Jacquelyn Em Grev, Mallary Van Tol, Brooke Welker, Bette Schumacher, Lori Mulder, Andrea Dykstra, Laurie Richards
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引用次数: 0
Abstract
Background: Rates of neonatal early onset sepsis (EOS) in term infants have recently decreased. The 2018 AAP guidelines for the management of infants at risk for early onset sepsis allows for using a multivariate risk assessment to determine need for empiric antibiotics in infants 35 weeks or greater, including those exposed to chorioamnionitis.
Methods: A quality improvement (QI) project was undertaken to implement use of EOS calculator in chorioamnionitis exposed infants with an aim to safely decrease antibiotic exposure. Multiple Plan-Do-Study-Act (PDSA) cycles occurred to implement the change. Data regarding antibiotics, labs, length of stay and safety metrics were collected.
Results: Implementing the EOS calculator's use in chorioamnionitis exposed neonates decreased antibiotic exposure from 100% to 75%, and decreased average duration of antibiotics from 68 to 40 hours. Implementation decreased prolonged courses of antibiotics, lumbar punctures, length of stay and laboratory tests. No cases of early culture confirmed EOS were missed, and none occurred in this well appearing population.
Conclusions: Quality improvement initiatives to implement evidence-based tools can safely and appropriately decrease antibiotic exposure in neonates.
背景：最近，足月儿中新生儿早发败血症（EOS）的发病率有所下降。2018 年美国儿科协会（AAP）早发败血症风险婴儿管理指南允许使用多变量风险评估来确定 35 周或更大的婴儿是否需要使用经验性抗生素，包括那些暴露于绒毛膜羊膜炎的婴儿：方法：开展了一项质量改进（QI）项目，在绒毛膜羊膜炎暴露婴儿中使用 EOS 计算器，目的是安全地减少抗生素暴露。为实施这一变革，进行了多次 "计划-实施-研究-行动"（PDSA）循环。收集了有关抗生素、实验室、住院时间和安全指标的数据：结果：在暴露于绒毛膜羊膜炎的新生儿中使用 EOS 计算器后，抗生素暴露率从 100% 降至 75%，平均抗生素使用时间从 68 小时降至 40 小时。抗生素疗程延长、腰椎穿刺、住院时间和实验室检查次数均有所减少。没有遗漏任何早期培养确诊的 EOS 病例，也没有在这一表现良好的人群中发生任何 EOS 病例：结论：实施循证工具的质量改进措施可以安全、适当地减少新生儿的抗生素暴露。
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