新生儿患有死角性肠球炎的抗菌药物管理:质量改善倡议
Devon Pace1, Shale J Mack2, Shannon Chan3
1Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Journal of pediatric surgery
|July 21, 2023
概括
在新生儿重症监护室实施抗生素管理途径,减少了piperacillin-tazobactam的使用,但没有恶化患者的治疗结果. 这一策略有效地指导了为患有NEC的早产婴儿选择抗生素.
科学领域:
- 新生儿重症监护室新生儿重症监护室
- 儿科外科手术 儿科外科手术
- 传染性疾病传染性疾病.
背景情况:
- 新生儿重症监护室 (NICU) 过度使用抗生素存在风险,死角性肠球炎 (NEC) 是早产婴儿使用抗生素的常见原因.
- 对于NEC管理中最佳的抗生素疗法存在有限的证据.
- 这项研究解决了减少新生儿NEC的抗生素暴露和向治疗的需要.
研究的目的:
- 为了减少使用 piperacillin-tazobactam 和缩短新生儿诊断出NEC的整体抗生素持续时间.
- 实施一种使用修改的贝尔阶段分类系统进行NEC管理的抗生素管理途径.
主要方法:
- 一个多学科的团队开发了一个基于贝尔阶段的NEC管理协议.
- 协议建议使用特定的抗生素方案:安培/珍塔素用于I和II阶段,添加美特罗尼达用于IIIA阶段,以及皮佩拉-塔扎巴克坦用于IIIB阶段.
- 包括抗生素暴露,手术NEC,复发,耐药性,细菌病/真菌病和死亡率在实施前和后的结果被评估.
主要成果:
- 抗生素暴露从每1000个患者日的119.19天治疗减少到80.65天.
- 皮佩拉西林-塔扎巴克坦的暴露显著减少,从每1000个患者日的中位数68.78天到7.97天的治疗 (p=0.002).
- 在干预前和干预后的组之间,在发病率或死亡率结果中没有发现显著差异.
结论:
- 抗生素管理策略可以安全地在NICU中实施,用于NEC管理.
- 钟阶段分层是指导NEC抗生素选择的有效方法.
- 建议对较大种群进行进一步的研究,以优化治疗方案并确认安全性.
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