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
Center For Clinical Epidemiology and Outcomes Research (CLEO), 11528 Athens, Greece.
Infectious Diseases Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece.
Antibiotics (Basel). 2021 Mar 9;10(3):275. doi: 10.3390/antibiotics10030275.
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 ( = 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 ( = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days ( = 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.
抗生素在新生儿重症监护病房（NICU）中经常被使用，而在这些病房中实施管理干预具有挑战性。希腊是一个抗生素耐药率很高的国家，迫切需要降低抗生素的使用量。我们试图评估一种低成本、低资源干预措施在希腊新生儿重症监护病房实施“低垂果实”方法以减少抗生素使用的有效性。在希腊17家公立新生儿重症监护病房中的15家进行了一项前瞻性准实验研究（2016年9月至2019年6月）。选择的干预措施是，对于孕周≥37周、无败血症记录迹象或症状、CRP≤10mg/L且在开始使用抗生素后3天内培养结果为阴性的新生儿，在5天内停用抗生素。通过第5天停用治疗方案的百分比、治疗时长（LOT）和住院时间来评估干预效果。用每1000患者日的治疗天数（DOT）来评估抗生素使用趋势。总体而言，在≤5天内抗生素停用率增加了9%（P = 0.003）。总共有7/13（53.8%）的病房显示增加了≥10%。总体而言，每1000名患者节省了615天的抗生素使用时间。中断时间序列分析确定，相对于干预前的趋势，每1000患者日的DOT呈下降趋势（P = 0.002）；每月下降率为28.96 DOT/1000患者日（P = 0.001，95%CI [-45.33，-12.60]）。该干预措施对抗生素选择没有影响。采用“低垂果实”方法成功降低了希腊新生儿重症监护病房的抗生素使用量。在资源有限的环境中，可以应用类似的有针对性的管理干预措施。
