目的 调查并分析江苏省极低/超低出生体重儿抗生素使用现状，为促进新生儿重症监护室（neonatal intensive care unit，NICU）抗生素管理质量及改进提供临床依据。 方法 回顾性分析2019年1月1日至2020年12月31日江苏省15家医院收治的极低/超低出生体重儿的一般情况及抗生素使用情况的相关资料，并设计减少抗生素使用措施的10项调查问卷表，通过问卷调查了解干预措施的实施情况。 结果 共纳入1 920例极低/超低出生体重儿，其中1 846例（96.15%）使用抗生素，抗生素使用率（antibiotic use rate，AUR）中位数为50/100住院日。15家医院AUR为24~100/100住院日。采用Poisson回归，调整胎龄、出生体重、新生儿危重评分混杂因素后，各医院间调整后抗生素使用率（adjusted antibiotic use rate，aAUR）差异有统计学意义（P<0.01）。调查结果显示，10项减少抗生素使用的措施中，8项措施开展的医院不足一半；干预措施实施项目数与aAUR呈负相关（rs=-0.564，P=0.029）。 结论 江苏省15家医院极低/超低出生体重儿AUR高，且医院之间差异大；实施减少抗生素使用措施少的医院AUR高，促进NICU抗生素使用管理的质量改进，有望减少极低/超低出生体重儿的AUR。 ［中国当代儿科杂志，2022，24（9）：988-993］
Abstract
Objective To investigate the current status of antibiotic use in very low birth weight/extremely low birth weight infants in Jiangsu Province of China, and to provide a clinical basis for the quality and improvement of antibiotic management in the neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on the data on general conditions and antibiotic use in the very low birth weight/extremely low birth weight infants who were admitted to 15 hospitals of Jiangsu Province from January 1, 2019 to December 31, 2020. A questionnaire containing 10 measures to reduce antibiotic use was designed to investigate the implementation of these intervention measures. Results A total of 1 920 very low birth weight/extremely low birth weight infants were enrolled, among whom 1 846 (96.15%) were treated with antibiotic, and the median antibiotic use rate (AUR) was 50/100 patient-days. The AUR ranged from 24/100 to 100/100 patient-days in the 15 hospitals. After adjustment for the confounding factors including gestational age, birth weight, and neonatal critical score, the Poisson regression analysis showed that there was a significant difference in the adjusted AUR (aAUR) among the hospitals (P<0.01). The investigation results showed that among the 10 measures to reduce antibiotic use, 8 measures were implemented in less than 50% of these hospitals, and the number of intervention measures implemented was negatively correlated with aAUR (rs=-0.564, P=0.029). Conclusions There is a high AUR among the very low birth weight/extremely low birth weight infants in the 15 hospitals of Jiangsu Province, with a significant difference among hospitals. The hospitals implementing a relatively few measures to reduce antibiotic use tend to have a high AUR. It is expected to reduce AUR in very low birth weight/extremely low birth weight infants by promoting the quality improvement of antibiotic use management in the NICU. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 988-993
关键词
抗生素 /
多中心研究 /
极低出生体重儿 /
超低出生体重儿
Key words
Antibiotic /
Multicenter survey /
Very low birth weight infant /
Extremely low birth weight infant
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参考文献
1 Harriman TL, Carter B, Dail RB, et al. Golden hour protocol for preterm infants: a quality improvement project[J]. Adv Neonatal Care, 2018, 18(6): 462-470. PMID: 30212389. DOI: 10.1097/ANC.0000000000000554.
2 Cotten CM, Taylor S, Stoll B, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants[J]. Pediatrics, 2009, 123(1): 58-66. PMID: 19117861. PMCID: PMC2760222. DOI: 10.1542/peds.2007-3423.
3 Kuppala VS, Meinzen-Derr J, Morrow AL, et al. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants[J]. J Pediatr, 2011, 159(5): 720-725. PMID: 21784435. PMCID: PMC3193552. DOI: 10.1016/j.jpeds.2011.05.033.
4 Saiman L, Ludington E, Dawson JD, et al. Risk factors for Candida species colonization of neonatal intensive care unit patients[J]. Pediatr Infect Dis J, 2001, 20(12): 1119-1124. PMID: 11740316. DOI: 10.1097/00006454-200112000-00005.
5 Araujo da Silva AR, Marques A, Di Biase C, et al. Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review[J]. Arch Dis Child, 2020, 105(6): 563-568. PMID: 32156697. DOI: 10.1136/archdischild-2019-318026.
6 Jiang S, Zhang L, Yan W, et al. Antibiotic use in neonatal intensive care units in China: a multicenter cohort study[J]. J Pediatr, 2021, 239: 136-142.e4. PMID: 34461063. DOI: 10.1016/j.jpeds.2021.08.067.
7 Ting JY, Synnes A, Roberts A, et al. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis[J]. JAMA Pediatr, 2016, 170(12): 1181-1187. PMID: 27775765. DOI: 10.1001/jamapediatrics.2016.2132.
8 Lu C, Liu Q, Yuan H, et al. Implementation of the smart use of antibiotics program to reduce unnecessary antibiotic use in a neonatal ICU: a prospective interrupted time-series study in a developing country[J]. Crit Care Med, 2019, 47(1): e1-e7. PMID: 30285980. DOI: 10.1097/CCM.0000000000003463.
