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

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 -res...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000600/
https://www.ncbi.nlm.nih.gov/pubmed/33803250
http://dx.doi.org/10.3390/antibiotics10030275
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author 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
author_facet 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
author_sort Kopsidas, Ioannis
collection PubMed
description 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.
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spelling pubmed-80006002021-03-28 Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach 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 Antibiotics (Basel) Article 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. MDPI 2021-03-09 /pmc/articles/PMC8000600/ /pubmed/33803250 http://dx.doi.org/10.3390/antibiotics10030275 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Article
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
Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title_full Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title_fullStr Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title_full_unstemmed Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title_short Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach
title_sort reducing duration of antibiotic use for presumed neonatal early-onset sepsis in greek nicus. a “low-hanging fruit” approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000600/
https://www.ncbi.nlm.nih.gov/pubmed/33803250
http://dx.doi.org/10.3390/antibiotics10030275
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