Antibiotic stewardship in the newborn surgical patient: A quality improvement project in the neonatal intensive care unit

被引:24
作者
Walker, Sarah [1 ]
Datta, Ankur [2 ]
Massotuni, Roxanne L. [3 ]
Gross, Erica R. [4 ]
Uhing, Michael [2 ]
Arca, Marjorie J. [1 ]
机构
[1] Med Coll Wisconsin, Childrens Hosp Wisconsin, Div Pediat Surg, Milwaukee, WI 53226 USA
[2] Med Coll Wisconsin, Childrens Hosp Wisconsin, Div Neonatol, Milwaukee, WI 53226 USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Los Angeles, CA 90095 USA
[4] Univ Colorado, Dept Pediat Surg, Childrens Hosp Colorado, Stony Brook, NY USA
关键词
BIRTH-WEIGHT INFANTS; PROPHYLAXIS; SURGERY; NICU;
D O I
10.1016/j.surg.2017.07.021
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. There is significant diversity in the utilization of antibiotics for neonates undergoing surgical procedures. Our institution standardized antibiotic administration for surgical neonates, in which no empiric antibiotics were given to infants with surgical conditions postnatally, and antibiotics are given no more than 72 hours perioperatively. Methods. We compared the time periods before and after implementation of antibiotic protocol in an institution review board approved, retrospective review of neonates with congenital surgical conditions who underwent surgical correction within 30 days after birth. Surgical site infection at 30 days was the primary outcome, and development of hospital-acquired infections or multidrug-resistant organism were secondary outcomes. Results. One hundred forty-eight infants underwent surgical procedures pre-protocol, and 127 underwent procedures post-protocol implementation. Surgical site infection rates were similar pre- and post-protocol, 14% and 9% respectively, (P=.21.) The incidence of hospital-acquired infections (13.7% vs 8.7%, P=.205) and multidrug-resistant organism (4.7% vs 1.6%, P=.143) was similar between the 2 periods. Conclusion. Elimination of empiric postnatal antibiotics did not statistically change rates of surgical site infection, hospital-acquired infections, or multidrug-resistant organisms. Limiting the duration of perioperative antibiotic prophylaxis to no more than 72 hours after surgery did not increase the rate of surgical site infection, hospital-acquired infections, or multidrug-resistant organism. Median antibiotic days were decreased with antibiotic standardization for surgical neonates.
引用
收藏
页码:1295 / 1303
页数:9
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