Martin-Mons Séverine, Gouyon Béatrice, Lorrain Séverine, Abasse Soumeth, Alexandre Cénéric, Binson Guillaume, Brat Roselyne, Caeymaex Laurence, Couringa Yvan, Desbruyeres Cécile, Meglio Marine Dorsi-Di, Escourrou Guillaume, Flamein Florence, Flechelles Olivier, Girard Olivier, Kermorvant-Duchemin Elsa, Lapillonne Alexandre, Lafon Catherine, Di Maio Massimo, Mazeiras Gaël, Mourdie Julien, Moussy-Durandy Amélie, Pages Anne-Sophie, Ramful Duksha, Razafimahefa Hasinirina, Rosenthal Jean-Marc, Iacobelli Silvia, Gouyon Jean-Bernard
Centre D'Etudes Périnatales de L'Océan Indien (UR 7388), Université de La Réunion, 97410 Saint-Pierre, France.
Société LogipremF, 97410 Saint-Pierre, France.
Antibiotics (Basel). 2021 Nov 20;10(11):1422. doi: 10.3390/antibiotics10111422.
: Aminoglycosides are the most prescribed antibiotics in neonatal intensive care units (NICU). Reducing exposure to antibiotics in the NICU is highly desirable, particularly through benchmarking methods. Description of aminoglycosides prescriptions in 23 French NICU using the same computerized system over a 4-year period (2017-2020). A benchmarking program of antibiotics prescription was associated. The population included 53,818 patients. Exposition rates to gentamicin and amikacin were 31.7% ( = 17,049) and 9.1% ( = 4894), respectively. Among neonates exposed to gentamicin, 90.4% of gentamicin and 77.6% of amikacin treatments were started within the 1st week of life. Among neonates exposed to amikacin, 77.6% started amikacin within the 1st week. The average daily dose of gentamicin at first prescription increased over the study period from 3.9 in 2017 to 4.4 mg/kg/d in 2020 ( < 0.0001). Conversely, the corresponding amikacin daily doses decreased from 13.0 in 2017 to 12.3 mg/kg/d in 2020 ( = 0.001). The time interval between the first 2 doses of gentamicin was mainly distributed in 3 values during the first week of life: 49.4% at 24 h, 26.4% at 36 h, and 22.9% at 48 h. At first amikacin prescription, the time interval was distributed in 4 categories: 48% at 24 h, 4.1% at 30 h, 8.5% at 36 h, and 37.1% at 48 h. As compared to literature guidelines, the rates of overdose and underdose in gentamicin (1.5% and 2.7%) and amikacin (0.3% and 1.0%). They significantly decreased for gentamicin over the study period. In multivariate analysis, the factors significantly associated with GENT overdose were the year of admission, prematurity, length of stay, and duration of the treatment. This prescription strategy ensured a low rate of overdose and underdose, and some benefits of the benchmarking program is suggested.
氨基糖苷类药物是新生儿重症监护病房（NICU）中处方量最多的抗生素。在NICU中减少抗生素暴露是非常必要的，特别是通过基准化方法。描述了法国23个NICU在4年期间（2017 - 2020年）使用同一计算机系统开具的氨基糖苷类药物处方情况。同时实施了抗生素处方基准化项目。研究人群包括53818名患者。庆大霉素和阿米卡星的暴露率分别为31.7%（n = 17049）和9.1%（n = 4894）。在暴露于庆大霉素的新生儿中，90.4%的庆大霉素治疗和77.6%的阿米卡星治疗在出生后第一周内开始。在暴露于阿米卡星的新生儿中，77.6%在第一周内开始使用阿米卡星。首次处方时庆大霉素的平均每日剂量在研究期间从2017年的3.9增加到2020年的4.4mg/kg/d（P < 0.0001）。相反，相应的阿米卡星每日剂量从2017年的13.0降至2020年的12.3mg/kg/d（P = 0.001）。庆大霉素前两剂之间的时间间隔在出生后第一周主要分布在3个值：24小时时为49.4%，36小时时为26.4%，48小时时为22.9%。首次开具阿米卡星处方时，时间间隔分布在4个类别：24小时时为48%，30小时时为4.1%，36小时时为8.5%，48小时时为37.1%。与文献指南相比，庆大霉素（1.5%和2.7%）和阿米卡星（0.3%和1.0%）的过量和不足剂量率。在研究期间庆大霉素的这些比率显著下降。在多变量分析中，与庆大霉素过量显著相关的因素是入院年份、早产、住院时间和治疗持续时间。这种处方策略确保了低过量和不足剂量率，并表明了基准化项目的一些益处。
