ABSTRACT

Background

Antibiotics play a critical role in neonatal sepsis but excessive use is associated with adverse outcomes and the current prescribing rates of antibiotics are unacceptably high.

Aim

To reduce antibiotic over-use in preterm neonates by implementing an antibiotic stewardship programme using a quality improvement (QI) initiative.

Methods

This study was conducted at a neonatal intensive care unit in a resource-limited setting. The reasons for antibiotic over-use were analysed and an antibiotic stewardship programme was implemented by using a QI initiative. The duration of the QI was a 1-month baseline phase followed by 3 months of implementation which was undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustainment phase was observed for 2 months. All neonates admitted to the preterm unit were included. The outcome measure was the antibiotic usage expressed as days of therapy (DOT)/1000 patient days.

Results

In the baseline phase, DOT/1000 patient days was 1464 which fell to 706, 511, and 442 DOT/1000 patient days, respectively, over 3 months, resulting in a 65% reduction in antibiotic usage. This was achieved by a combination of efforts directed towards defining the conditions for no antibiotics, revising existing antibiotic policy, stopping orders at 48 hours, de-escalation to the narrowest spectrum antibiotic, stopping prophylactic antifungal agents and limited use of broad-spectrum antibiotics. The results were achieved without an increase in culture-positive sepsis or mortality.

Conclusions

Implementation of a tailored antibiotic stewardship programme through a QI initiative was effective and safe in reducing antibiotic use in preterm neonates in a resource-limited setting.

Abbreviations

AIIMS, All India Institute of Medical Sciences; DOT, days of therapy; HIC, high-income countries; ICMR, Indian Council of Medical Research; LMIC, low- to middle-income countries; LOS, late-onset sepsis; NICU, neonatal intensive care unit; NNF, National Neonatology Forum; P-D-S-A, plan-do-study-act; QI, quality improvement; SNCU, Special newborn care unit.

中文翻译：

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通过在资源有限的环境中对早产儿实施抗生素管理计划来减少抗生素的过度使用——一项质量改进计划

摘要

背景

抗生素在新生儿败血症中起关键作用，但过度使用与不良后果相关，目前抗生素的处方率高得令人无法接受。

目标

通过使用质量改进 (QI) 倡议实施抗生素管理计划，减少早产儿抗生素的过度使用。

方法

这项研究是在资源有限的新生儿重症监护病房进行的。分析了抗生素过度使用的原因，并通过使用 QI 倡议实施了抗生素管理计划。QI 的持续时间是 1 个月的基线阶段，然后是 3 个月的实施，以计划-实施-研究-行动 (PDSA) 周期的形式进行。维持阶段被观察了 2 个月。纳入早产单元的所有新生儿都包括在内。结果测量是抗生素使用情况，表示为治疗天数 (DOT)/1000 患者天数。

结果

在基线阶段，DOT/1000 患者日为 1464，在 3 个月内分别下降至 706、511 和 442 DOT/1000 患者日，抗生素使用量减少了 65%。这是通过一系列努力来实现的，这些努力旨在确定不使用抗生素的条件、修改现有的抗生素政策、在 48 小时停止订单、降级为最窄谱抗生素、停止预防性抗真菌药物和限制使用广谱抗生素。结果是在没有增加培养阳性脓毒症或死亡率的情况下实现的。

结论

在资源有限的环境中，通过 QI 倡议实施量身定制的抗生素管理计划在减少早产新生儿的抗生素使用方面是有效且安全的。

缩写

AIIMS，全印度医学科学研究所；DOT，治疗天数；HIC，高收入国家；ICMR，印度医学研究委员会；LMIC，中低收入国家；LOS，迟发性败血症；NICU，新生儿重症监护室；NNF，全国新生儿学论坛；PDSA，计划-学习-行动；QI，质量改进；SNCU，特殊新生儿护理单元。