新生儿重症监护病房阳性尿液培养的处理：减少抗生素使用的指南。
Treatment of positive urine cultures in the neonatal intensive care unit: a guideline to reduce antibiotic utilization.
机构信息
Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA.
出版信息
J Perinatol. 2021 Jun;41(6):1474-1479. doi: 10.1038/s41372-021-01079-6. Epub 2021 May 14.
BACKGROUND
The pediatric definition of bacterial urinary tract infection (UTI) is >50,000 colony forming units (CFU) of a single organism on catheterized culture or 10,000-50,000 CFU with pyuria on urinalysis.
LOCAL PROBLEM
The diagnosis of UTI in our NICU is clinician-dependent and not based on the accepted pediatric definition.
METHODS
A retrospective review of positive urine cultures between 2015 and 2017 was performed.
INTERVENTION
A treatment guideline for positive urine cultures was adopted and PDSA methodology utilized for incremental improvements.
RESULTS
For 909 pre-intervention neonates, 26 of 38 positive urine cultures were treated for UTI but only 23% (6/26) met the pediatric definition. For 644 post-guideline neonates, only 7 of 25 positive urine cultures were treated and 86% met guideline criteria with no increase in urosepsis.
CONCLUSIONS
A guideline to treat positive urine cultures resulted in a decreased rate of UTI diagnosis and thus prevented unnecessary antibiotic exposure.
背景
儿科中泌尿道感染（UTI）的定义为导尿管培养出单一菌种>50,000 菌落形成单位（CFU），或非导尿尿液分析中白细胞酯酶阳性且 10,000-50,000 CFU。
本地问题
我们新生儿重症监护病房（NICU）中 UTI 的诊断依赖于临床医生的判断，而不是基于公认的儿科定义。
方法
我们对 2015 年至 2017 年间的阳性尿液培养进行了回顾性分析。
干预措施
我们采用了阳性尿液培养的治疗指南，并利用 PDCA 方法进行了逐步改进。
结果
在 909 例接受治疗前的新生儿中，38 例阳性尿液培养中有 26 例被诊断为 UTI，但仅有 23%（6/26）符合儿科定义。在 644 例接受治疗后指南的新生儿中，仅有 25 例阳性尿液培养中有 7 例被治疗，符合指南标准的比例为 86%，并没有增加脓毒症。
结论
治疗阳性尿液培养的指南降低了 UTI 的诊断率，从而避免了不必要的抗生素暴露。
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