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Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach

1
Center For Clinical Epidemiology and Outcomes Research (CLEO), 11528 Athens, Greece
2
Infectious Diseases Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece
3
B’ Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
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Third Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece
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Neonatal Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
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Patras Medical School, University General Hospital of Patras, 26504 Patra, Greece
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Neonatal Intensive Care Unit, “Panagiotis & Aglaia Kyriakou” Children’s Hospital, 11528 Athens, Greece
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Neonatal Intensive Care Unit, Elenas Venizelou Maternity Hospital, 11521 Athens, Greece
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A’ Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, 11528 Athens, Greece
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Neonatal Intensive Care Unit, General Hospital of Nikaia and Piraeus ‘‘Aghios Panteleimon’’, 18454 Athens, Greece
11
Second Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
12
Third Department of Pediatrics, National and Kapodistrian University of Athens, General University Hospital “Attikon”, 12462 Athens, Greece
13
Neonatal Intensive Care Unit, Venizelio Hospital, 71409 Heraklion, Greece
14
Neonatal Unit of the First Department of Pediatrics, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Neonatal Intensive Care Unit, General District Hospital Athens “Alexandra”, 11528 Athens, Greece
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Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece
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Neonatal Intensive Care Unit, Neonatal Department, University General Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece
18
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
*
Author to whom correspondence should be addressed.
These are collaborators. For the PHiG Investigators: Fani Anatolitou, George Baroutis, Stavroula Bounta, Susan Coffin, Gabriel Dimitriou, Aikaterini Drougia, Eleni Fanaraki, Theodoros Gouvias, Aikaterini Kaffe, Paraskevi Karagianni, Marina Koropouli, Katerina Lappa, Stefania Maistreli, George Mavrogeorgos, Antonia Moumouletsa, Angeliki Nika, Irini Nikaina, Stamatia Papadopoulou, Anastasia Papageorgiou, Marianna Skordala-Riti, Athanasios Skoutelis, Maria Theodoraki, Christina Thomou, Pinelopi Triantafyllidou, Asimina Tsintoni, Sotirios Tsiodras, Adamantios Vontzalidis, Kirikas Zannikos.
Academic Editor: Albert Figueras
Antibiotics 2021, 10(3), 275; https://doi.org/10.3390/antibiotics10030275
Received: 12 February 2021 / Revised: 4 March 2021 / Accepted: 5 March 2021 / Published: 9 March 2021
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a “low-hanging fruit” approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016–06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase (p = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend (p = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days (p = 0.001, 95%CI [−45.33, −12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a “low-hanging fruit” approach. In resource-limited settings, similar targeted stewardship interventions can be applied. View Full-Text
Keywords: early discontinuation; antibiotic stewardship; prolonged duration; empiric treatment; negative cultures; neonatal intensive care early discontinuation; antibiotic stewardship; prolonged duration; empiric treatment; negative cultures; neonatal intensive care
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MDPI and ACS Style

Kopsidas, I.; Tsopela, G.-C.; Molocha, N.-M.; Bouza, E.; Chorafa, E.; Chorianopoulou, E.; Giapros, V.; Gkentzi, D.; Gkouvas, T.; Kapetanaki, A.; Karachristou, K.; Karavana, G.; Kourkouni, E.; Kourlaba, G.; Lithoxopoulou, M.; Papaevangelou, V.; Polychronaki, M.; Roilides, E.; Siahanidou, T.; Stratiki, E.; Syrogiannopoulos, G.A.; Triantafyllou, C.; Tsolia, M.N.; Tsouvala, E.; Zaoutis, T.; Spyridis, N.; Preventing Hospital-Acquired Infections in Greece Investigators. Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach. Antibiotics 2021, 10, 275. https://doi.org/10.3390/antibiotics10030275

AMA Style

Kopsidas I, Tsopela G-C, Molocha N-M, Bouza E, Chorafa E, Chorianopoulou E, Giapros V, Gkentzi D, Gkouvas T, Kapetanaki A, Karachristou K, Karavana G, Kourkouni E, Kourlaba G, Lithoxopoulou M, Papaevangelou V, Polychronaki M, Roilides E, Siahanidou T, Stratiki E, Syrogiannopoulos GA, Triantafyllou C, Tsolia MN, Tsouvala E, Zaoutis T, Spyridis N, Preventing Hospital-Acquired Infections in Greece Investigators. Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach. Antibiotics. 2021; 10(3):275. https://doi.org/10.3390/antibiotics10030275

Chicago/Turabian Style

Kopsidas, Ioannis; Tsopela, Grammatiki-Christina; Molocha, Nafsika-Maria; Bouza, Eleni; Chorafa, Elisavet; Chorianopoulou, Evangelia; Giapros, Vasileios; Gkentzi, Despoina; Gkouvas, Theodoros; Kapetanaki, Anastasia; Karachristou, Korina; Karavana, Georgia; Kourkouni, Eleni; Kourlaba, Georgia; Lithoxopoulou, Maria; Papaevangelou, Vassiliki; Polychronaki, Maria; Roilides, Emmanuel; Siahanidou, Tania; Stratiki, Evangelia; Syrogiannopoulos, George A.; Triantafyllou, Christos; Tsolia, Maria N.; Tsouvala, Emmanouela; Zaoutis, Theoklis; Spyridis, Nikos; Preventing Hospital-Acquired Infections in Greece Investigators. 2021. "Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach" Antibiotics 10, no. 3: 275. https://doi.org/10.3390/antibiotics10030275

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