Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Pediatr Neonatol. 2012 Aug;53(4):245-51. doi: 10.1016/j.pedneo.2012.06.009. Epub 2012 Jul 20.
In order to reduce the unnecessary use of and provide appropriate guidance for the administration of antibiotics, the neonatal bacterial infections screening score (NBISS) was developed to assess each new patient that is admitted to the neonatal intensive care unit (NICU).
NBISS was designed based on maternal risk factors, clinical presentations, and laboratory data. The total score of each new patient is calculated at the time of admission. The first period of this study was an observational survey. Receiver operating characteristic (ROC) curves were used to determine the best cut-off NBISS for the diagnosis of bacterial infection (BI) and guide the use of antibiotics during the second period of this study.
Of 250 neonates who were admitted to the NICU, 237 (94.8%) received antibiotics during the first period of study. The initial total scores were not statistically different between the BI and non-BI groups (p = 0.155). We weighted C-reaction protein (CRP) (by 8×), the presence of a bulging fontanelle, pus from the ear canal, redness around the umbilicus, reduced movement, and being unable to feed (each by 5×) as significantly different between the BI and non-BI groups (p = 0.015). Weighted scores >8 points demonstrated the best diagnostic accuracy for indicating BI. After introducing NBISS for predicting BI in new patients admitted to NICU, the rate of antibiotic use significantly decreased from 94.8% to 60.3% between the two periods.
Using this simple screening strategy, we were able to clinically reduce the use of unnecessary antibiotics.
为了减少抗生素的不必要使用，并为其使用提供适当的指导，新生儿细菌感染筛查评分（NBISS）被开发出来，用于评估每一位入住新生儿重症监护病房（NICU）的新患者。
NBISS 是基于产妇危险因素、临床表现和实验室数据设计的。每位新患者在入院时计算总分。该研究的第一阶段是观察性调查。受试者工作特征（ROC）曲线用于确定用于诊断细菌感染（BI）的最佳 NBISS 截断值，并在研究的第二阶段指导抗生素的使用。
在 250 名入住 NICU 的新生儿中，有 237 名（94.8%）在研究的第一阶段接受了抗生素治疗。BI 组和非 BI 组的初始总分无统计学差异（p=0.155）。我们将 C 反应蛋白（CRP）（乘以 8）、前囟膨隆、耳道脓液、脐周发红、运动减少和无法进食（各乘以 5）作为 BI 组和非 BI 组之间的显著差异（p=0.015）。评分>8 分对指示 BI 具有最佳的诊断准确性。在将 NBISS 引入预测 NICU 新入院患者 BI 后，抗生素的使用率从两个阶段的 94.8%显著下降至 60.3%。
使用这种简单的筛选策略，我们能够在临床上减少不必要的抗生素使用。
