Martin-Mons Séverine, Lorrain Simon, Iacobelli Silvia, Gouyon Béatrice, Gouyon Jean-Bernard
Centre D'Etudes Périnatales de L'Océan Indien (Université de La Réunion), CHU de La Réunion Site Sud, Saint-Pierre, France.
Société LogipremF, Saint-Pierre, France.
Front Pharmacol. 2021 Jan 25;11:585018. doi: 10.3389/fphar.2020.585018. eCollection 2020.
Prescribing antibiotics to newborns is challenging, as excess antibiotics are a risk factor for increased morbidity and mortality. The objective of this study was to describe the evolution of antibiotic exposure over three years in a large network of level 3 neonatal wards where each center is informed yearly of its own results and the results of other centers and has full autonomy to improve its performance. This is a prospective, observational study of antibiotics prescriptions over the 2017-2019 period in a network of 23 French level 3 neonatal wards. The network relied on an internal benchmarking program based on a computerized prescription ordering system. Among others, antibiotics exposure, treatment duration, and antibiotics spectrum index were analyzed. The population consisted of 39,971 neonates (51.5% preterm), 44.3% of which were treated with antibiotics. Of the treated patients, 78.5% started their first antibiotic treatment in the first three days of life. Antibiotic exposure rate significantly declined from 2017 to 2019 (from 46.8% to 42.8%, < 0.0001); this decline was significant in groups with gestational age >26 weeks, but not in the group with extremely low gestational age <27 weeks. Gentamicin, cefotaxime, amoxicillin (ampicillin), vancomycin, and amikacin were the antibiotics most prescribed. The lower the gestational age, the higher the exposure for cefotaxime, vancomycin, and amikacin. Compared to 2017, cefotaxime exposure in 2019 declined by 12.6%, but the change was only significant in the gestational age group of 32-36 weeks (17.4%) and at term (20.3%). The triple combination of antibiotics in the first three days decreased by 28.8% from 2017 to 2019, and this was significant in each gestational age group. During the study, the delayed ending of antibiotics in unconfirmed early-onset neonatal infection increased from 9.6% to 11.9%. This study showed that a strategy characterized by the collection of information via a computerized order-entry system, analysis of the results by a steering committee representative of all neonatal wards, and complete autonomy of neonatal wards in the choice of prescription modalities, is associated with a significant reduction in the use of antibiotics in newborns with gestational age greater than 26 weeks.
给新生儿开抗生素具有挑战性，因为过量使用抗生素是发病率和死亡率上升的一个风险因素。本研究的目的是描述在一个大型三级新生儿病房网络中三年来抗生素暴露情况的演变，在这个网络中，每个中心每年都会被告知自己的结果以及其他中心的结果，并且在改善其绩效方面拥有完全自主权。这是一项对法国23个三级新生儿病房网络在2017 - 2019年期间抗生素处方的前瞻性观察研究。该网络依靠一个基于计算机化处方订购系统的内部基准程序。除其他外，还分析了抗生素暴露、治疗持续时间和抗生素谱指数。研究人群包括39971名新生儿（51.5%为早产儿），其中44.3%接受了抗生素治疗。在接受治疗的患者中，78.5%在出生后的头三天开始了首次抗生素治疗。抗生素暴露率从2017年到2019年显著下降（从46.8%降至42.8%，<0.0001）；这种下降在孕周>26周的组中显著，但在孕周极低<27周的组中不显著。庆大霉素、头孢噻肟、阿莫西林（氨苄西林）、万古霉素和阿米卡星是最常开具的抗生素。孕周越低，头孢噻肟、万古霉素和阿米卡星的暴露率越高。与2017年相比，2019年头孢噻肟的暴露率下降了12.6%，但这种变化仅在32 - 36周的孕周组（17.4%）和足月儿组（20.3%）中显著。从2017年到2019年，头三天使用三联抗生素的情况下降了28.8%，并且在每个孕周组中都很显著。在研究期间，未确诊的早发性新生儿感染中抗生素延迟停药的情况从9.6%增加到了11.9%。这项研究表明，一种以通过计算机化医嘱录入系统收集信息、由所有新生儿病房代表组成的指导委员会分析结果以及新生儿病房在选择处方方式上拥有完全自主权为特征的策略，与孕周大于26周的新生儿抗生素使用的显著减少相关。
