Abstract：
To evaluate the safety and effectiveness of evidence-based antibiotic stewardship in a neonatal unit in China. The study period consisted of two phases, one retrospective (the baseline period, January to December 2018, and the transition period, January 2019 to August 2020) and one prospective intervention period (September 2020 to August 2021). During the prospective period, evidence-based antibiotic stewardship was applied to neonates with suspected infections, pneumonia, and culture-negative sepsis. The antibiotic stewardship included the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis. The change in antibiotic use measured by days of therapy per 1000 patient-days between the baseline and intervention period was analyzed. Safety outcomes included reinitiation of antibiotics within 14 days, length of stay, occurrence of late-onset sepsis and necrotizing enterocolitis (Bell stage ≥ II), multidrug-resistant organism infections, and mortality. A total of 7705 neonates were enrolled during the baseline (n = 4804) and the intervention periods (n = 2901). The total antibiotic usage during the baseline period was 771 days of therapy per 1000 patient-days, while that was 525 days of therapy per 1000 patient-days during the intervention period, indicating a 32% decrease in antibiotic consumption. No significant difference in safety outcomes was observed between the baseline and intervention period (P > 0.05), whereas the length of stay was longer during the intervention period (P < 0.001).
CONCLUSIONS: The evidence-based antibiotic stewardship can safely and effectively reduce antibiotic use and shorten the duration of therapy in the neonatal unit.
BACKGROUND: • Overuse of antibiotics has been associated with adverse events in neonates, including necrotizing enterocolitis, multidrug-resistant organism infections, and death. • More clinical effectiveness evidence is needed to support antibiotic stewardship of neonates in China.
BACKGROUND: • Using prospective audit, targeted stewardship interventions, this study shows that a 32% reduction in overall antibiotic consumption was achieved safely. • Implementation of evidence-based neonatal antibiotic stewardship, including the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis, is safe and effective among newborns in a developing country.
CONCLUSIONS: The evidence-based antibiotic stewardship can safely and effectively reduce antibiotic use and shorten the duration of therapy in the neonatal unit.
BACKGROUND: • Overuse of antibiotics has been associated with adverse events in neonates, including necrotizing enterocolitis, multidrug-resistant organism infections, and death. • More clinical effectiveness evidence is needed to support antibiotic stewardship of neonates in China.
BACKGROUND: • Using prospective audit, targeted stewardship interventions, this study shows that a 32% reduction in overall antibiotic consumption was achieved safely. • Implementation of evidence-based neonatal antibiotic stewardship, including the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis, is safe and effective among newborns in a developing country.
摘要：
评价中国新生儿病房循证抗生素管理的安全性和有效性。研究期间包括两个阶段，一次回顾性(基线期，2018年1月至12月，以及过渡期，2019年1月至2020年8月）和一个前瞻性干预期（2020年9月至2021年8月）。在预期期间，基于证据的抗生素管理应用于疑似感染的新生儿，肺炎,和培养阴性脓毒症。抗生素管理包括新生儿感染的观察表，对可疑感染的抗生素治疗不超过48小时，肺炎和培养阴性脓毒症5天。分析了基线和干预期之间每1000名患者的治疗天数测量的抗生素使用变化。安全性结果包括14天内重新使用抗生素，逗留时间,迟发性脓毒症和坏死性小肠结肠炎的发生（Bell分期≥II），多药耐药菌感染，和死亡率。在基线（n=4804）和干预期（n=2901）期间共招募了7705名新生儿。基线期间的抗生素总使用量为每1000名患者天771天的治疗，而在干预期间，每1000名患者天接受525天的治疗，表明抗生素消费量减少了32%。基线和干预期的安全性结果无显著差异(P>0.05)。而干预期间住院时间较长(P<0.001)。
结论：基于证据的抗生素管理可以安全有效地减少新生儿病房的抗生素使用并缩短治疗时间。
背景：•抗生素的过度使用与新生儿不良事件有关，包括坏死性小肠结肠炎,多药耐药菌感染，和死亡。•需要更多的临床有效性证据来支持中国新生儿的抗生素管理。
背景：•使用前瞻性审计，有针对性的管理干预措施，这项研究表明,抗生素总消耗量安全地减少了32%.•实施循证新生儿抗生素管理，包括新生儿感染的观察表，对可疑感染的抗生素治疗不超过48小时，肺炎和培养阴性脓毒症5天，在发展中国家的新生儿中是安全有效的。
结论：基于证据的抗生素管理可以安全有效地减少新生儿病房的抗生素使用并缩短治疗时间。
背景：•抗生素的过度使用与新生儿不良事件有关，包括坏死性小肠结肠炎,多药耐药菌感染，和死亡。•需要更多的临床有效性证据来支持中国新生儿的抗生素管理。
背景：•使用前瞻性审计，有针对性的管理干预措施，这项研究表明,抗生素总消耗量安全地减少了32%.•实施循证新生儿抗生素管理，包括新生儿感染的观察表，对可疑感染的抗生素治疗不超过48小时，肺炎和培养阴性脓毒症5天，在发展中国家的新生儿中是安全有效的。
