Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Pediatr Infect Dis J. 2011 May;30(5):365-70. doi: 10.1097/INF.0b013e31820243d3.
Few data exist on time trends of antibiotic consumption among neonates.
To assess secular trends in antibiotic consumption in the context of an antibiotic policy and the effect of antibiotic use on the development of antimicrobial resistance and outcome among neonates in a single center.
We performed a prospective cohort study between 2001 and 2008 to monitor antibiotic consumption among neonates. In parallel, we initiated a policy to shorten antibiotic therapy for clinical sepsis and for infections caused by coagulase-negative staphylococci and to discontinue preemptive treatment when blood cultures were negative. Time trend analyses for antibiotic use and mortality were performed.
In total, 1096 of 4075 neonates (26.7%) received 1281 courses of antibiotic treatment. Overall, days of therapy were 360 per 1000 patient-days. Days of therapy per 1000 patient-days decreased yearly by 2.8% (P < 0.001). Antibiotic-days to treat infections decreased yearly by 6.5% (P = 0.01) while antibiotic-days for preemptive treatment increased by 3.4% per year (P = 0.03). Mean treatment duration for confirmed infections decreased by 2.9% per year (P < 0.001). No significant upward trend was observed for infection-associated mortality. Of 271 detected healthcare-associated infections, 156 (57.6%) were microbiologically documented. The most frequent pathogens were coagulase-negative staphylococci (48.5%) followed by Escherichia coli (13.5%) and enterococci (9.4%). Rates for extended-spectrum beta-lactamase-producing microorganisms and methicillin-resistant Staphylococcus aureus remained low.
Shortening antibiotic therapy and reducing preemptive treatment resulted in a moderate reduction of antibiotic use in the neonatal intensive care unit and did not increase mortality.
关于新生儿抗生素使用的时间趋势，相关数据较少。
评估在抗生素政策背景下，抗生素使用的变化趋势，以及抗生素的使用对单个中心新生儿的抗生素耐药性发展和结局的影响。
我们进行了一项 2001 年至 2008 年的前瞻性队列研究，以监测新生儿的抗生素使用情况。与此同时，我们启动了一项政策，缩短临床败血症和凝固酶阴性葡萄球菌感染的抗生素治疗时间，并在血培养阴性时停止预防性治疗。对抗生素使用和死亡率进行了时间趋势分析。
共有 4075 例新生儿中的 1096 例（26.7%）接受了 1281 例抗生素治疗。总的来说，每 1000 个患者日治疗天数为 360 天。每 1000 个患者日的治疗天数每年减少 2.8%（P<0.001）。每 1000 个患者日的抗生素治疗天数每年减少 6.5%（P=0.01），而预防性治疗的抗生素天数每年增加 3.4%（P=0.03）。确诊感染的平均治疗时间每年减少 2.9%（P<0.001）。未观察到感染相关死亡率的显著上升趋势。在 271 例检测到的医源性感染中，156 例（57.6%）有微生物学证据。最常见的病原体是凝固酶阴性葡萄球菌（48.5%），其次是大肠埃希菌（13.5%）和肠球菌（9.4%）。产超广谱β-内酰胺酶微生物和耐甲氧西林金黄色葡萄球菌的发生率仍然较低。
缩短抗生素治疗时间和减少预防性治疗导致新生儿重症监护病房的抗生素使用量适度减少，且未增加死亡率。
