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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (4): 272-275.DOI: 10.3969/j.issn.1673-5501.2023.04.005

• 论著 • 上一篇    下一篇

抗菌药物管理项目对减少新生儿肺炎抗菌药物使用的质量改进研究

孟瑶,丁翊君,王晓玲,齐宇洁   

  1. 首都医科大学附属北京儿童医院北京，100045
  • 收稿日期:2023-01-16 修回日期:2023-08-08 出版日期:2023-08-25 发布日期:2023-08-25
  • 通讯作者: 齐宇洁

Effect of antimicrobial stewardship program on reducing antimicrobial use for neonatal pneumonia: A quality improvement study

MENG Yao, DING Yijun, WANG Xiaoling, QI Yujie    

  1. Beijing Children's Hospital, Capital Medical University National Center for Children's Health, Beijing 100045, China
  • Received:2023-01-16 Revised:2023-08-08 Online:2023-08-25 Published:2023-08-25
  • Contact: QI Yujie, email: qiyj0805@yeah.net

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摘要： 背景：抗菌药物是NICU频繁使用的药物类别。抗菌药物管理项目（ASP）能促进NICU抗菌药物的使用合理化。 目的：探讨实施ASP减少新生儿肺炎的抗菌药物使用的效果。 设计：质量改进研究。 方法：本研究以新生儿肺炎为研究对象，以2019年1月1日起开始实施ASP时点前后分为对照组和干预组。对照组由主治医师基于抗菌谱经验性选择抗生素治疗，特殊病原或药物经感染科医师会诊后使用；干预组以MDTASP团队实施NICU特色的ASP，MDTASP团队包括新生儿科医师、临床药师、感染科医师、微生物室检验科医师和放射科医师等，进行定期查房、用药评估和抗菌药物使用指导。干预组样本量与对照组满足1∶1时截止纳入。 主要结局指标：抗菌药物联合用药比例。 结果：2018年1月1日至2018年6月30日回顾性纳入对照组229例，2019年1月1日至2019年5月30日前瞻性纳入干预组229例。两组新生儿一般资料和母亲基本信息差异均无统计学意义。对照组和干预组抗菌药物联合用药比例分别为24.5%（56/229）和7.0%（16/229），差异有统计学意义(χ2=26.367,P＜0.001)。对照组较干预组， 抗菌药物治疗天数由12(3~60)d缩短至8(0~35)d(P＜0.001)，住院时间由10(7~33)d缩短至9(5~46)d(P=0.005)，差异均有统计学意义。两组抗菌药物使用后出现NEC以及在院死亡的比例差异均无统计学意义。 结论：ASP可减少新生儿肺炎抗菌药物的使用，减少不必要的抗菌药物暴露。

关键词: 抗菌药物管理项目, 新生儿肺炎, 新生儿中心, 多学科团队, 抗菌药物联合使用

Abstract: Background：Antibiotics are a frequently used drug category in NICU. The Antibacterial Drug Management Project (ASP) can promote the rationalization of the use of antibiotics in NICU. Objective：To explore the effectiveness of implementing ASP to reduce the use of antibiotics in newborns with pneumonia. Design：Quality improvement research. Methods：This study focuses on infants with neonatal pneumonia and divides them into a control group and an intervention group before and after the implementation of ASP starting from January 1, 2019. The control group was treated with antibiotics selected by the attending physician based on empirical antimicrobial spectrum, and special pathogens or drugs were used after consultation with infectious disease physicians. The intervention group implemented NICU's characteristic ASP through the MDTASP team, which includes neonatologists, clinical pharmacists, infectious disease physicians, microbiology laboratory physicians, and radiologists. The MDTASP team conducted regular rounds, medication evaluations, and guidance on antibiotic use. When the sample size of the intervention group and the control group meet a 1∶1 ratio, inclusion will be terminated. Main outcome measures：Proportion of combined use of antibiotics in newborns with pneumonia. Results：From January 1, 2018 to June 30, 2018, 229 cases were retrospectively included in the control group, and from January 1, 2019 to May 30, 2019, 229 cases were prospectively included in the intervention group. There was no statistically significant difference between the two groups in terms of general information of the child and basic information of the mother. The proportion of combined use of antibiotics in the control group and intervention group was 24.5% (56/229) and 7.0% (16/229), respectively（χ2=26.367, P＜0.001). Compared with the intervention group, the days of antimicroial therapy was shortened from 12 (360) days to 8 (035) days (P＜0.001), and the length of hospital stay was shortened from 10 (733) days to 9 (546) days (P=0.005). There was no statistically significant difference in the proportion of necrotizing enterocolitis and death between the two groups after the use of antibacterial drugs. Conclusions：ASP can reduce the use of antimicrobial agents so as to decrease unnecessary antimicrobial exposure in neonatal department.

Key words: antimicrobial stewardship program, Neonatal pneumonia, Neonatal center, Multidisciplinary team, Antimicrobial combination