because of the heterogeneity between units regarding patient mix and other characteristics, site-specific targets for reduction must be identified. Here we present a model to address the issue by means of an observational cohort study.Setting: A tertiary, multidisciplinary, neonatal, and pediatric intensive care unit of a university teaching hospital.Patients: All newborns and children present in the unit (n = 456) between September 1998 and March 1999. Reasons for admission included postoperative care after cardiac surgery, major neonatal or pediatric surgery, severe trauma, and medical conditions requiring critical care.Methods: Daily recording of antibiotics given and of indications for initiation. After discontinuation, each treatment episode was assessed as to the presence or absence of infection.Results: Of the 456 patients 258 (56.6 %)received systemic antibiotics, amounting to 1815 exposure days (54.6 %) during 3322 hospitalization days. Of these, 512 (28 %) were prescribed as prophylaxis and 1303 for suspected infection. Treatment for suspected ventilator-associated pneumonia accounted for 616 (47 %) of 1303 treatment days and suspected sepsis for 255 days (20 %). Patients were classified as having no infection or viral infection during 552 (40 %) treatment days. The average weekly exposure rate in the unit varied considerably during the 29-week study period (range: 40-77/100 hospitalization days). Patient characteristics did not explain this variation.Conclusion: In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.