| Objective:Compare the use of antibiotics in preterm infants with birth weight ≤1500g before and after optimizing antibiotic management,and explore the clinical impact of optimizing antibiotic management on preterm infants with birth weight ≤1500g.Methods:To retrospectively collect clinical data of premature infants with birth weight ≤1500g and age ≤72 hours admitted to the neonatal intensive care unit of a tertiary grade A children’s specialized hospital in Hunan Province,and the medical records of admission from January 1 to December 31,2017 As the control group,the medical records of admission from January to December 31,2019 after the implementation of optimized antibiotic management are the intervention group.Optimizing antibiotic management includes the establishment of an antibiotic management team,antibiotic ward rounds and discussions,standardizing antibiotic use indications,close monitoring of infections,and timely discontinuation of antibiotics.The main monitoring indicators are 1000 days of hospitalization with antibiotics(DOT/1000PDs),and the secondary monitoring indicators are the intensity of antibiotics(AUD),the frequency of antibiotics(DDDs),and DOT/1000 PDs of different types of antibiotics.The clinical evaluation uses the mortality rate as the main indicator.The secondary indicators include nosocomial infection,clinical sepsis,blood culture positive sepsis,fungal infection,bronchopulmonary dysplasia,necrotizing enterocolitis,periventricular-intraventricular hemorrhage,length of stay and hospitalization expenses.Perform statistical analysis on the data.Results:1.A total of 243 premature infants met the inclusion criteria.According to the birth weight,they were divided into two groups with a birth weight of <1000 g and 1000-1500 g.The number of cases was 67(30 in the control group and 37 in the intervention group)and 176(121 in the control group 55 cases in the intervention group).There was no significant difference in gestational age and birth weight between the control group and the intervention group between the two groups of children(P >0.05).2.Stratified by birth weight,birth weight <1000g or birth weight 1000-1500 g,the incidence of clinical sepsis,hospital infection rate,fungal infection rate,and gram-negative bacteria infection rate were not statistically different between the control group and the intervention group(P >0.05).The birth weight was less than 1000 g,and the positive detection rate of blood culture in the intervention group(43.2%) was higher than that in the control group(20%)(P = 0.04).The infection rate of gram-positive bacteria in the intervention group(29.7%)was higher than that in the control group(6.7%)(P = 0.02).The birth weight was 1000-1500 g,and the positive detection rate of blood culture was higher in the intervention group(32.7%)than in the control group(P = 0.046).The infection rate of gram-positive bacteria in the intervention group(25.5%)was higher than that in the control group(5.8%)(P <0.001).3.There was no significant difference in birth weight <1000g,DOT/1000 PDs,total number of days of antibiotic use,AUD,DDDs between the control group and the intervention group(P >0.05).With a birth weight of 1000-1500 g,the DOT/1000 PDs intervention group [468.8(292.7,666.7)days] was significantly lower than the control group [800(608.5,982.2)days](P <0.001).The total number of days of antibiotic use in the intervention group [20(11,37)days] was significantly less than that in the control group [40(21.5,52)days](P <0.001).The AUD intervention group [1.9(1.0,2.8)] was significantly lower than the control group [3.9(2.5,6.4)](P = 0.001).The DDDs intervention group[0.75(0.4,1.6)] was significantly less than the control group [2.1(0.7,4)](P <0.001).4.Birth weight <1000g or birth weight 1000-1500 g,hospitalization time and hospitalization expenses were not statistically different between the control group and the intervention group(P>0.05).Birth weight <1000g,the rate of umbilical vein catheterization in the intervention group(81.1%)was higher than that of the control group(53.3%)(P = 0.02),the birth weight was 1000-1500 g,the rate of umbilical vein catheterization in the intervention group(19%)was higher than the control Group(70.9%)increased(P <0.001).5.There was no statistically significant difference in the mortality rate and the incidence of BPD,NEC,IVH between the control group and the intervention group for birth weight <1000g or birth weight1000-1500g(P >0.05).Conclusion:1.After optimizing the management of antibiotics in the NICU,the rate and intensity of antibiotic use in preterm infants with a birth weight of 1000-1500 g decreased significantly.2.Premature infants with a birth weight of ≤1500g,after optimizing antibiotic management,the positive blood culture detection rate was significantly increased,the mortality rate did not increase,and the length of hospital stay did not extend. |
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