Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2018 Dec;142(6). doi: 10.1542/peds.2017-4322.
: media-1vid110.1542/5839992664001PEDS-VA_2017-4322 BACKGROUND: The Centers for Disease Control and Prevention (CDC) published the Core Elements of Hospital Antibiotic Stewardship Programs (ASPs), while the Choosing Wisely for Newborn Medicine Top 5 list identified antibiotic therapy as an area of overuse. We identify the baseline prevalence and makeup of newborn-specific ASPs and assess the variability of NICU antibiotic use rates (AURs).
Data were collected using a cross-sectional audit of Vermont Oxford Network members in February 2016. Unit measures were derived from the 7 domains of the CDC's Core Elements of Hospital ASPs, including leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Patient-level measures included patient demographics, indications, and reasons for therapy. An AUR, defined as the number of infants who are on antibiotic therapy divided by the census that day, was calculated for each unit.
Overall, 143 centers completed structured self-assessments. No center addressed all 7 core elements. Of the 7, only accountability (55%) and drug expertise (62%) had compliance >50%. Centers audited 4127 infants for current antibiotic exposure. There were 725 infants who received antibiotics, for a hospital median AUR of 17% (interquartile range 10%-26%). Of the 412 patients on >48 hours of antibiotics, only 26% (107 out of 412) had positive culture results.
Significant gaps exist between CDC recommendations to improve antibiotic use and antibiotic practices during the newborn period. There is wide variation in point prevalence AURs. Three-quarters of infants who received antibiotics for >48 hours did not have infections proven by using cultures.
疾病控制与预防中心 (CDC) 发布了医院抗生素管理计划 (ASPs) 的核心要素，而明智选择新生儿医学 5 大清单确定抗生素治疗是过度使用的一个领域。我们确定了新生儿特异性 ASP 的基线流行率和构成，并评估了 NICU 抗生素使用率 (AUR) 的可变性。
2016 年 2 月，我们使用对佛蒙特牛津网络成员的横断面审计收集数据。单位措施源自 CDC 医院 ASP 核心要素的 7 个领域，包括领导力承诺、问责制、药物专业知识、行动、跟踪、报告和教育。患者层面的措施包括患者的人口统计学特征、适应症和治疗原因。为每个单位计算了定义为接受抗生素治疗的婴儿数量除以当天的普查数的 AUR。
共有 143 个中心完成了结构化的自我评估。没有一个中心满足所有 7 个核心要素。在这 7 个要素中，只有问责制 (55%) 和药物专业知识 (62%) 的合规性超过 50%。中心对 4127 名有当前抗生素暴露的婴儿进行了审计。有 725 名婴儿接受了抗生素治疗，医院中位数 AUR 为 17%（四分位间距 10%-26%）。在接受 >48 小时抗生素治疗的 412 名患者中，只有 26%（412 名中的 107 名）有阳性培养结果。
在改善抗生素使用和新生儿期抗生素实践方面，CDC 的建议与实际情况之间存在显著差距。AUR 的点患病率存在很大差异。四分之三接受抗生素治疗 >48 小时的婴儿没有通过培养证实感染。
