Holgate Sandi L, Bekker Adrie, Pillay-Fuentes Lorente Veshni, Dramowski Angela
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Front Pediatr. 2022 Mar 3;10:838153. doi: 10.3389/fped.2022.838153. eCollection 2022.
Antimicrobial prescription and administration-related errors occur frequently in very low birth weight (VLBW; <1,500 g) neonates treated for bloodstream infections (BSI).
Antimicrobial prescriptions for the treatment of laboratory-confirmed BSI were retrospectively analyzed for VLBW neonates at Tygerberg Hospital, Cape Town, South Africa (1 July 2018 - 31 December 2019), describing antimicrobial type, indication, duration of therapy and BSI outcomes. The prevalence of, and risk factors for prescription (dose, interval) and administration errors (hang-time, delayed/missed doses) were determined.
One hundred and sixty-one BSI episodes [16 (9.9%)] early-onset, 145 [90.1%] healthcare-associated) affected 141 neonates (55% male, 25% born to mothers living with HIV, 46% <1,000 g birth weight) with 525 antimicrobial prescription episodes [median 3.0 (IQR 2-4) prescriptions/BSI episode]. The median duration of therapy for primary BSI, BSI-associated with meningitis and BSI-associated with surgical infections was 9, 22, and 28 days, respectively. The prevalence of dose and dosing interval errors was 15.6% (77/495) and 16.4% (81/495), respectively with prescription errors occurring most commonly for piperacillin-tazobactam and vancomycin given empirically. Administration errors were less frequent [3.8% (219/5,770) doses missed; 1.4% (78/5,770) delayed], however 64% had a hang-time (time from sepsis diagnosis to 1st dose of antimicrobial) exceeding 60 min. On multivariable analysis, postnatal age >7 days was associated with prescription errors ( = 0.028). The majority of neonates with BSI required escalation of respiratory support (52%) and 26% required intensive care admission. Despite fair concordance between empiric antimicrobial/s prescription and pathogen susceptibility (74.5%), BSI-attributable mortality in this cohort was 30.4%.
VLBW neonates with BSI's were critically ill and had high mortality rates. Hang-time to first antimicrobial administration was delayed in two-thirds of BSI episodes and prescription errors affected almost 1 in 6 prescriptions. Targets for intervention should include reducing hang-time, use of standardized antimicrobial dosing guidelines and implementation of antimicrobial stewardship recommendations.
在接受血流感染（BSI）治疗的极低出生体重（VLBW；<1500克）新生儿中，抗菌药物处方和给药相关错误频繁发生。
回顾性分析了南非开普敦泰格伯格医院（2018年7月1日至2019年12月31日）VLBW新生儿治疗实验室确诊BSI的抗菌药物处方，描述了抗菌药物类型、适应症、治疗持续时间和BSI结局。确定了处方（剂量、间隔）和给药错误（悬挂时间、延迟/漏服剂量）的发生率及危险因素。
161例BSI发作[16例（9.9%）早发型，145例（90.1%）医疗相关型]累及141例新生儿（55%为男性，25%母亲为HIV感染者，46%出生体重<1000克），有525次抗菌药物处方发作[中位数3.0（四分位间距2 - 4）次处方/BSI发作]。原发性BSI、与脑膜炎相关的BSI和与手术感染相关的BSI的中位治疗持续时间分别为9天、22天和28天。剂量和给药间隔错误的发生率分别为15.6%（77/495）和16.4%（81/495），经验性使用哌拉西林 - 他唑巴坦和万古霉素时处方错误最常见。给药错误较少见[3.8%（219/5770）剂量漏服；1.4%（78/5770）延迟]，然而64%患儿的悬挂时间（从败血症诊断到首次使用抗菌药物的时间）超过60分钟。多变量分析显示出生后年龄>7天与处方错误相关（P = 0.028）。大多数BSI新生儿需要升级呼吸支持（52%）且26%需要入住重症监护病房。尽管经验性抗菌药物处方与病原体敏感性之间一致性尚可（74.5%），但该队列中BSI所致死亡率为30.4%。
患有BSI的VLBW新生儿病情危重且死亡率高。三分之二的BSI发作中首次使用抗菌药物的悬挂时间延迟，近六分之一的处方存在处方错误。干预目标应包括缩短悬挂时间、使用标准化抗菌药物给药指南以及实施抗菌药物管理建议。
