Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A "Low-Hanging Fruit" Approach.
Ioannis KopsidasGrammatiki-Christina TsopelaNafsika-Maria MolochaEleni BouzaElisavet ChorafaEvangelia ChorianopoulouVasileios GiaprosDespoina GkentziTheodoros GkouvasAnastasia KapetanakiKorina KarachristouGeorgia KaravanaEleni KourkouniGeorgia KourlabaMaria LithoxopoulouVassiliki PapaevangelouMaria PolychronakiEmmanuel RoilidesTania SiahanidouEvangelia StratikiGeorge A SyrogiannopoulosChristos TriantafyllouMaria N TsoliaEmmanouela TsouvalaTheoklis ZaoutisNikos Spyridisnull Preventing Hospital-Acquired Infections In Greece PHiG InvestigatorsPublished in: Antibiotics (Basel, Switzerland) (2021)
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.
Keyphrases
- randomized controlled trial
- early onset
- intensive care unit
- gestational age
- end stage renal disease
- case report
- healthcare
- chronic kidney disease
- newly diagnosed
- stem cells
- ejection fraction
- depressive symptoms
- peritoneal dialysis
- bone marrow
- prognostic factors
- weight loss
- body mass index
- mesenchymal stem cells
- septic shock
- sleep quality
- energy transfer
- low birth weight