Philips Research, Cambridge, MA, 02141, USA.
Philips Clinical Professional Services, Cambridge, MA, 02141, USA.
Antimicrob Resist Infect Control. 2022 Jan 31;11(1):21. doi: 10.1186/s13756-022-01057-3.
There is a need for robust antibiotic stewardship programs (ASPs) in the neonatal population. This study's objectives were to assess neonatal antibiotic use practices over an extended period across an integrated delivery network (IDN), including six Neonatal Intensive Care Units (NICUs), to identify those most successful practices reducing use rates.
A retrospective cohort study was conducted, including 15,015 NICU admissions from an integrated delivery network, across six hospitals over eight years (50% Level III and 50% Level II) computing antibiotic use rates (AURs) stratified by usage: in the first few days of the stay vs. later in the stay and by gestational age. Several metrics were examined for assumptions of strong correlation with AUR: (1) the percentage of infants given antibiotics early in their stays and (2) durations of courses of antibiotics.
Results conclude a wide variation in AURs and trends that these rates followed over time. However, there was a decrease in overall AUR from 15.7-16.6 to 10.1-10.8%, with four of the six NICUs recording statistically significant reductions in AUR vs. their first year of measurement. Specifically, the level III NICUs overall AUR decreases from 15.1-16.22 to 8.6-9.4%, and level II NICUs overall AUR 20.3-24.4 to 14.1-16.1%. A particularly successful level II NICU decreased its AUR from 22.9-30.6 to 5.9-9.4%.
To our knowledge, this is the first study to utilize data analytics at an IDN level to identify trends in AUR, We have identified practices that allowed an institution to reduce NICU AURs significantly, and which, if done as a standard practice, could be replicated on a broader scale.
新生儿群体需要强有力的抗生素管理项目（ASPs）。本研究的目的是评估在一个综合交付网络（IDN）中，包括六个新生儿重症监护病房（NICU）在内的较长时间段内新生儿抗生素使用情况，以确定那些最成功的实践可以降低使用率。
我们进行了一项回顾性队列研究，纳入了来自一个综合交付网络的 15015 例 NICU 住院患者，涉及六家医院八年的情况（50%为三级，50%为二级），计算了抗生素使用率（AUR），并按使用情况分层：住院初期 vs. 住院后期和按胎龄分层。对几种指标进行了检查，以确定与 AUR 有较强相关性的假设：（1）在住院初期给予抗生素的婴儿比例和（2）抗生素疗程的持续时间。
结果表明 AUR 存在广泛差异，并且这些比率随着时间的推移而变化。然而，总体 AUR 从 15.7-16.6%降至 10.1-10.8%，其中六个 NICU 中有四个记录的 AUR 与第一年的测量值相比呈统计学显著降低。具体来说，三级 NICU 的总体 AUR 从 15.1-16.22%降至 8.6-9.4%，二级 NICU 的总体 AUR 从 20.3-24.4%降至 14.1-16.1%。一个特别成功的二级 NICU 将其 AUR 从 22.9-30.6%降至 5.9-9.4%。
据我们所知，这是第一项利用 IDN 水平数据分析来确定 AUR 趋势的研究。我们已经确定了一些实践，可以显著降低 NICU 的 AUR，如果作为标准实践，可以在更广泛的范围内复制。
