Improving Antimicrobial Prescribing Practices in the Neonatal Intensive Care Unit

抗生素耐药性的增加与抗生素的过度使用有关， 在医院里抗菌药物管理计划被广泛认为是改善 适当使用抗生素，减少抗生素耐药性，降低成本。然而，几乎没有数据 描述了这些项目在儿科人群中的效果，特别是在新生儿重症监护中， 单位（NICU）。本研究的长期目标是通过实施抗生素耐药性 创新的跨学科干预措施，旨在改善NICU的抗生素处方实践， 从而为这一人群确定最佳干预措施。具体目标是：1）衡量影响 疾病预防控制中心分类的三个跨学科干预包， 预防抗生素耐药性的12步运动计划; 2）确定这些措施的影响。 干预束的阻力密度，即，婴儿感染率的变化和 多重耐药微生物（MDRO）和NICU工作人员携带MDRO比例的变化 手; 3）确定干预措施在预防血流方面的成本效益 MDRO引起的感染。 研究设计是一项准实验性前瞻性临床试验，其中4个研究NICU在美国 国家（总床位- 214，年排放量- 3649）将berandomized到连续束 干预与常规护理，以确定哪种干预组合的影响最大 抗生素的适当使用、耐药性和成本。这些干预措施已经被开发出来 使用PRECEDE-PROCEED健康促进规划模型，该模型建议改变 健康行为应包括诱发因素、促成因素和强化因素。因此，教育 本研究中的干预措施涉及工作人员对抗菌药物的易感知识和信念， 阻力，并帮助制定目标，改善处方做法。临床决策支持- 计算机化供应商订单输入干预在电子健康记录中提供计算机提示， 更好地决定停止，改变或继续抗生素治疗。审计和 处方者反馈干预加强了所需的处方实践，因为提供者可以监控 他们的处方决定对健康结果的成功，并得到赞扬和鼓励， 学习团队。

The increased emergence of antibiotic resistance has been linked to the overuse of antibiotics, particularly in hospitals. Antimicrobial stewardship programs are widely acknowledged as essential to improve appropriate antibiotic use, decrease antimicrobial resistance, and reduce cost. However, few data exist describing the efficacy of such programs in pediatric populations, particularly in the neonatal intensive care unit (NICU). The long-term objectives of this study are to reduce antimicrobial resistance by implementing innovative interdisciplinary interventions aimed to improve antibiotic prescribing practices in the NICU and thereby define the optimal interventions for this population. The Specific Aims are to: 1) measure the impact of three interdisciplinary intervention bundles on inappropriate antimicrobial use as categorized by the CDC 12 Step Campaign Program to Prevent Antimicrobial Resistance; 2) determine the impact of these . intervention bundles on resistance density, i.e., changes in the rate of infant infections and colonization with multidrug-resistant organisms (MDROs) and changes in the proportion of MDROs carried on NICU staff hands; and 3) determine the cost effectiveness of the intervention bundles in preventing bloodstream infections caused by MDROs. The Study Design is a quasi-experimental prospective clinical trial whereby 4 study NICUs in the United States (total beds - 214, annual discharges - 3649) will berandomized to successive bundles of interventions versus usual care to determine which combinations of interventions have the greatestjmpact on appropriate antibiotic use, antimicrobial resistance, and cost. The interventions have beendeveloped using the PRECEDE-PROCEEDhealth promotion planning model which suggests that programsto change health behavior should include predisposing, enabling, and reinforcing factors. Thus, the Education intervention in this study addresses the predisposing knowledge and beliefs of staff regarding antimicrobial resistance and helps set goals for improving prescribing practices. The Clinical Decision Support- Computerized Provider Order Entry intervention provides computer prompts in the electronic health record to enable better decisions about stopping, changing, or continuing antibiotic treatment. The Audit and Prescriber Feedback intervention reinforces desired prescribing practices as providers can monitor the success of their prescribing decisions on health outcomes and receive praise and encouragement from the study team.