9 Wang B, Li G, Jin F, et al. Effect of weekly antibiotic round on antibiotic use in the neonatal intensive care unit as antibiotic stewardship strategy[J]. Front Pediatr, 2020, 8: 604244. PMID: 33384975. PMCID: PMC7769868. DOI: 10.3389/fped.2020.604244.
10 曹云, 程国强, 侯新琳, 等. 新生儿细菌性脑膜炎病因、诊断与治疗[J]. 中华围产医学杂志, 2016, 19(12): 881-884. DOI: 10.3760/cma.j.issn.1007-9408.2016.12.001.
11 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257. PMID: 30934196. DOI: 10.3760/cma.j.issn.0578-1310.2019.04.005.
12 中国医师协会新生儿科医师分会循证专业委员会. 新生儿坏死性小肠结肠炎临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2021, 23(1): 1-11. PMID: 33476530. PMCID: PMC7818154. DOI: 10.7499/j.issn.1008-8830.2011145.
13 Stein R, Dogan HS, Hoebeke P, et al. Urinary tract infections in children: EAU/ESPU guidelines[J]. Eur Urol, 2015, 67(3): 546-558. PMID: 25477258. DOI: 10.1016/j.eururo.2014.11.007.
14 Ho T, Dukhovny D, Zupancic JA, et al. Choosing wisely in newborn medicine: five opportunities to increase value[J]. Pediatrics, 2015, 136(2): e482-e489. PMID: 26195536. DOI: 10.1542/peds.2015-0737.
15 Cantey JB, Wozniak PS, Pruszynski JE, et al. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study[J]. Lancet Infect Dis, 2016, 16(10): 1178-1184. PMID: 27452782. DOI: 10.1016/S1473-3099(16)30205-5.
16 Meyers JM, Tulloch J, Brown K, et al. A quality improvement initiative to optimize antibiotic use in a level 4 NICU[J]. Pediatrics, 2020, 146(5): e20193956. PMID: 33055227. DOI: 10.1542/peds.2019-3956.
17 Centers for Disease Control and Prevention. The core elements of hospital antibiotic stewardship programs: 2019[EB/OL]. [2021-08-25]. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf.
18 中华医学会急诊学分会儿科学组. 中华医学会儿科学分会急诊学组、新生儿学组. 新生儿危重病例评分法(草案)[J]. 中华儿科杂志, 2001, 39(1): 42-43. DOI: 10.3760/j.issn:0578-1310.2001.01.013.
19 江苏省NICU母乳喂养质量改进临床研究协作组. 极/超低出生体重儿住院期间人乳喂养情况多中心回顾性分析[J]. 中华新生儿科杂志, 2020, 35(3): 164-168. DOI: 10.3760/cma.j.issn.2096-2932.2020.03.002.
20 江苏省新生儿重症监护病房母乳质量改进临床研究协作组. 多中心回顾性分析极低及超低出生体重儿支气管肺发育不良的临床特点及高危因素[J]. 中华儿科杂志, 2019, 57(1): 33-39. PMID: 30630229. DOI: 10.3760/cma.j.issn.0578-1310.2019.01.009.
21 江苏省NICU母乳喂养质量改进临床研究协作组. 江苏省13家医院极早产儿死亡危险因素分析[J]. 中华新生儿科杂志, 2021, 36(5): 24-29. DOI: 10.3760/cma.j.issn.2096-2932.2021.05.006.
22 Shah PS, Seidlitz W, Chan P, et al. Internal audit of the Canadian neonatal network data collection system[J]. Am J Perinatol, 2017, 34(12): 1241-1249. PMID: 28499309. DOI: 10.1055/s-0037-1603325.
23 王铭杰, 岳少杰, 林锦, 等. 湖南省极低/超低出生体重儿抗生素使用多中心调查报告[J]. 中国当代儿科杂志, 2020, 22(6): 561-566. PMID: 32571452. PMCID: PMC7390206. DOI: 10.7499/j.issn.1008-8830.1912085.
24 Stoll BJ, Hansen NI, Sánchez PJ, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues[J]. Pediatrics, 2011, 127(5): 817-826. PMID: 21518717. PMCID: PMC3081183. DOI: 10.1542/peds.2010-2217.
25 吴新萍, 谷传丽, 韩树萍, 等. 极早产儿存活率和并发症的多中心回顾性研究[J]. 中国当代儿科杂志, 2021, 23(8): 814-820. PMID: 34511171. PMCID: PMC8428915. DOI: 10.7499/j.issn.1008-8830.2102037.
26 Patel SJ, Rosen E, Zaoutis T, et al. Neonatologists' perceptions of antimicrobial resistance and stewardship in neonatal intensive care units[J]. Infect Control Hosp Epidemiol, 2010, 31(12): 1298-1300. PMID: 20979494. PMCID: PMC4526133. DOI: 10.1086/657334.
基金
南京市医学科技发展基金（ZKX16062、YKK17176）；江苏省妇幼健康科研项目（F201642）；江苏省妇幼健康重点人才（FRC201740）。
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