Division of Neonatology, University of Illinois College of Medicine Peoria, Peoria, Illinois.
OSF Children's Hospital of Illinois, Peoria, Illinois.
Hosp Pediatr. 2023 May 1;13(5):435-448. doi: 10.1542/hpeds.2022-006644.
Overuse of antibiotics in NICUs is a problem worldwide. Unnecessary antibiotic exposure leads to resistance, changes in the microbiome, and increases the risk of bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis (LOS), and mortality in neonates. We aimed to safely reduce the antibiotic usage rate (AUR) in our level IV unit by 10% by December 2018.
A multidisciplinary quality improvement project took place as part of a Vermont Oxford Network initiative in 2018. Multiple interventions took place, including identification of variations in practices and subsequent standardization through the creation of early onset and LOS guidelines, mass education, improved visibility of the guidelines, and standardized documentation. The main outcome measure for this project was the AUR for infants born <35 weeks' gestation expressed as antibiotic doses per 1000 patient days.
The AUR decreased from a mean of 524 to 394, for a decrease of 24.8%. Results have been sustained for 3 years. Main contributors that led to the sustained success include decreasing the overall use of antibiotics for early onset sepsis, as well as the duration when cultures are negative. The number of LOS courses also decreased slightly. We noted no cases of inadequately treated sepsis resulting in subsequent positive cultures.
Creation of guidelines with mass education and ongoing feedback/monitoring can result in a safe reduction of AUR in the NICU.
在 NICU 中过度使用抗生素是一个全球性的问题。不必要的抗生素暴露会导致耐药性、微生物组变化，并增加支气管肺发育不良、早产儿视网膜病变、脑室周围白质软化、坏死性小肠结肠炎、晚发型败血症（LOS）和新生儿死亡率的风险。我们的目标是在 2018 年 12 月前将我们的四级单位的抗生素使用率（AUR）安全降低 10%。
2018 年，作为 Vermont Oxford Network 倡议的一部分，进行了一项多学科质量改进项目。实施了多项干预措施，包括确定实践中的差异，随后通过制定早发型和 LOS 指南、大规模教育、提高指南的可见性、标准化文档来实现标准化。该项目的主要结果测量是出生时胎龄<35 周的婴儿的 AUR，用每 1000 个患者天的抗生素剂量表示。
AUR 从平均 524 降至 394，降低了 24.8%。结果已经持续了 3 年。导致持续成功的主要因素包括减少早期败血症的整体抗生素使用，以及培养结果为阴性时的持续时间。LOS 疗程的数量也略有减少。我们没有发现因治疗不足导致随后培养阳性的败血症病例。
制定指南并进行大规模教育和持续反馈/监测可以安全降低 NICU 中的 AUR。
