降低新生儿暂时性呼吸急促使用抗生素的质量改进措施。
A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn.
机构信息
Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA.
Department of Pediatrics, Division of Pediatric Infectious Diseases, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA.
出版信息
J Perinatol. 2024 Jan;44(1):119-124. doi: 10.1038/s41372-023-01850-x. Epub 2023 Dec 20.
OBJECTIVE
Evidence suggests that antibiotics are unnecessary in infants with transient tachypnea of the newborn (TTN) that are low-risk for early-onset sepsis. The aim was to reduce ampicillin and gentamicin days of therapy (DOT) in infants with suspected TTN by 10% within 12 months.
STUDY DESIGN
We used the Model for Improvement to test interventions from August 2019 to September 2021 to decrease antibiotic utilization in low-risk infants with TTN. Interventions included the creation of an evidence-based clinical pathway, admission huddles, and prescriber audit and feedback.
RESULTS
We reduced ampicillin and gentamicin use by 26% and 23%, respectively. In 123 infants with suspected TTN, we sequentially decreased starting antibiotics in this group from 71% to 41%, 13% and 0%. There were no cases of missed bacteremia.
CONCLUSION
Creation of a multidisciplinary antimicrobial stewardship QI team and subsequent interventions were successful in safely reducing antibiotic use in infants with TTN.
目的
有证据表明，对于低危早发性败血症风险的新生儿短暂性呼吸急促（TTN）患儿，抗生素是不必要的。目的是在 12 个月内将疑似 TTN 婴儿的氨苄西林和庆大霉素治疗天数（DOT）减少 10%。
研究设计
我们使用改进模型来测试 2019 年 8 月至 2021 年 9 月的干预措施，以减少低危 TTN 婴儿的抗生素使用。干预措施包括制定基于证据的临床路径、入院小组讨论以及处方审核和反馈。
结果
我们分别减少了 26%和 23%的氨苄西林和庆大霉素的使用。在 123 名疑似 TTN 的婴儿中，我们逐渐将该组的起始抗生素从 71%降至 41%、13%和 0%。没有漏诊菌血症的病例。
结论
多学科抗菌药物管理 QI 团队的创建以及随后的干预措施成功地安全减少了 TTN 婴儿的抗生素使用。
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