Managing antibiotics wisely: a quality improvement programme in a tertiary neonatal unit in the UK.
Managing antibiotics wisely: a quality improvement programme in a tertiary neonatal unit in the UK.
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DOI：
10.1136/bmjoq-2017-000285
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发表时间：
2018
期刊：
影响因子：
1.4
通讯作者：
Banerjee S
中科院分区：
文献类型：
--
作者：
Makri V;Davies G;Cannell S;Willson K;Winterson L;Webb J;Kandhari A;Mansour M;Thomas J;Morris G;Matthes J;Banerjee S
微生物对抗生素的耐药性是一个严重的全球性健康问题，抗生素的过度使用和对新抗生素研究的投资有限使这一问题更加严重。不适当的围产期抗生素暴露通过其对发育中的微生物组的影响与终身不良后果越来越相关。抗生素管理可能是目前唯一有效的预防策略。作为英国第一个与佛蒙特州牛津网络（VON）合作开展国际质量改进计划（QIP）的三级新生儿单位，我们提出了我们的抗生素管理计划的结果。QIP于2016年1月正式启动，旨在于2016年12月31日前将抗生素使用率（AUR）降低20%，同时不影响患者安全。一个由专业人士和家长代表组成的多学科团队通过国际网络研讨会和地方会议分享了良好做法和改进战略，设计了统一的数据收集方法，并实施了一些精心挑选的“计划-实施-学习-行动”周期。使用运行图显示数据，并在适当情况下进行统计分析以比较结局。QIP导致AUR从基线中位数347/1000患者-天持续降低至198/1000患者-天（降低43%）。在36-48小时内停用抗生素的培养阴性脓毒症筛查比例从基线的32.5%持续增加至91%。出院时每位患者的抗生素使用天数中位数从3天减少到2天，实践差异也有所减少。VON组（<30周或<1500 g）的年死亡率和坏死性小肠结肠炎率是有史以来最好的，分别为5.5%和1.4%。审计证实，工作人员和家庭对QIP的认识很高。QIP在不影响患者安全的情况下实现了抗生素使用的持续减少。我们面临的挑战是安全地维持这种改进。
Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative. The QIP was officially launched in January 2016 and aimed to reduce antibiotic usage rate (AUR) by 20% of baseline by 31st December 2016 without compromising patient safety. A multidisciplinary team of professionals and parent representatives shared good practices and improvement strategies through international webinars and local meetings, devised uniform data collection methodology and implemented a number of carefully selected ‘Plan–Do–Study–Act’ cycles. Run charts were used to present data and, where appropriate, statistical analysis undertaken to compare outcomes. The QIP resulted in a sustained reduction in AUR from a baseline median of 347 to 198 per 1000 patient-days (a reduction of 43%). The proportion of culture-negative sepsis screens where antibiotics were stopped within 36–48 hours increased consistently from a baseline of 32.5% to 91%. The antibiotic days per patient at discharge reduced from a median of 3 to 2 days, and there was a reduction in practice variation. Our annual mortality and necrotising enterocolitis rates for the VON cohort (<30 weeks or <1500 g) were the best ever recorded, 5.5% and 1.4%, respectively. Audits confirmed a high level of staff and family awareness of the QIP. The QIP achieved a sustained reduction in antibiotic use without compromising patient safety. Our challenge is to sustain this improvement safely.