Effects Of Antibacterial Drugs’ Clinical Application Control On Neonatal Bloodstream Infections

Objective: To study the effects of antibacterial drugs’clinicalapplication control on the pathogen and clinical manifestation of neonatalbloodstream infections, which provides an evidence for the betterantibacterial drugs specification.Methods: All patients admitted to the neonatal ward of our hospitalin the year of2010(group before control) and2013(group after control)are involved in this retrospective study. Within each group,542and1239patients are diagnosed as neonatal septicemia, purulent meningitis or acutehematogenous osteomyelitis, no matter confirmed or suspected. Accordingto the diagnostic criteria in the fourth edition of Practical Neonatology andthe fourth edition of Pediatric Surgery, we get168and470casesconfirmed diagnosed as the above three bloodstream infectious diseases.Results:1.The overall situation of all hospitalized cases in2010and2013:(1) There is a total of7265patients in2013and6045patients in2010, admitted rate of bloodstream infection cases of2013(6.47%) ishigher than that of2010(2.78%)(P<0.01).(2) Bloodstream nosocomial infection incidence of2013(0.70%) is higher than that of2010(0.30%)(P=0.001).(3) Utilization rate of antibacterial drugs of2013(79.25%) islower than that of2010(91.83%)(P＜0.01), antibiotic use density of2013(8.37) is lower than that of2010(10.65).2. The situation of neonatalbloodstream infection cases in2010and2013:(1) Gram positive bacteriainfection rate of2013(52.08%) is lower than that of2010(75.32%)(P=0.001), Gram negative bacteria and fungus infection rate of2013(40.97%,6.94%) are both higher than those of2010(24.68%,0.00%)(P=0.016,P=0.018).(2) The four leading pathogens of blood culture of2010and2013are similar, including staphylococcus haemolyticus,staphylococcus epidermidis, klebsiella pneumoniae pneumoniae andescherichia coli, which have no statistical differences of MRS,β-lactamase positive and ESBL positive rate between2010and2013(P>0.05).(3) Utilization rates of penicillins, the first and secondgenerations of cephalosporins, the third and fourth generations ofcephalosporins of2013(73.62%,21.28%,39.79%) are all lower thanthose of2010(92.86%,75%,53.57%)(P＜0.01), utilization rate ofcarbapenems of2013(35.74%) is higher than that of2010(16.07%)(P＜0.01), whereas no statistical difference of the utilization rate ofglycopeptides between2010and2013(P=0.261).(4) The antibacterialdrugs combined usage of2013is mainly single use (59.87%)，which issignificantly higher than that of2010(8.33%)(P<0.01).(5) The times antibacterial drugs being changed of2013(0.83±1.037) is less than that of2010(1.07±1.135)(P=0.013).(6) The days antibacterial drugs being usedof2013(15.45±13.36) is more than that of2010(12.12±10.7)(P=0.001).(7) There’s no statistical difference of the patients’ outcome between2010and2013(P>0.05).(8) The average hospitalized days of2013(16.08±14.345) is more than that of2010(11.96±12.356)(P<0.01).Conclusion: The program of antibacterial drugs’ clinical applicationcontrol was put into implementation since august2012in the neonatalward of our hospital. The utilization rate and use density of antibacterialdrugs of2013are both significantly lower than that of2010. For thebloodstream infection cases, there is no significant variation of thecommon pathogens and their drug resistance between2010and2013,meanwhile, the change times and combined usage of antibacterial drugs of2013are significantly improved than2010, although bloodstreamnosocomial infection rate is increased in2013, there is no deterioration ofthe outcomes of these cases.