Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork, Ireland.
INFANT, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland.
Acta Paediatr. 2018 Oct;107(10):1716-1721. doi: 10.1111/apa.14337. Epub 2018 Apr 23.
Antimicrobial stewardship plays an important role in ensuring that the appropriate drug, dose, route and duration are employed to provide adequate treatment while minimising the risks of unnecessary antibiotic use. Surveillance of antibiotic use with prescriber feedback is recommended as a high-impact stewardship intervention. The aim of this study was to reduce unnecessary antimicrobial use in a neonatal unit.
A prospective audit was performed to assess compliance with antimicrobial guidelines. Following this, educational interventions were applied, electronic prescribing was introduced to the neonatal unit, and re-audit was performed. The primary outcome was a reduction in days of therapy (DOT).
There were 312 neonatal admissions. There was a significant overall reduction in the primary outcome of DOT/1000 patient days from 572 to 417 DOT. This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment courses >36 hours in negative sepsis evaluations were reduced from 82 DOT to 7.5 DOT. Similarly, treatment courses greater than five days for culture-negative sepsis were reduced from 46.5 DOT to 7 DOT.
Monitoring antibiotic prescribing data can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced.
抗菌药物管理在确保使用适当的药物、剂量、途径和疗程提供充分治疗的同时，最大限度地减少不必要的抗生素使用风险方面发挥着重要作用。建议采用监测抗生素使用情况并提供处方反馈作为高影响力的管理干预措施。本研究旨在减少新生儿病房中不必要的抗菌药物使用。
进行了一项前瞻性审核，以评估抗菌药物指南的遵守情况。在此之后，实施了教育干预措施，在新生儿病房中引入了电子处方，并进行了重新审核。主要结果是减少治疗天数（DOT）。
共有 312 名新生儿入院。DOT/1000 患者天数的主要结果总体显著减少，从 572 降至 417 DOT。这代表抗生素总使用量减少了 27%。在阴性脓毒症评估中，抗生素治疗疗程 >36 小时的情况从 82 DOT 减少到 7.5 DOT。同样，对于培养阴性脓毒症的疗程大于 5 天的情况，从 46.5 DOT 减少到 7 DOT。
监测抗生素处方数据可以为抗生素使用趋势提供有用的见解，并告知临床医生在哪些方面可以安全地减少抗生素使用。
