Osowicki Joshua, Gwee Amanda, Noronha Jesuina, Britton Philip N, Isaacs David, Lai Tony B, Nourse Clare, Avent Minyon, Moriarty Paul, Francis Joshua R, Blyth Christopher C, Cooper Celia M, Bryant Penelope A
From the *Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; †Murdoch Children's Research Institute, Parkville, Victoria, Australia; ‡Department of Paediatric Infectious Diseases, Monash Children's Hospital, Clayton, Victoria, Australia; §Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; ¶Pharmacy Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; ‖Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; **Department of Paediatrics, University of Queensland, South Brisbane, Queensland, Australia; ††Mater Pharmacy Services, Mater Health, South Brisbane, Queensland, Australia; ‡‡University of Queensland Centre for Clinical Research, South Brisbane, Queensland, Australia; §§Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; ¶¶Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia; ‖‖School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia; ***PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, Western Australia, Australia; †††Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; ‡‡‡SA Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia; and §§§Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Pediatr Infect Dis J. 2015 Aug;34(8):e185-90. doi: 10.1097/INF.0000000000000719.
There is increasing recognition of the threat to neonatal patients from antibiotic resistance. There are limited data on antimicrobial prescribing practices for hospitalized neonates. We aimed to describe antimicrobial use in hospitalized Australian neonatal patients, and to determine its appropriateness.
Multicentre single-day hospital-wide point prevalence survey in 2012, in conjunction with the Antimicrobial Resistance and Prescribing in European Children study. The appropriateness of antimicrobial prescriptions was also assessed. All patients admitted at 8 am on the survey day, in 6 neonatal units in tertiary children's hospitals across 5 states, were included in an analysis of the quantity and quality of all antimicrobial prescriptions.
The point prevalence survey included 6 neonatal units and 236 patients. Of 109 patients (46%) receiving at least 1 antimicrobial, 66 (61%) were being treated for infection, with sepsis the most common indication. There were 216 antimicrobial prescriptions, 134 (62%) for treatment of infection and 82 (38%) for prophylaxis, mostly oral nystatin. Only 15 prescriptions were for targeted as opposed to empirical treatment. Penicillin and gentamicin were the most commonly prescribed antibiotics, with vancomycin third most common. Half of all treated patients were receiving combination antimicrobial therapy. There was marked variation in vancomycin and gentamicin dosing. Overall, few prescriptions (4%) were deemed inappropriate.
This is the first Australia-wide point prevalence survey of neonatal antimicrobial prescribing in tertiary children's hospitals. The findings highlight positive practices and potential targets for quality improvement.
抗生素耐药性对新生儿患者构成的威胁日益受到关注。关于住院新生儿抗菌药物处方行为的数据有限。我们旨在描述澳大利亚住院新生儿患者的抗菌药物使用情况，并确定其合理性。
2012年开展多中心全医院单日现患率调查，同时开展欧洲儿童抗菌药物耐药性与处方研究。还评估了抗菌药物处方的合理性。对调查日上午8点在5个州三级儿童医院的6个新生儿病房收治的所有患者的所有抗菌药物处方的数量和质量进行分析。
现患率调查涵盖6个新生儿病房和236名患者。在109名（46%）至少接受1种抗菌药物治疗的患者中，66名（61%）因感染接受治疗，其中败血症是最常见的指征。共有216份抗菌药物处方，134份（62%）用于治疗感染，82份（38%）用于预防，主要是口服制霉菌素。只有15份处方是针对性治疗而非经验性治疗。青霉素和庆大霉素是最常开具的抗生素，万古霉素排第三。所有接受治疗的患者中有一半接受联合抗菌药物治疗。万古霉素和庆大霉素的剂量存在显著差异。总体而言，很少有处方（4%）被认为不合理。
这是澳大利亚首次在三级儿童医院开展的全范围新生儿抗菌药物处方现患率调查。研究结果突出了积极的做法和质量改进的潜在目标。
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