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

Antibiotics

Preventing Hospital-Acquired Infections in Greece (PHiG) Investigators¹  Korina Karachristou²  Eleni Bouza³  Theoklis Zaoutis⁴  Georgia Kourlaba⁴  Ioannis Kopsidas⁴  Christos Triantafyllou⁴  Grammatiki-Christina Tsopela⁴  Nafsika-Maria Molocha⁴  Evangelia Chorianopoulou⁴  Eleni Kourkouni⁴  George A. Syrogiannopoulos⁵  Maria N. Tsolia⁶  Nikos Spyridis⁶  Anastasia Kapetanaki⁷  Evangelia Stratiki⁸  Georgia Karavana⁹  Emmanouela Tsouvala^1,10  Vasileios Giapros^1,11  Maria Polychronaki^1,12  Theodoros Gkouvas^1,13  Tania Siahanidou^1,14  Despoina Gkentzi^1,15  Maria Lithoxopoulou^1,16  Elisavet Chorafa^1,17  Emmanuel Roilides^1,17  Vassiliki Papaevangelou^1,18 

[1] ;A’ Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, 11528 Athens, Greece;B’ Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;Center For Clinical Epidemiology and Outcomes Research (CLEO), 11528 Athens, Greece;Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;Infectious Diseases Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece;Neonatal Intensive Care Unit, Elenas Venizelou Maternity Hospital, 11521 Athens, Greece;Neonatal Intensive Care Unit, General District Hospital Athens “Alexandra”, 11528 Athens, Greece;Neonatal Intensive Care Unit, General Hospital of Nikaia and Piraeus ‘‘Aghios Panteleimon’’, 18454 Athens, Greece;Neonatal Intensive Care Unit, Neonatal Department, University General Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece;Neonatal Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece;Neonatal Intensive Care Unit, Venizelio Hospital, 71409 Heraklion, Greece;Neonatal Intensive Care Unit, “Panagiotis & Aglaia Kyriakou” Children’s Hospital, 11528 Athens, Greece;Neonatal Unit of the First Department of Pediatrics, National and Kapodistrian University of Athens, 11528 Athens, Greece;Patras Medical School, University General Hospital of Patras, 26504 Patra, Greece;Second Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;Third Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece;Third Department of Pediatrics, National and Kapodistrian University of Athens, General University Hospital “Attikon”, 12462 Athens, Greece;

关键词: early discontinuation;    antibiotic stewardship;    prolonged duration;    empiric treatment;    negative cultures;    neonatal intensive care;   

DOI  :  10.3390/antibiotics10030275

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown