PDF(Pubmed)
Abstract：
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.
摘要：
在低收入和中等收入国家，在那里，抗菌药物的使用可能是不稳定的，新生儿败血症病原体经常是多重耐药的，经验性抗生素处方实践可能与世界卫生组织(WHO)指南不同.这项研究检查了哈博罗内三级转诊医院新生儿病房中新生儿败血症的抗生素处方，博茨瓦纳,使用467名新生儿的前瞻性队列数据。我们回顾了第一次疑似脓毒症的抗生素处方，归类为早发性(EOS，第0-3天)或迟发性(LOS，>3天）。WHO处方指南用于确定抗生素是“指南同步”还是“指南发散”。Logistic回归模型检查了新生儿败血症发病时间与估计胎龄（EGA）之间的独立关联，并与指南不同的抗生素使用。大多数（325/470，69％）开了一种或多种抗生素，和31（10％）接受了指南不同的抗生素。指南不同处方的危险因素包括新生儿LOS，与EOS相比（aOR[95%CI]：4.89（1.81，12.57））。早产是指南不同处方的风险因素。EGA每减少1周导致使用指南不同抗生素的几率增加11％（OR[95％CI]：0.89（0.81，0.97））。患有LOS的早产儿有较高的指南分歧处方几率。需要研究来确定这种指南差异率的原因，以指导未来的干预措施。
