California Department of Health Care Services, California Children's Services, Sacramento, California;
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California; and California Perinatal Quality Care Collaborative, Stanford, California.
Pediatrics. 2015 May;135(5):826-33. doi: 10.1542/peds.2014-3409. Epub 2015 Apr 20.
Treatment of suspected infection is a mainstay of the daily work in the NICU. We hypothesized that NICU antibiotic prescribing practice variation correlates with rates of proven infection, necrotizing enterocolitis (NEC), mortality, inborn admission, and with NICU surgical volume and average length of stay.
In a retrospective cohort study of 52,061 infants in 127 NICUs across California during 2013, we compared sample means and explored linear and nonparametric correlations, stratified by NICU level of care and lowest/highest antibiotic use rate quartiles.
Overall antibiotic use varied 40-fold, from 2.4% to 97.1% of patient-days; median = 24.5%. At all levels of care, it was independent of proven infection, NEC, surgical volume, or mortality. Fifty percent of intermediate level NICUs were in the highest antibiotic use quartile, yet most of these units reported infection rates of zero. Regional NICUs in the highest antibiotic quartile reported inborn admission rate 218% higher (0.24 vs 0.11, P = .03), and length of stay 35% longer (90.2 days vs 66.9 days, P = .03) than regional NICUs in the lowest quartile.
Forty-fold variation in NICU antibiotic prescribing practice across 127 NICUs with similar burdens of proven infection, NEC, surgical volume, and mortality indicates that a considerable portion of antibiotic use lacks clear warrant; in some NICUs, antibiotics are overused. Additional study is needed to establish appropriate use ranges and elucidate the determinants and directionality of relationships between antibiotic and other resource use.
在新生儿重症监护病房（NICU）中，对疑似感染的治疗是日常工作的主要内容。我们假设，NICU 抗生素处方实践的差异与已证实的感染、坏死性小肠结肠炎（NEC）、死亡率、院内感染率、NICU 手术量和平均住院时间相关。
在加利福尼亚州 127 家 NICU 中，对 2013 年期间 52061 名婴儿进行回顾性队列研究，我们比较了样本平均值，并按 NICU 护理水平和最低/最高抗生素使用率四分位数进行了线性和非参数相关性的探索。
总的抗生素使用率变化范围很大，从 2.4%到 97.1%的患者日；中位数为 24.5%。在所有护理水平中，它与已证实的感染、NEC、手术量或死亡率无关。50%的中级 NICU 处于抗生素使用率最高的四分位数，然而，这些单位中的大多数报告的感染率为零。在抗生素使用率最高的四分位数中，区域 NICU 的院内感染率高出 218%（0.24 比 0.11，P =.03），住院时间延长 35%（90.2 天比 66.9 天，P =.03），高于抗生素使用率最低四分位数的区域 NICU。
在 127 家 NICU 中，抗生素处方实践的差异达到 40 倍，这些 NICU 面临着相似的已证实感染、NEC、手术量和死亡率负担，这表明相当一部分抗生素的使用缺乏明确的依据；在某些 NICU 中，抗生素使用过度。需要进一步研究来确定适当的使用范围，并阐明抗生素与其他资源使用之间关系的决定因素和方向性。
