新生儿病房不同抗生素应用策略对新生儿治疗结局的影响

Influence of different antibiotic strategies on outcomes of hospitalized neonates

目的探讨将新生儿抗生素使用策略由风险评估策略改变为风险评估加感染筛查及监测策略对住院新生儿抗生素使用率以及对治疗结局的影响。方法采用队列研究,选取2010年1月至2011年5月住院新生儿4406例为对照组,按照风险评估策略使用抗生素;2011年7月至2012年10月住院新生儿4476例为研究组,按照风险评估加感染筛查及监测策略使用抗生素。分别对比两组患儿抗生素使用率、平均住院日、再入院率和病死率。结果抗生素应用策略改变后,住院新生儿抗生素使用率明显降低(P<0.01);患儿的平均住院日、再入院率和病死率差异无统计学意义(均P>0.05)。结论将住院新生儿抗生素应用策略由风险评估策略改为风险评估加感染筛查及监测策略,能够明显减少抗生素使用率,而且不会对患儿产生不良影响。

Objective To observe the outcomes of hospitalized neonates who were managed with two different antibiotics strategies, namely, the risk factor based antibiotic strategy and the combination antibiotic strategy that is based on risk factors, infection screening and monitoring. Methods A cohort study was performed on a control group of 4 406 cases of neonates hospitalized between January 2010 and May 2011 and an observed group of 4 476 neonates hospitalized between July 2011 and October 2012. The control group adopted the risk factor based antibiotic strategy and the observed group received a combination antibiotic strategy based on risk factors, infection screening and monitoring. The rate of antibiotic use, average length of stay, readmission rate and mortality rate were compared between the two groups. Results With the change from the risk factor based antibiotic strategy to the combination antibiotic strategy, the total rate of antibiotic use decreased from 79.6% to 50.5% （P〈0.01）. There were no differences in the average length of stay, readmission rate, and mortality rate between the two groups. Conclusions The combination antibiotic strategy based on risk factors, infection screening and monitoring can reduce antibiotic use substantially and has no adverse effects on treatment outcomes in hospitalized neonates.