RESUMEN
A neonate of 29 weeks' gestation who received probiotics developed clinical signs suggesting surgical necrotizing enterocolitis. A specimen of resected ileum revealed fungal forms within the bowel wall. Rhizopus oryzae was detected via DNA sequencing from probiotic powder and tissue specimens from the infant. To our knowledge, this is the first report linking gastrointestinal zygomycosis to the administration of contaminated probiotics.
Asunto(s)
Enterocolitis Necrotizante/diagnóstico , Enterocolitis Necrotizante/etiología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/microbiología , Probióticos/efectos adversos , Cigomicosis/diagnóstico , Cigomicosis/etiología , Resultado Fatal , Enfermedades Gastrointestinales/diagnóstico , Edad Gestacional , Humanos , Lactante , Enfermedades del Prematuro/etiología , Enfermedades del Prematuro/microbiología , Masculino , Rhizopus oryzae/genética , Rhizopus oryzae/patogenicidadRESUMEN
OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012. METHODS We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance. RESULTS Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time. CONCLUSIONS Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices. Infect Control Hosp Epidemiol 2017;38:1137-1143.
Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Utilización de Medicamentos , Uso Excesivo de Medicamentos Recetados/prevención & control , Antiinfecciosos/uso terapéutico , Connecticut , Utilización de Medicamentos/estadística & datos numéricos , Revisión de la Utilización de Medicamentos , Adhesión a Directriz , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Análisis de Series de Tiempo Interrumpido , Pautas de la Práctica en Medicina , Evaluación de Programas y Proyectos de Salud , Centros de Atención TerciariaRESUMEN
Validation of the number of central line-days by hospitals is required by the National Healthcare Safety Network. A prospective study that compared a daily report of such days generated by an electronic medical record with observational audits by nurses revealed that the report was 100% sensitive and 99.9% specific.