Department of Pediatrics, Columbia University, New York, NY 10032, USA.
Semin Perinatol. 2012 Dec;36(6):431-6. doi: 10.1053/j.semperi.2012.06.005.
The judicious use of antibiotics is an important means to limit the emergence of antibiotic-resistant organisms. Although specific guidelines for neonates are often lacking, antibiotic stewardship principles can be applied to the neonatal intensive care unit. Principles include accurately identifying patients who need antibiotic therapy, using local epidemiology to guide the selection of empiric therapy, avoiding agents with overlapping activity, adjusting antibiotics when culture results become available, monitoring for toxicity, and optimizing the dose, route, and duration of therapy. Neonatal intensive care units should develop interdisciplinary antimicrobial stewardship teams with the support of their institutions. Prescriber audit and feedback, as well as preauthorization and formulary restriction of selected antibiotics, are recommended antimicrobial stewardship interventions. Ancillary strategies include education and computerized decision support. Metrics to evaluate antimicrobial stewardship programs should include measurements of patient safety and quality, such as rates of adverse drug events, and appropriate dosing and timing of perioperative prophylaxis.
合理使用抗生素是限制抗生素耐药菌出现的重要手段。尽管新生儿通常缺乏具体的指南，但抗生素管理原则可以应用于新生儿重症监护病房。这些原则包括准确识别需要抗生素治疗的患者，利用当地的流行病学数据来指导经验性治疗药物的选择，避免使用具有重叠活性的药物，在获得培养结果时调整抗生素，监测毒性，并优化治疗的剂量、途径和持续时间。新生儿重症监护病房应在其机构的支持下组建跨学科的抗菌药物管理团队。推荐的抗菌药物管理干预措施包括处方审核和反馈，以及选定抗生素的预授权和处方限制。辅助策略包括教育和计算机决策支持。评估抗菌药物管理计划的指标应包括患者安全和质量的测量，如药物不良反应发生率，以及围手术期预防用药的适当剂量和时间。
