Single-central Investigation Research Of Meropenem Medication In Neonatal Infectious Diseases

Objective:Through investigation of the distribution of pathogen in the neonatal unit of Northwest Women’s and Children’s Hospital,we analyzed the current clinical application of meropenem in neonatal infectious diseases and adopted the modified Drug use evaluation(DUE)criterion to evaluate the rationality of meropenem in neonatal clinical application,so as to provide reference for the rational and standardized use of meropenem in neonates.Method:1.The pathogen information and drug sensitivity test results of all kinds of specimens isolated from the Department of Neonatology of Northwest Women’s and Children’s Hospital during the period of 5 years in a row were collected to understand the distribution and drug resistance of pathogens.2.Data were collected for cases treated with meropenem in the neonatology department during the same period.The clinical effects of meropenem in preterm and term infants,early-onset sepsis(EOS)group,late-onset sepsis(LOS)group,non-shock group and shock group were compared.To analyze the independent risk factors affecting the poor prognosis of neonatal infectious diseases treated with meropenem.3.The modified DUE criteria for meropenem in neonatal departments,to evaluate the safety and rationality of meropenem in Neonates.Plato was used to analyze the distribution of clinical diagnosis and types of irrational drug use in children treated with meropenem.Provide evidence for medication.Results:1.A total of 1,473 non-repetitive pathogenic strains were isolated from our neonatal unit in five consecutive years,of which 42.4%(624/1473)were Gram-positive bacteria(G~+bacteria),52.9%(780/1473)were Gram-negative bacteria(G~-bacteria),4.7%(69/1473)were fungi,16.4%(242/1473)were multi-drug resistant strains,of which 84.3%(204/242)were ESBLs-producing Enterobacteriaceae;70.9%(1045/1473)were from blood specimens.2.Among the 539 children who received meropenem anti-infective treatment,submission rate of clinical microorganism specimen before treatment accounted for 80.9%(436/539).The positive rate of pathogenic bacteria accounted for 41.7%(182/436),mainly G~-bacteria,accounting for 76.4%(139/182),of which Escherichia coli(E.coli)accounted for 13.2%(24/182),Klebsiella pneumoniae(Kpn)accounted for 18.7%(34/182);G~+bacteria accounted for 16.5%(30/182),fungi accounted for 7.1%(13/182);MDROs accounted for 34.6%(63/182),of which Enterobacter strains produced ESBLs accounted for 93.6%(59/63).3.Logistic regression analysis showed that septic shock(OR=9.09,P<0.001),invasive ventilation(OR=2.99,P=0.004)and gestational age<28 weeks(OR=2.47,P=0.031)were independent risk factors affecting the prognosis of neonatal infectious diseases treated with meropenem.4.According to the modified DUE guidelines,the standardized using rate of meropenem has increased from 65.5%in 2016 to 82.2%in 2020.Plato analysis showed that the main factors of nonstandard medication were no monitoring of liver and kidney function after 1 week of medication,irregular combination medication,irregular etiological inspection,and unsuitable drug indications.5.There were no serious adverse reactions in the survey results,and it was found that the adverse reactions possibly related to meropenem accounted for 1.7%,and the adverse reactions could recover on their own after drug withdrawal.Conclusions:1.Among the positive pathogen cultures before using meropenem to treat neonatal infectious diseases,34.6%(63/182)were multi-drug resistant bacteria,mainly ESBLs-producing Enterobacteriaceae.According to the DUE score,the empirical application of meropenem in clinical practice is relatively reasonable.2.The evaluation of the modified DUE criteria found that the rational use of meropenem in the neonatal department was increasing,and no serious adverse events were found;Logistic regression analysis found that invasive ventilation,septic shock and gestational age less than 28 weeks were independent risk factors affecting the prognosis of neonatal infectious diseases treated with meropenem,suggesting that individual evaluation and comprehensive management should be performed.3.The modified DUE criteria for neonatal meropenem,and multi-faceted evaluation can help improve the rationality evaluation of meropenem in neonates,it has some promotion value.