江苏省15家医院极低/超低出生体重儿抗生素使用现状调查

Antibiotic use in very low birth weight/extremely low birth weight infants in 15 hospitals in Jiangsu Province of China: a multicenter survey

摘要:

目的 调查并分析江苏省极低/超低出生体重儿抗生素使用现状，为促进新生儿重症监护室（neonatal intensive care unit，NICU）抗生素管理质量及改进提供临床依据。 方法 回顾性分析2019年1月1日至2020年12月31日江苏省15家医院收治的极低/超低出生体重儿的一般情况及抗生素使用情况的相关资料，并设计减少抗生素使用措施的10项调查问卷表，通过问卷调查了解干预措施的实施情况。 结果 共纳入1 920例极低/超低出生体重儿，其中1 846例（96.15%）使用抗生素，抗生素使用率（antibiotic use rate，AUR）中位数为50/100住院日。15家医院AUR为24~100/100住院日。采用Poisson回归，调整胎龄、出生体重、新生儿危重评分混杂因素后，各医院间调整后抗生素使用率（adjusted antibiotic use rate，aAUR）差异有统计学意义（P<0.01）。调查结果显示，10项减少抗生素使用的措施中，8项措施开展的医院不足一半；干预措施实施项目数与aAUR呈负相关（r_s=-0.564，P=0.029）。 结论 江苏省15家医院极低/超低出生体重儿AUR高，且医院之间差异大；实施减少抗生素使用措施少的医院AUR高，促进NICU抗生素使用管理的质量改进，有望减少极低/超低出生体重儿的AUR。 ［中国当代儿科杂志，2022，24（9）：988-993］

Abstract:

Objective To investigate the current status of antibiotic use in very low birth weight/extremely low birth weight infants in Jiangsu Province of China, and to provide a clinical basis for the quality and improvement of antibiotic management in the neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on the data on general conditions and antibiotic use in the very low birth weight/extremely low birth weight infants who were admitted to 15 hospitals of Jiangsu Province from January 1, 2019 to December 31, 2020. A questionnaire containing 10 measures to reduce antibiotic use was designed to investigate the implementation of these intervention measures. Results A total of 1 920 very low birth weight/extremely low birth weight infants were enrolled, among whom 1 846 (96.15%) were treated with antibiotic, and the median antibiotic use rate (AUR) was 50/100 patient-days. The AUR ranged from 24/100 to 100/100 patient-days in the 15 hospitals. After adjustment for the confounding factors including gestational age, birth weight, and neonatal critical score, the Poisson regression analysis showed that there was a significant difference in the adjusted AUR (aAUR) among the hospitals (P<0.01). The investigation results showed that among the 10 measures to reduce antibiotic use, 8 measures were implemented in less than 50% of these hospitals, and the number of intervention measures implemented was negatively correlated with aAUR (rs=-0.564, P=0.029). Conclusions There is a high AUR among the very low birth weight/extremely low birth weight infants in the 15 hospitals of Jiangsu Province, with a significant difference among hospitals. The hospitals implementing a relatively few measures to reduce antibiotic use tend to have a high AUR. It is expected to reduce AUR in very low birth weight/extremely low birth weight infants by promoting the quality improvement of antibiotic use management in the NICU. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 988-993