Ting Joseph Y, Roberts Ashley, Tilley Peter, Robinson Joan L, Dunn Michael S, Paquette Vanessa, Lee Kyong-Soon, Shah Vibhuti, Yoon Eugene, Richter Lindsay L, Lodha Abhay, Shivananda Sandesh, Thampi Nisha, Autmizguine Julie, Shah Prakesh S
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Open. 2020 Dec 10;10(12):e043403. doi: 10.1136/bmjopen-2020-043403.
Early empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada.
Our study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology.
Ethics for the study has been granted by the University of British Columbia Children's & Women's Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications.
NCT04388293.
由于感染的临床表现不具特异性，新生儿重症监护病房（NICU）中使用广谱抗菌药物进行早期经验性治疗很常见。然而，过度和不适当使用抗菌药物会导致耐药菌的出现以及不良的新生儿结局。本研究旨在制定并实施一项全国性的针对NICU的抗菌药物管理计划（ASP），以促进抗菌药物的合理使用，并控制加拿大多重耐药菌（MDROs）的出现。
我们的研究对象将包括所有入住加拿大参与研究的三级NICU的极低出生体重儿。基于现有的有限文献，我们将就NICU抗菌药物管理干预措施达成共识，以加强最佳实践。利用扩展后的加拿大新生儿网络（CNN）平台，我们将在2年时间内收集抗菌药物使用情况以及血液和脑脊液临床样本中鉴定出的微生物药敏数据。这些数据将用于为所有NICU利益相关者提供经中心调整后的抗菌药物使用基准和MDROs流行率报告。在随后几年中，将在各个单位和国家层面制定ASP计划。知识转化策略将通过成熟的基于证据的质量改进实践方法来实施。
本研究已获得英属哥伦比亚大学儿童与妇女研究伦理委员会（H19 - 02490）的伦理批准，并得到CNN执行委员会的支持。研究结果将通过国家组织和开放获取的同行评审出版物进行传播。
NCT04388293。
