背景:新生儿重症监护病房(NICU)的抗生素使用存在很大差异。关于早产极低出生体重(VLBW)婴儿的抗菌药物管理(AS)计划和长期维持AS干预措施的数据有限。
方法:我们扩展了一项在意大利NICU进行的单中心观察性研究。比较了三个时期:I.“基线”(2011-2012年),II.“干预”(2016-2017年),和III。“维护”(2020-2021年)。在第一阶段和第二阶段之间对医务人员和护理人员进行AS的强化培训。在II期和III期之间维持并实施AS协议和算法。
结果:在I期,有111、119和100名VLBW婴儿,II,III,分别。在“干预期”中,抗生素的使用减少了,报告为每1000名患者天的抗生素治疗天数(215vs.302,p<0.01)。在“维护期”中,培养证实的脓毒症数量增加.然而,未感染的VLBW婴儿的抗生素暴露较低,而没有发生与脓毒症相关的死亡。我们的限制主要针对缩短抗生素治疗方案,并采用48小时排除脓毒症的政策(早期经验性抗生素的中位天数:6vs.3vs.2在时期I,II,III,分别,p<0.001)。此外,用于所谓培养阴性脓毒症的抗生素减少(22%vs.11%vs.6%,p=0.002),特别是对于出生体重在1000至1499g之间的婴儿。
结论:AS在早产VLBW婴儿中是可行的,和抗生素的使用可以安全地减少。作为干预措施,即,缩短未感染婴儿的抗生素疗程,通过定期的临床审核和工作人员对抗菌治疗的日常讨论,可以持续一段时间。
BACKGROUND: There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants.
METHODS: We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared: I. \"baseline\" (2011-2012), II. \"intervention\" (2016-2017), and III. \"maintenance\" (2020-2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III.
RESULTS: There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the \"intervention period\", there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the \"maintenance period\", the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics: 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g.
CONCLUSIONS: AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members.