Restricted Usage of Prophylactic Antibiotics in Extremely Low Birth Weight Infants for Early-Onset Sepsis as Quality Improvement Program
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Purpose: The prevalence of antibiotics resistant bacterial infection among preterm infants has been increased due to indeliberate use of prophylactic broad spectrum antibiotics. The objective of this study was to assess the effectiveness of restricted usage of prophylactic antibiotics by comparing the incidence of culture proven early onset sepsis (EOS). Methods: This was a retrospective cohort study for extremely low birth weight infants who were born in Seoul National University Children’s Hospital during 2009-2014. The groups were divided into two periods, from 2009 to 2011 (period I) and from 2012 to 2014 (period II) based on the implementation on quality improvement activity since 2012. The indication of prophylactic antibiotics were; 1) umbilical vein catheter (UVC) insertion for resuscitation in delivery room, 2) prolonged preterm premature rupture of membrane >18 hours, 3) maternal fever during labor or sustained septic amniotic fluid. The incidence of EOS and the rate of empirical antibiotics usage were compared between two periods. Results: A total of 245 infants were admitted to the neonatal intensive care unit during the study period. Baseline demographics and clinical characteristics were similar between two periods except UVC insertion rate. The rate of empirical antibio- tics usage significantly decreased in period II (71.1% for period I vs. 56.4% for period 2, P=0.022). Incidence of EOS was not different between two periods whether pro- phylactic antibiotics use or not. Conclusion: Quality improvement for reducing prophylactic antibiotics use may be effective to reduce a use of antibiotics without increasing EOS.
Abstract
Purpose: The prevalence of antibiotics resistant bacterial infection among preterm infants has been increased due to indeliberate use of prophylactic broad spectrum antibiotics. The objective of this study was to assess the effectiveness of restricted usage of prophylactic antibiotics by comparing the incidence of culture proven early onset sepsis (EOS). Methods: This was a retrospective cohort study for extremely low birth weight infants who were born in Seoul National University Children’s Hospital during 2009-2014. The groups were divided into two periods, from 2009 to 2011 (period I) and from 2012 to 2014 (period II) based on the implementation on quality improvement activity since 2012. The indication of prophylactic antibiotics were; 1) umbilical vein catheter (UVC) insertion for resuscitation in delivery room, 2) prolonged preterm premature rupture of membrane >18 hours, 3) maternal fever during labor or sustained septic amniotic fluid. The incidence of EOS and the rate of empirical antibiotics usage were compared between two periods. Results: A total of 245 infants were admitted to the neonatal intensive care unit during the study period. Baseline demographics and clinical characteristics were similar between two periods except UVC insertion rate. The rate of empirical antibio- tics usage significantly decreased in period II (71.1% for period I vs. 56.4% for period 2, P=0.022). Incidence of EOS was not different between two periods whether pro- phylactic antibiotics use or not. Conclusion: Quality improvement for reducing prophylactic antibiotics use may be effective to reduce a use of antibiotics without increasing EOS.
참고문헌 (16)
- Stoll BJ, "Late-onset sepsis in very low birth weight neonates:the experience of the NICHD Neonatal Research Network", Pediatrics, 110, pp.285~291 (2002)
- Stoll BJ, "Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection", JAMA, 292, pp.2357~2365 (2004)
- Heo JS, "Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: trends over 18 years", Pediatr Int, 57, pp.909~916 (2015)
- Stoll BJ, "Early-onset sepsis in very low birth weight neonates:a report from the National Institute of Child Health and Human Development Neonatal Research Network", J Pediatrics, 129, pp.72~80 (1996)
- Stoll BJ, "Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants", N Engl J Med, 347, pp.240~247 (2002)
- Stoll BJ, "Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003", Pediatr Infect Dis J, 24, pp.635~639 (2005)
- Lee SM, "Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in Korea", J Korean Med Sci, 30, pp.S67~S74 (2015)
- Klinger G, "Outcome of early-onset sepsis in a national cohort of very low birth weight infants", Pediatrics, 125, pp.e736~e740 (2010)
- 박누리, "극소 저체중 출생아에서 초기 경험적 항생제 치료 기간이 신생아기 예후에 미치는 영향", Perinatology, 23(2), pp.69~75 (2012), 대한주산의학회[DOI]
- Kuppala VS, "Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants", J Pediatr, 159, pp.720~725 (2011)
- Garner JS, "CDC definitions for nosocomial infections, 1988", Am J Infect Control, 16, pp.128~140 (1988)
- Bauserman MS, "Group B Streptococcus and Escherichia coli infections in the intensive care nursery in the era of intrapartum antibiotic prophylaxis", Pediatr Infect Dis J, 32, pp.208~212 (2013)
- Auriti C, "Short antibiotic prophylaxis for bacterial infections in a neonatal intensive care unit: a randomized controlled trial", J Hosp Infect, 59, pp.292~298 (2005)
- Hammerberg O, "Randomized trial using piperacillin versus ampicillin and amikacin for treatment of premature neonates with risk factors for sepsis", Eur J Clin Microbiol Infect Dis, 8, pp.241~244 (1989)
- Weston EJ, "The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008", Pediatr Infect Dis J, 30, pp.937~941 (2011)
- Hornik CP, "Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units", Early Hum Dev, 88, pp.S69~S74 (2012)