All authors: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Crit Care Med. 2019 Jan;47(1):e1-e7. doi: 10.1097/CCM.0000000000003463.
We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance.
We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period.
Level 3-4 neonatal ICU in one referral center.
All 13,540 infants who received antibiotics during their hospital stay from 2015 to 2017.
Prospective audit of targeted antibiotic stewardship program.
The primary outcome was the change in total antibiotic days of therapy per 1,000 patient-days between the baseline and intervention periods. The secondary outcomes included readmissions for infection, late-onset sepsis (length of stay), necrotizing enterocolitis, or death in infants at 32 weeks of gestation or younger and the prevalence of multidrug-resistant organism colonization. No differences in safety outcomes were observed between the intervention and baseline periods. Following the implementation of our Smart Use of Antibiotics Program, the total quantity of antibiotics in the intervention phase was significantly decreased from 543 days of therapy per 1,000 patient-days to 380 days of therapy/1,000 patient-days compared with that of baseline (p = 0.0001), which occurred in parallel with a reduction in length of stay from 11.4% during the baseline period to 6.5% during the intervention period (p = 0.01). A reduced multidrug-resistant organism rate was also observed following Smart Use of Antibiotics Program implementation (1.4% vs 1.0%; p = 0.02). The overall readmission rate did not differ between the two periods (1.2% vs 1.1%; p = 0.16).
Smart Use of Antibiotics Program implementation was effective in reducing antibiotic exposure without affecting quality of care. Antibiotic stewardship programs are attainable through tailoring to special stewardship targets even in a developing country.
我们旨在实施智能抗生素使用计划，以确保抗生素的合理使用，改善患者的治疗效果和预后，并降低不良反应和抗生素耐药性的风险。
我们通过在 29 个月的中断期间对所有抗生素使用进行监测和评估，比较了实施抗生素方案前后（基线和干预）的时间。
一家转诊中心的 3-4 级新生儿重症监护病房。
2015 年至 2017 年期间住院期间接受抗生素治疗的 13540 名婴儿。
针对目标抗生素管理计划的前瞻性审核。
主要结果是基线和干预期间每 1000 个患者日的总抗生素治疗天数的变化。次要结果包括感染、晚发性败血症（住院时间）、坏死性小肠结肠炎或胎龄 32 周或更小的婴儿死亡以及多重耐药菌定植的患病率。干预组和基线组之间未观察到安全性结果的差异。在实施我们的智能抗生素使用计划后，与基线相比，干预阶段的抗生素总用量从每 1000 个患者日 543 天的治疗量显著减少到 380 天的治疗量/1000 个患者日（p=0.0001），同时住院时间从基线期的 11.4%减少到干预期的 6.5%（p=0.01）。在实施智能抗生素使用计划后，也观察到多重耐药菌率降低（1.4%比 1.0%；p=0.02）。两个时期的总体再入院率没有差异（1.2%比 1.1%；p=0.16）。
智能抗生素使用计划的实施在不影响护理质量的情况下，有效减少了抗生素的暴露。即使在发展中国家，通过针对特殊管理目标进行调整，也可以实现抗生素管理计划。
