Dowling Jameson, Arscott-Mills Tonya, Bayani One, Boustany Mickael, Moorad Banno, Richard-Greenblatt Melissa, Tlhako Nametso, Zalot Morgan, Steenhoff Andrew P, Gezmu Alemayehu M, Nakstad Britt, Strysko Jonathan, Coffin Susan E, McGann Carolyn
College of Public Health, Temple University, Philadelphia, PA 19122, USA.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Microorganisms. 2023 Oct 27;11(11):2641. doi: 10.3390/microorganisms11112641.
In low- and middle-income countries, where antimicrobial access may be erratic and neonatal sepsis pathogens are frequently multidrug-resistant, empiric antibiotic prescribing practices may diverge from the World Health Organization (WHO) guidelines. This study examined antibiotic prescribing for neonatal sepsis at a tertiary referral hospital neonatal unit in Gaborone, Botswana, using data from a prospective cohort of 467 neonates. We reviewed antibiotic prescriptions for the first episode of suspected sepsis, categorized as early-onset (EOS, days 0-3) or late-onset (LOS, >3 days). The WHO prescribing guidelines were used to determine whether antibiotics were "guideline-synchronous" or "guideline-divergent". Logistic regression models examined independent associations between the time of neonatal sepsis onset and estimated gestational age (EGA) with guideline-divergent antibiotic use. The majority (325/470, 69%) were prescribed one or more antibiotics, and 31 (10%) received guideline-divergent antibiotics. Risk factors for guideline-divergent prescribing included neonates with LOS, compared to EOS (aOR [95% CI]: 4.89 (1.81, 12.57)). Prematurity was a risk factor for guideline-divergent prescribing. Every 1-week decrease in EGA resulted in 11% increased odds of guideline-divergent antibiotics (OR [95% CI]: 0.89 (0.81, 0.97)). Premature infants with LOS had higher odds of guideline-divergent prescribing. Studies are needed to define the causes of this differential rate of guideline-divergent prescribing to guide future interventions.
在低收入和中等收入国家，抗菌药物的可及性可能不稳定，且新生儿败血症病原体常常具有多重耐药性，经验性抗生素处方做法可能与世界卫生组织（WHO）的指南不一致。本研究利用来自博茨瓦纳哈博罗内一家三级转诊医院新生儿科467名新生儿的前瞻性队列数据，调查了新生儿败血症的抗生素处方情况。我们回顾了疑似败血症首次发作时的抗生素处方，分为早发型（EOS，0 - 3天）或晚发型（LOS，>3天）。采用WHO处方指南来确定抗生素使用是“符合指南”还是“偏离指南”。逻辑回归模型研究了新生儿败血症发病时间和估计胎龄（EGA）与偏离指南使用抗生素之间的独立关联。大多数（325/470，69%）新生儿被开具了一种或多种抗生素，31名（10%）接受了偏离指南的抗生素治疗。偏离指南处方的危险因素包括LOS新生儿，与EOS新生儿相比（调整后比值比[aOR][95%置信区间]：4.89（1.81，12.57））。早产是偏离指南处方的一个危险因素。EGA每减少1周，偏离指南使用抗生素的几率增加11%（比值比[OR][95%置信区间]：0.89（0.81，0.97））。LOS的早产儿偏离指南处方的几率更高。需要开展研究来确定这种偏离指南处方差异率的原因，以指导未来的干预措施。
