评估万古霉素管理计划在IV级新生儿重症监护病房的有效性。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-02-06 DOI:10.1016/j.jhin.2025.01.009

M. Tas , E. Onal , A. Tapisiz , S. Bas , I.M. Hirfanoglu , H. Tezer , C. Turkyilmaz , E. Ergenekon , E. Koc

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引用次数: 0

摘要

背景和目的：尽管建议限制万古霉素对已知耐药感染的使用，但它仍然是新生儿重症监护病房（NICUs）最常用的抗生素之一。减少不必要抗生素暴露的最有效方法之一是实施抗生素管理计划（asp）。本研究的目的是评估asp在减少我们NICU住院新生儿万古霉素使用方面的有效性。方法：本研究是一项准实验性单中心研究，旨在提高质量（QI）。实施干预措施以限制万古霉素的使用，包括对新生儿重症监护团队的教育、万古霉素治疗的标准化以及前瞻性审计和反馈。将干预前与干预后进行比较。结果：万古霉素的起始用药次数由干预前的166次减少到管理实施后的71次，减少了57.2%。万古霉素总DOT / 1000 PD从113逐渐下降到45（60.2%）。结论：本研究表明，实施有效的多学科策略可以显著减少新生儿重症监护病房的万古霉素暴露。在新生儿重症监护室应用ASP做法和管理是必不可少的，而且是可以实现的，不会增加住院时间或死亡率。

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Evaluating the effectiveness of a vancomycin stewardship programme in a level IV neonatal intensive care unit

Background

Despite recommendations to limit the use of vancomycin for known resistant infections, it remains one of the most commonly prescribed antibiotics in neonatal intensive care units (NICUs). One of the most effective approaches to reducing unnecessary antibiotic exposure is through the implementation of antibiotic stewardship programmes (ASPs).

Aim

The objective of this study was to evaluate the effectiveness of ASPs in reducing the use of vancomycin in neonates hospitalized in our NICU.

Methods

This study was a quasi-experimental single-centre study for a quality improvement (QI) initiative. Interventions were implemented to limit the use of vancomycin, including education of the neonatal intensive care team, standardization of vancomycin therapy, and prospective audit and feedback. The pre-intervention period was compared with the post-intervention period.

Findings

The initiation of vancomycin decreased from 166 times in the pre-intervention period to 71 times after stewardship implementations, representing a 57.2% reduction. Total vancomycin days of therapy per 1000 patient days gradually declined from 113 to 45 (60.2%) (P<0.001) during the study period. There was an increase in the Gram-positive growth in the culture of patients who were started on vancomycin (P=0.04). The number of patients receiving two or more courses of vancomycin treatment decreased by 85.7% (P=0.03).

Conclusions

This study has demonstrated that implementing effective multi-disciplinary strategies can significantly reduce vancomycin exposure in the NICU. The application of ASP practices and management in the NICU is essential and achievable, without any increase in the duration of hospitalization or mortality rates.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.