《绒毛膜羊膜炎暴露新生儿的抗生素管理：一项质量改进项目》。
Antibiotic Stewardship in Chorioamnionitis Exposed Neonates, A Quality Improvement Project.
机构信息
University of South Dakota Sanford School of Medicine.
Sanford Children's Hospital, Boekelheide NICU, Sioux Falls, South Dakota.
出版信息
S D Med. 2024 Jul;77(7):300-303.
BACKGROUND
Rates of neonatal early onset sepsis (EOS) in term infants have recently decreased. The 2018 AAP guidelines for the management of infants at risk for early onset sepsis allows for using a multivariate risk assessment to determine need for empiric antibiotics in infants 35 weeks or greater, including those exposed to chorioamnionitis.
METHODS
A quality improvement (QI) project was undertaken to implement use of EOS calculator in chorioamnionitis exposed infants with an aim to safely decrease antibiotic exposure. Multiple Plan-Do-Study-Act (PDSA) cycles occurred to implement the change. Data regarding antibiotics, labs, length of stay and safety metrics were collected.
RESULTS
Implementing the EOS calculator's use in chorioamnionitis exposed neonates decreased antibiotic exposure from 100% to 75%, and decreased average duration of antibiotics from 68 to 40 hours. Implementation decreased prolonged courses of antibiotics, lumbar punctures, length of stay and laboratory tests. No cases of early culture confirmed EOS were missed, and none occurred in this well appearing population.
CONCLUSIONS
Quality improvement initiatives to implement evidence-based tools can safely and appropriately decrease antibiotic exposure in neonates.
背景
近期足月新生儿早发性败血症（EOS）的发生率有所下降。2018 年 AAP 关于有早发性败血症风险的婴儿管理指南允许使用多变量风险评估来确定是否需要对 35 周或以上的婴儿（包括那些暴露于绒毛膜羊膜炎的婴儿）使用经验性抗生素。
方法
开展了一项质量改进（QI）项目，以实施 EOS 计算器在绒毛膜羊膜炎暴露婴儿中的使用，旨在安全地减少抗生素暴露。实施了多次计划-执行-研究-行动（PDSA）循环来实施这一改变。收集了有关抗生素、实验室、住院时间和安全指标的数据。
结果
在绒毛膜羊膜炎暴露的新生儿中实施 EOS 计算器的使用，将抗生素的暴露率从 100%降低到 75%，并将抗生素的平均持续时间从 68 小时减少到 40 小时。实施减少了延长的抗生素疗程、腰椎穿刺、住院时间和实验室检查。没有错过一例经早期培养证实的 EOS，而且在这个外观良好的人群中也没有发生。
结论
实施循证工具的质量改进举措可以安全、适当地减少新生儿的抗生素暴露。
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