Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique
| Autor: | D Trupp, G Padilla, D D Wirtschafter, K Wan, E E Simon Fayard, O Suh |
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| Rok vydání: | 2011 |
| Předmět: |
Cross infection
Catheterization Central Venous medicine.medical_specialty Pediatrics Bacteremia Catheters Indwelling Intensive Care Units Neonatal medicine Humans Maternal fetal Practice Patterns Physicians' Antibiotic use Intensive care medicine Quality Indicators Health Care Cross Infection Central line Practice patterns business.industry Infant Newborn Obstetrics and Gynecology medicine.disease Drug Utilization Anti-Bacterial Agents Multicenter study Pediatrics Perinatology and Child Health business Blood stream |
| Zdroj: | Journal of Perinatology. 31:514-518 |
| ISSN: | 1476-5543 0743-8346 |
| Popis: | To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate.Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started ≤3 d or ≥4 d post birth and as rule-out sepsis or presumed infection (PI) if treated ≤4 d or ≥5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven.The cohort included 754 patients, 18,345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6-30) higher for ACs (5.40 vs 0.38/1000 PD, P0.0001) or 8.8 fold (CI 7.1-11) higher for ADs (48.3 vs 5.5/1000 PD, P0.0001).CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts. |
| Databáze: | OpenAIRE |
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