Abstract：
The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72 h and for pneumonia was more than 7 days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72 h, treatment duration for culture-negative pneumonia less than 7 days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3 days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72 h for 47.48% patients with rule-out sepsis and within 7 days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.
摘要：
中国新生儿重症监护病房抗生素管理的调查很少。本研究旨在分析在4级NICU中进行为期2年的全面抗生素管理的效果。在2017年10月1日至2019年10月1日的这个基线期间，对于排除的脓毒症疗程，继续进行经验性抗生素治疗超过72小时，对于肺炎超过7天。使用美罗培南或万古霉素，即使它们不是唯一的细菌敏感抗生素。干预期为2019年10月2日至2021年8月23日。我们中心针对质量改进的三个领域：在72小时内排除的败血症中停止使用抗生素，培养阴性肺炎的治疗持续时间少于7天，除非培养的细菌对万古霉素或美罗培南敏感，否则不使用万古霉素或美罗培南。从基线到干预期，每1000名患者的抗生素总消耗量从791.1天降至466.3天。47.48％的排除脓毒症患者在72小时内停用抗生素，75.70％的肺炎患者在7天内停用抗生素，而基线期间分别为11.56％和37.69％。多重耐药菌的患病率从67.20降至48.90%。美罗培南或万古霉素的总使用率从7.6％下降到1.8％。我们对抗生素策略的质量改进方法显着降低了NICU中抗生素的使用和多药耐药菌的患病率。
