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新生儿重症监护病房中的抗生素管理：取消常规 CRP 检测以减少早发性败血症风险新生儿的抗生素使用。

Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis.

机构信息

Children's Hospital at Dartmouth, Lebanon, NH, USA.

出版信息

J Perinatol. 2021 Oct;41(10):2488-2494. doi: 10.1038/s41372-021-01110-w. Epub 2021 Jun 8.

DOI:10.1038/s41372-021-01110-w
PMID:34103671
Abstract

OBJECTIVE: Antibiotic overuse is common in the neonatal intensive care units (NICUs). We evaluated the change in antibiotic utilization rate (AUR) by eliminating routine CRP in the management of early-onset sepsis (EOS). METHODS: Retrospective before-after cohort study in a Level 3B NICU. We made the following practice changes in the management of EOS: (1) stop routine CRP and (2) implement an automatic stop order (ASO) for antibiotics at 48 h. We compared the AUR, defined as any antibiotic use per 1000 patient days before and after practice change. RESULT: There was an absolute reduction of 30% in AUR and a decrease in the proportion of neonates receiving antibiotics from the day of life 3-6 in postintervention period. We did not identify any case of partially treated EOS with change in practice. CONCLUSION: Elimination of routine CRP and ASO implementation for antibiotics in neonates at risk for EOS decreased AUR.

摘要

目的：新生儿重症监护病房（NICU）中抗生素的过度使用较为常见。我们通过在早发性败血症（EOS）的管理中消除常规 C 反应蛋白（CRP）来评估抗生素使用率（AUR）的变化。

方法：在 3B 级 NICU 中进行回顾性前后队列研究。我们在 EOS 的管理中进行了以下实践改变：（1）停止常规 CRP；（2）在 48 小时时实施抗生素自动停止医嘱（ASO）。我们比较了实践改变前后每 1000 个患者日使用抗生素的 AUR。

结果：AUR 绝对减少了 30%，并且在干预后时期，第 3-6 天接受抗生素治疗的新生儿比例降低。我们没有发现任何因实践改变而导致的 EOS 治疗不彻底的病例。

结论：在有 EOS 风险的新生儿中消除常规 CRP 和实施抗生素 ASO 减少了 AUR。

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引用本文的文献

[1]
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Pediatr Res. 2025-7-29

[2]
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Sci Rep. 2025-4-1

[3]
A systematic review of Perinatal Antibiotic Stewardship - where we are, where to go?

J Perinatol. 2025-1-20

[4]
Use and utility of C-reactive protein (CRP) in neonatal early-onset sepsis: a secondary analysis of a prospective surveillance study.

J Perinatol. 2025-1

[5]
Incidence of Antibiotic Exposure for Suspected and Proven Neonatal Early-Onset Sepsis between 2019 and 2021: A Retrospective, Multicentre Study.

Antibiotics (Basel). 2024-6-10

[6]
Factors Associated with Prolonged Antibiotic Therapy in Neonates with Suspected Early-Onset Sepsis.

Antibiotics (Basel). 2024-4-25

[7]
Stop in Time: How to Reduce Unnecessary Antibiotics in Newborns with Late-Onset Sepsis in Neonatal Intensive Care.

Trop Med Infect Dis. 2024-3-19

[8]
Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation.

J Pediatr (Rio J). 2024

[9]
Diagnostic Performance and Patient Outcomes With C-Reactive Protein Use in Early-Onset Sepsis Evaluations.

J Pediatr. 2023-5

[10]
Should we give antibiotics to neonates with mild non-progressive symptoms? A comparison of serial clinical observation and the neonatal sepsis risk calculator.

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本文引用的文献

[1]
C-reactive Protein (CRP) as a Single Biomarker for Diagnosis of Neonatal Sepsis: A Comprehensive Meta-analysis.

Mymensingh Med J. 2017-4

[2]
Patterns of Empiric Antibiotic Administration for Presumed Early-Onset Neonatal Sepsis in Neonatal Intensive Care Units in the United States.

Am J Perinatol. 2017-6

[3]
Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants.

Am J Perinatol. 2017-1

[4]
C-reactive protein as a single useful parameter for discontinuation of antibiotic treatment in Thai neonates with clinical sepsis.

J Med Assoc Thai. 2015-4

[5]
Predictive values of serial C-reactive protein in neonatal sepsis.

J Med Assoc Thai. 2002-11

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