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，尤其是 在医院里。抗菌管理计划被广泛认为是改善 合理使用抗生素，减少耐药性，降低成本。然而，存在的数据很少 描述此类方案在儿科人群中的效果，特别是在新生儿重症监护中的效果 单位(NICU)。这项研究的长期目标是通过实施 创新的跨学科干预措施，旨在改善NICU和 从而确定适合这一人群的最佳干预措施。具体目标是：1)衡量影响 疾病预防控制中心分类的三个关于不适当使用抗菌药的跨学科干预捆绑包 预防抗菌素耐药性的12步运动计划；2)确定这些计划的影响。 干预措施捆绑在耐药性密度上，即婴儿感染率和定殖率的变化 NICU工作人员多药耐药菌(MDRO)及其比例的变化 手；以及3)确定干预束在预防血流方面的成本效益 由MDRO引起的感染。 研究设计是一项准实验性前瞻性临床试验，由4个美国的NICU进行研究 各州(总床位-214张，年排污量-3649张)将随机分配到连续的 干预措施与常规护理的对比，以确定哪些干预措施的组合具有最好的效果 关于抗生素的适当使用、抗菌素耐药性和成本。干预措施已经开发出来了 使用先行先试的健康促进计划模式，该模式建议计划改变 健康行为应包括易感因素、促成因素和强化因素。因此，教育 这项研究的干预措施涉及员工关于抗菌剂的易感知识和信念 抵抗力，并有助于制定目标，以改善处方做法。临床决策支持- 计算机化的提供者订单输入干预在电子健康记录中提供计算机提示以 使您能够更好地决定是否停止、更改或继续抗生素治疗。审计和 处方反馈干预加强了所需的处方实践，因为提供者可以监控 关于健康结果的处方决定的成功，并得到来自 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.