抗生素使用策略改进对胎龄<35周早产儿近期临床结局的影响

Effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of<35 weeks

目的分析抗生素使用策略改进对胎龄<35周早产儿近期临床结局的影响。方法收集2014年1月1日至2016年12月31日在中南大学湘雅医院新生儿重症监护室住院的865例胎龄<35周早产儿的临床资料。改进的抗生素使用策略于2015年1月1日开始实施,根据改进抗生素使用策略实施时间将收集的临床资料分为3组:调整前组303例(2014年1月1日至2014年12月31日),调整后Ⅰ组293例(2015年1月1日至2015年12月31日),调整后Ⅱ组269例(2016年1月1日至2016年12月31日),回顾性分析比较3组患儿的临床资料。结果3组早产儿的胎龄、小于胎龄儿比例、性别及出生方式等方面比较差异无统计学意义(P>0.05)。与调整前组相比,调整后Ⅰ组及调整后Ⅱ组在生后早期和住院期间抗生素使用率下降,使用时间明显缩短(P<0.05);生后早期抗生素使用时间≤3 d和4~7 d比例均升高,>7 d比例明显降低(P<0.05)。与调整后Ⅰ组相比,调整后Ⅱ组在生后早期和住院期间抗生素使用时间进一步缩短(P<0.05);生后早期抗生素使用时间≤3 d比例升高,4~7 d和>7 d比例明显降低(P<0.05)。调整后Ⅰ组和调整后Ⅱ组肠外营养使用时间及住院时间较调整前组明显缩短(P<0.05)。≥Ⅲ度脑室内出血及晚发型败血症发生率在抗生素使用策略调整前后呈逐步下降趋势。多因素logistic回归分析提示,调整抗生素使用策略对近期临床不良结局无影响,抗生素使用>7 d明显增加了近期临床不良结局的发生风险(P<0.05)。结论改进抗生素使用策略,减少胎龄<35周早产儿不必要抗生素的使用是可行的,同时明显缩短肠外营养使用时间和住院时间,且≥Ⅲ度脑室内出血及晚发型败血症发生率也呈下降趋势。

Objective To study the effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks.Methods The medical data were retrospectively collected from865 preterm infants with a gestational age of <35 weeks who were admitted to the Neonatal Intensive Care Unit of Xiangya Hospital of Central South University from January 1,2014 to December 31,2016.The improved antibiotic use strategy was implemented since January 1,2015.According to the time of implementation,the infants were divided into three groups:pre-adjustment(January 1,2014 to December 31,2014;n=303),post-adjustment Ⅰ(January 1,2015 to December 31,2015;n=293),and post-adjustment Ⅱ(January 1,2016 to December 31,2016;n=269).The medical data of the three groups were compared.Results There were no significant differences among the three groups in gestational age,proportion of small-for-gestational-age infants,sex,and method of birth(P>0.05).Compared with the pre-adjustment group,the post-adjustment I and post-adjustment Ⅱ groups had a significant reduction in the rate of use of antibiotics and the duration of antibiotic use in the early postnatal period and during hospitalization(P<0.05),with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days or 4-7 days and a significant reduction in the proportion of infants with a duration of antibiotic use of >7 days in the early postnatal period(P<0.05).Compared with the postadjustment Ⅰ group,the post-adjustment Ⅱ group had a significant reduction in the duration of antibiotic use in the early postnatal period and during hospitalization(P<0.05),with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days and a significant reduction in the proportion of infants with a duration of antibiotic use of 4-7days or >7 days(P<0.05).Compared with the pre-adjustment group,the post-adjustment I and post-adjustment Ⅱ groups had significantly shorter duration of parenteral nutrition and length of hospital stay(P<0.05).There were gradual reductions in the incidence rates of grade ≥Ⅲ intraventricular hemorrhage(IVH) and late-onset sepsis(LOS) after the adjustment of antibiotic use strategy.The multivariate logistic regression analysis showed that the adjustment of antibiotic use strategy had no effect on short-term adverse clinical outcomes,and antibiotic use for >7 days significantly increased the risk of adverse clinical outcomes(P<0.05).Conclusions It is feasible to reduce unnecessary antibiotic use by the improvement in antibiotic use strategy in preterm infants with a gestational age of <35 weeks,which can also shorten the duration of parenteral nutrition and the length of hospital stay and reduce the incidence rates of grade ≥Ⅲ IVH and LOS.