Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
Pediatrics, All India Institute of Medical Sciences-Nagpur, Nagpur, Maharashtra, India.
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001456.
Antibiotic misuse is the most common cause of antimicrobial resistance-a globally declared emergency. This necessitates the introduction of rational antibiotic usage management policy. The paediatrics department of a public teaching hospital with around 500 neonatal intensive care unit (NICU) admissions annually revealed 75% of NICU admission exposure to any antibiotics. The aim was to institute antibiotic stewardship programme (ASP) to optimise antibiotic usage from existing 75% to 40% in a 6-month period through a quality improvement (QI) project.A root cause analysis using fishbone diagram was performed to identify the possible reasons for the high antibiotic usage. Six Plan-Do-Study-Act cycles were conducted to implement the protocols for usage of antibiotics for well-defined indications; active laboratory engagement to decrease the turnaround time for blood culture results; a hard stop to all antibiotic orders after 72 hours; streamlining of antibiotic usage; strengthening universal aseptic practices; and confidence building of staff. The outcomes monitored were antibiotic exposure rates, average number of antibiotic days in all NICU admissions, sepsis rates and mortality.Institution of ASP had significantly reduced antibiotic exposure in NICU admissions, that is, from 75% in March to 41% in August 2018. Median (IQR) antibiotic days per infant in NICU went down from 3 to 0 (0-6). The per cent of NICU admission with culture-positive sepsis and all-cause mortality rate in NICU declined from 18% to 11.56% and 25% to 16%, respectively, over these 6 months.Thus, ASP for rationalising antibiotic usage was successfully instituted in NICU of a rural medical college in central India through QI, without any adverse effect on sepsis and mortality.
抗生素滥用是导致抗菌药物耐药性的最常见原因——这是一个全球宣布的紧急情况。这就需要引入合理的抗生素使用管理政策。一家拥有约 500 名新生儿重症监护病房（NICU）入院人数的公立教学医院的儿科部门发现，75%的 NICU 入院患者接触过任何抗生素。目的是通过质量改进（QI）项目，在 6 个月内将抗生素使用率从现有的 75%优化至 40%，从而建立抗生素管理计划（ASP）。使用鱼骨图进行根本原因分析，以确定抗生素高使用率的可能原因。进行了六轮 Plan-Do-Study-Act 循环，以实施明确适应症抗生素使用的方案；积极与实验室合作，缩短血培养结果的周转时间；在 72 小时后停止所有抗生素医嘱；简化抗生素使用；加强普遍无菌操作；增强员工信心。监测的结果包括抗生素暴露率、所有 NICU 入院患者的平均抗生素使用天数、败血症发生率和死亡率。ASP 的实施显著降低了 NICU 入院患者的抗生素暴露率，即从 2018 年 3 月的 75%降至 8 月的 41%。NICU 中每个婴儿的抗生素天数中位数（IQR）从 3 天降至 0 天（0-6 天）。培养阳性败血症和 NICU 全因死亡率的 NICU 入院百分比从 18%降至 11.56%，从 25%降至 16%。因此，通过质量改进，在印度中部的一所农村医学院的 NICU 中成功实施了 ASP，以合理使用抗生素，而不会对败血症和死亡率产生任何不良影响。
