Duber Herbert C, Hartford Emily A, Schaefer Alexandra M, Johanns Casey K, Colombara Danny V, Iriarte Emma, Palmisano Erin B, Rios-Zertuche Diego, Zuniga-Brenes Paola, Hernández-Prado Bernardo, Mokdad Ali H
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.
BMJ Glob Health. 2018 May 24;3(3):e000650. doi: 10.1136/bmjgh-2017-000650. eCollection 2018.
Neonatal sepsis is a leading cause of mortality among children under-5 in Latin America. The Salud Mesoamérica Initiative (SMI), a multicountry results-based aid programme, was designed to improve maternal, newborn and child health in impoverished communities in Mesoamérica. This study examines the delivery of timely and appropriate antibiotics for neonatal sepsis among facilities participating in the SMI project. A multifaceted health facility survey was implemented at SMI inception and approximately 18 months later as a follow-up. A random sample of medical records from neonates diagnosed with sepsis was reviewed, and data regarding antibiotic administration were extracted. In this paper, we present the percentage of patients who received timely (within 2 hours) and appropriate antibiotics. Multilevel logistic regression was used to assess for potential facility-level determinants of timely and appropriate antibiotic treatment. Among 821 neonates diagnosed with sepsis in 63 facilities, 61.8% received an appropriate antibiotic regimen, most commonly ampicillin plus an aminoglycoside. Within 2 hours of presentation, 32.3% received any antibiotic and only 26.6% received an appropriate regimen within that time. Antibiotic availability improved over the course of the SMI project, increasing from 27.5% at baseline to 64.0% at follow-up, and it was highly correlated with timely and appropriate antibiotic administration (adjusted OR=5.36, 95% CI 2.85 to 10.08). However, we also found a decline in the percentage of neonates documented to have received appropriate antibiotics (74.4% vs 51.1%). Our study demonstrated early success of the SMI project through improvements in the availability of appropriate antibiotic regimens for neonatal sepsis. At the same time, overall rates of timely and appropriate antibiotic administration remain low, and the next phase of the initiative will need to address other barriers to the provision of life-saving antibiotic treatment for neonatal sepsis.
新生儿败血症是拉丁美洲5岁以下儿童死亡的主要原因。中美洲健康倡议（SMI）是一项基于成果的多国援助计划，旨在改善中美洲贫困社区的孕产妇、新生儿和儿童健康状况。本研究调查了参与SMI项目的医疗机构中，为新生儿败血症及时提供适当抗生素的情况。在SMI启动时以及大约18个月后的随访中，实施了多方面的医疗机构调查。对诊断为败血症的新生儿的医疗记录进行随机抽样审查，并提取有关抗生素使用的数据。在本文中，我们呈现了接受及时（2小时内）且适当抗生素治疗的患者百分比。采用多水平逻辑回归分析来评估及时和适当抗生素治疗的潜在机构层面决定因素。在63家医疗机构的821例诊断为败血症的新生儿中，61.8%接受了适当的抗生素治疗方案，最常用的是氨苄西林加一种氨基糖苷类药物。在就诊后2小时内，32.3%的患儿接受了任何抗生素治疗，而在此期间只有26.6%接受了适当的治疗方案。在SMI项目实施过程中，抗生素的可获得性有所改善，从基线时的27.5%增至随访时的64.0%，且与及时和适当的抗生素使用高度相关（调整后的比值比=5.36，95%置信区间为2.85至10.08）。然而，我们还发现记录显示接受适当抗生素治疗的新生儿百分比有所下降（74.4%对51.1%）。我们的研究表明，通过改善新生儿败血症适当抗生素治疗方案的可获得性，SMI项目取得了早期成功。与此同时，及时和适当抗生素使用的总体比例仍然较低，该倡议的下一阶段需要解决为新生儿败血症提供救命抗生素治疗的其他障碍。
