Viel-Thériault Isabelle, Agarwal Amisha, Bariciak Erika, Le Saux Nicole, Thampi Nisha
Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier de l'Université Laval, Québec, Québec, Canada.
Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Am J Perinatol. 2022 Sep;39(12):1288-1291. doi: 10.1055/s-0040-1722600. Epub 2021 Jan 17.
Previous analyses of neonatal intensive care units (NICU) antimicrobial stewardship programs have identified key contributors to overall antibiotic use, including prolonged empiric therapy >48 hours for early-onset sepsis (EOS). However, most were performed in mixed NICU settings with onsite birthing units, resulting in a high proportion of inborn patient admissions. The study aimed to describe and analyze the most common reasons for antimicrobial use in an outborn tertiary care NICU.
This was a 10-month review of all antimicrobial doses prescribed in a 20-bed level III NICU. The primary outcome was the total days of therapy (DOT) and length of therapy (LOT) for each clinical indication. Secondary outcomes included total DOT for each antimicrobial and appropriateness of antimicrobial courses.
Of 235 antibiotic courses and 1,899 DOT (519 DOT/1,000 patient days) prescribed in 173 infants during the study period, the most common indications were suspected EOS, followed by prophylaxis. Among the 85 DOT/1,000 patient days (PD; 38 courses) prescribed for prophylaxis, 52.5 DOT/1,000 PD (25 courses; 62%) were for surgical prophylaxis. Of 17 postoperative antibiotic courses, 15 (88.2%) were deemed to be inappropriate mostly due to a duration greater than 24 hours postoperatively ( = 13; median LOT = 3 days).
Surgical prophylaxis is a common reason for antimicrobial misuse in outborn NICU. NICU-based prospective audit and feedback between neonatologists and antimicrobial stewardship teams alone may not be impactful in this setting. Partnerships with neonatologists and surgeons will be key to achieving the target of less than 24 hours of postoperative antimicrobials.
· Surgical prophylaxis is a common reason for antimicrobial misuse in the NICU.. · Antimicrobial prophylaxis duration of less than 24 hours postoperatively should be encouraged.. · NICU-based prospective audit and feedback may not be impactful unless surgeons are involved..
以往对新生儿重症监护病房（NICU）抗菌药物管理计划的分析确定了总体抗生素使用的关键因素，包括早发性脓毒症（EOS）经验性治疗延长>48小时。然而，大多数研究是在设有现场分娩单元的混合NICU环境中进行的，导致出生时即入院的患者比例很高。本研究旨在描述和分析外院三级护理NICU中抗菌药物使用的最常见原因。
这是一项对一家拥有20张床位的三级NICU中所有规定抗菌药物剂量进行的为期10个月的回顾性研究。主要结局是每种临床指征的总治疗天数（DOT）和治疗时长（LOT）。次要结局包括每种抗菌药物的总DOT以及抗菌药物疗程的合理性。
在研究期间，173例婴儿共开具了235个抗生素疗程和1899个DOT（519个DOT/1000个患者日），最常见的指征是疑似EOS，其次是预防用药。在为预防用药开具的85个DOT/1000个患者日（PD；38个疗程）中，52.5个DOT/1000个PD（25个疗程；62%）用于外科手术预防。在17个术后抗生素疗程中，15个（88.2%）被认为不合理，主要原因是术后持续时间超过24小时（n = 13；中位LOT = 3天）。
外科手术预防是外院NICU抗菌药物使用不当的常见原因。仅靠NICU内新生儿科医生与抗菌药物管理团队之间的前瞻性审核和反馈在这种情况下可能没有效果。新生儿科医生与外科医生之间的合作对于实现术后抗菌药物使用少于24小时的目标至关重要。
· 外科手术预防是NICU抗菌药物使用不当的常见原因。· 应鼓励术后抗菌药物预防持续时间少于24小时。· 除非有外科医生参与，基于NICU的前瞻性审核和反馈可能没有效果。
