Antibiotic use in very low birth weight/extremely low birth weight infants in 15 hospitals in Jiangsu Province of China: a multicenter survey

ZHAO Juan-Juan; HAN Shu-Ping; YU Zhang-Bin; PAN Zhao-Juan; ZHOU Qin; JIANG Shan-Yu; WAN Jun; ZHANG Lin; WANG Huai-Yan; MENG Meng; XU Yan; CHEN Xiao-Qing; XUE Mei; YANG Li; WU Ming-Fu; GU Li; LU Hong-Yan; QIAO Yu; WU Xin-Ping; GU Chuan-Li; HOU Wei-Wei; GAO Yan; YANG Shou-Hong; ZHANG Ji-Hua; LIU Song-Lin

doi:10.7499/j.issn.1008-8830.2204165

PDF(581 KB)

Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (9) : 988-993. DOI: 10.7499/j.issn.1008-8830.2204165

CLINICAL RESEARCH

Antibiotic use in very low birth weight/extremely low birth weight infants in 15 hospitals in Jiangsu Province of China: a multicenter survey

ZHAO Juan-Juan, HAN Shu-Ping, YU Zhang-Bin, PAN Zhao-Juan, ZHOU Qin, JIANG Shan-Yu, WAN Jun, ZHANG Lin, WANG Huai-Yan, MENG Meng, XU Yan, CHEN Xiao-Qing, XUE Mei, YANG Li, WU Ming-Fu, GU Li, LU Hong-Yan, QIAO Yu, WU Xin-Ping, GU Chuan-Li, HOU Wei-Wei, GAO Yan, YANG Shou-Hong, ZHANG Ji-Hua, LIU Song-Lin

Author information +

History +

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 (r_s=-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

Key words

Antibiotic / Multicenter survey / Very low birth weight infant / Extremely low birth weight infant

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

ZHAO Juan-Juan, HAN Shu-Ping, YU Zhang-Bin, PAN Zhao-Juan, ZHOU Qin, JIANG Shan-Yu, WAN Jun, ZHANG Lin, WANG Huai-Yan, MENG Meng, XU Yan, CHEN Xiao-Qing, XUE Mei, YANG Li, WU Ming-Fu, GU Li, LU Hong-Yan, QIAO Yu, WU Xin-Ping, GU Chuan-Li, HOU Wei-Wei, GAO Yan, YANG Shou-Hong, ZHANG Ji-Hua, LIU Song-Lin. Antibiotic use in very low birth weight/extremely low birth weight infants in 15 hospitals in Jiangsu Province of China: a multicenter survey[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(9): 988-993 https://doi.org/10.7499/j.issn.1008-8830.2204165

References

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.