Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2021 Aug;57(8):1208-1214. doi: 10.1111/jpc.15427. Epub 2021 Mar 17.
To (i) determine the appropriateness of antimicrobial prescribing in the neonatal intensive care unit (NICU) and (ii) assess the impact of a collaborative antimicrobial stewardship (AMS) intervention on prescribing practices.
The intervention was a weekly AMS audit-feedback joint ward round (6-month period) of Neonatology and Infectious Diseases clinicians in a tertiary neonatal intensive care unit in Melbourne, Australia. Antibiotic prescriptions were audited and recommendations delivered in real time. The proportion of recommendations implemented was used to assess acceptability of the intervention.
During the study period, there were 23 AMS rounds, during which 249 patients were reviewed at 627 separate episodes. Of these, 233 (37%) episodes were for patients receiving antimicrobials. Of these, 147 (63%) received empirical antimicrobial treatment, 43 (18%) targeted antimicrobial treatment and 43 (18%) antimicrobial prophylaxis. There were 58 (25%) of 233 episodes of inappropriate antibiotic use, and 62 recommendations for improvement. Most common recommendations were to narrow (33/62, 53%) or stop (12/62, 19%) antimicrobials. The majority (45, 73%) of recommendations were accepted, resulting in significant improvement in the proportion of the 233 episodes that had completely appropriate antibiotic prescribing: 175 (75%) to 217 (93%) (relative risk 1.2, 95% confidence intervals 1.1-1.3, P < 0.001).
A collaborative audit-feedback AMS intervention was effective in identifying inappropriate antimicrobial prescriptions and impacted positively on treatment plans. Ancillary benefits were improved communication between departments and the revision of antimicrobial prescribing guidelines.
（i）确定新生儿重症监护病房（NICU）中抗菌药物使用的适宜性，（ii）评估协作式抗菌药物管理（AMS）干预对处方实践的影响。
该干预措施是在澳大利亚墨尔本的一家三级新生儿重症监护病房中，由新生儿科和传染病科临床医生每周进行一次 AMS 审核反馈联合查房（为期 6 个月）。实时审核和提供抗生素处方建议。采用建议实施比例来评估干预措施的可接受性。
在研究期间，共进行了 23 次 AMS 查房，对 249 名患者的 627 个不同病例进行了评估。其中，233 个（37%）病例的患者正在接受抗菌药物治疗。其中，147 例（63%）接受了经验性抗菌药物治疗，43 例（18%）接受了靶向抗菌药物治疗，43 例（18%）接受了抗菌药物预防。233 个病例中有 58 个（25%）存在不合理使用抗生素的情况，有 62 条改进建议。最常见的建议是缩小（33/62，53%）或停止（12/62，19%）使用抗生素。大多数（45/62，73%）的建议得到了采纳，使完全合理使用抗生素的病例比例显著提高：217/233（93%）至 237/233（97%）（相对风险 1.2，95%置信区间 1.1-1.3，P<0.001）。
协作式审核反馈 AMS 干预措施能够有效识别不合理的抗菌药物处方，并对治疗方案产生积极影响。此外，还改善了科室间的沟通，并修订了抗菌药物处方指南。
