Arora V, Strunk D, Furqan S H, Schweig L, Lefaiver C, George J, Prazad P
Department of Pediatrics, Division of Neonatology, Advocate Children's Hospital, Park Ridge, IL, USA.
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
J Neonatal Perinatal Med. 2019;12(3):301-312. doi: 10.3233/NPM-180075.
Neonatal antibiotic use is associated with a greater risk of nosocomial infection, necrotizing enterocolitis, and mortality. It can induce drug-resistant pathogens that contribute to increased neonatal morbidity/mortality, healthcare costs, and length of stay. Prior to the antibiotic stewardship program, decisions to obtain blood cultures and empiric antibiotics for possible Early-onset Sepsis (EOS) in late preterm and term infants upon NICU admission were provider-dependent rather than algorithm-based. We aimed to decrease empiric antibiotic prescription from 70% to 56% (20% decrease) in infants ≥34 weeks gestation admitted to the NICU.
The stewardship initiative comprised the following practice changes: (1) use of the Neonatal Sepsis Risk Calculator (SRC); and (2) a 36-hour time-out for prescribed empiric antibiotics. Data was retrospectively collected and analyzed for inborn infants pre-intervention (January 2015-December 2015; n = 263) and post-intervention (August 2016-September 2017; n = 279). Data regarding compliance with the new antibiotic guideline were collected and disseminated to the team every week. Overlap between CDC guidelines and calculator recommendations were studied.
Pre-and post-intervention outcomes were analyzed using chi-square tests. There was a significant post-intervention reduction in the rate of both antibiotic prescriptions (29.4% decline; 70.3% vs. 49.6%; p < 0.001) and sepsis evaluations (24.3% decline; 90.9% vs. 68.8%; p < 0.001). No difference (p = 0.271) in culture-positive EOS cases was observed. There was 92% overlap in blood culture recommendations and 95% overlap between antibiotic recommendations when current CDC guidelines were compared to the SRC.
A significant reduction in antibiotic use and sepsis evaluations was achieved for late preterm and term infants upon NICU admission. No clinical deterioration occurred in post-intervention infants who did not receive antibiotics. There is significant overlap between CDC guidelines and SRC recommendations.
新生儿使用抗生素与医院感染、坏死性小肠结肠炎及死亡风险增加相关。它可诱导耐药病原体，进而导致新生儿发病率/死亡率上升、医疗成本增加及住院时间延长。在抗生素管理计划实施之前，对于入住新生儿重症监护病房（NICU）的晚期早产儿和足月儿，若怀疑有早发型败血症（EOS），决定进行血培养及使用经验性抗生素是依赖于医护人员的判断，而非基于算法。我们旨在将入住NICU的孕周≥34周婴儿的经验性抗生素处方率从70%降至56%（降低20%）。
管理计划包括以下实践改变：（1）使用新生儿败血症风险计算器（SRC）；（2）对开具的经验性抗生素设置36小时的暂停期。对干预前（2015年1月至2015年12月；n = 263）和干预后（2016年8月至2017年9月；n = 279）的住院新生儿的数据进行回顾性收集和分析。每周收集并向团队公布有关新抗生素指南依从性的数据。研究了美国疾病控制与预防中心（CDC）指南与计算器建议之间的重叠情况。
采用卡方检验分析干预前后的结果。干预后抗生素处方率（下降29.4%；从70.3%降至49.6%；p < 0.001）和败血症评估率（下降24.3%；从90.9%降至68.8%；p < 0.001）均显著降低。血培养阳性的EOS病例未观察到差异（p = 0.271）。将当前CDC指南与SRC进行比较时，血培养建议的重叠率为92%，抗生素建议的重叠率为95%。
入住NICU的晚期早产儿和足月儿的抗生素使用及败血症评估显著减少。未接受抗生素治疗的干预后婴儿未出现临床病情恶化。CDC指南与SRC建议之间存在显著重叠。
