@article{2999939,
    title = "Reducing duration of antibiotic use for presumed neonatal early-onset sepsis in greek nicus. A “low-hanging fruit” approach",
    author = "Kopsidas, I. and Tsopela, G.-C. and Molocha, N.-M. and Bouza, E. and Chorafa, E. and Chorianopoulou, E. and Giapros, V. and Gkentzi, D. and Gkouvas, T. and Kapetanaki, A. and Karachristou, K. and Karavana, G. and Kourkouni, E. and Kourlaba, G. and Lithoxopoulou, M. and Papaevangelou, V. and Polychronaki, M. and Roilides, E. and Siahanidou, T. and Stratiki, E. and Syrogiannopoulos, G.A. and Triantafyllou, C. and Tsolia, M.N. and Tsouvala, E. and Zaoutis, T. and Spyridis, N. and Preventing Hospital-Acquired Infections in Greece (PHiG) Investigators",
    journal = "Journal of Antibiotics",
    year = "2021",
    volume = "10",
    number = "3",
    publisher = "MDPI AG",
    issn = "0021-8820, 1881-1469",
    doi = "10.3390/antibiotics10030275",
    keywords = "ampicillin;  antibiotic agent;  C reactive protein;  gentamicin, antibiotic resistance;  antimicrobial stewardship;  Article;  cesarean section;  comparative effectiveness;  controlled study;  drug withdrawal;  female;  follow up;  gestational age;  hospitalization;  human;  length of stay;  major clinical study;  male;  neonatal intensive care unit;  newborn;  newborn sepsis;  prospective study;  quasi experimental study;  risk factor;  time series analysis;  treatment duration",
    abstract = "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. © 2021 by the authors. Licensee MDPI, Basel, Switzerland."
}