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Title: Epidemiology of neonatal infections and antibiotic use in Greek neonatal units : development of national guidelines for neonatal infections
Other Titles: Επιδημιολογία των νεογνικών λοιμώξεων και χρήση των αντιβιοτικών στις μονάδες νοσηλείας νεογνών στην Ελλάδα : ανάπτυξη πανελλαδικών κατευθυντηρίων οδηγιών για τις νεογνικές λοιμώξεις
Authors: Γκεντζή, Δέσποινα
Keywords: Neonatal infections
Keywords (translated): Νεογνικές λοιμώξεις
Abstract: Background & Aims: Data on the pathogens causing infections in the Neonatal Units (NNUs) in Greece are limited and the emergence of multi-drug resistant pathogens is an important public health concern. This study aims to describe the epidemiology of neonatal infections and the antimicrobial use in Greek NNUs in order to assist in the development of Evidence-Based national guidelines for treatment of neonatal sepsis. Methods: neonIN is an international web-based infection surveillance network for culture proven neonatal infections ( Data from participating Greek NNUs between January 2012 and August 2015 were extracted. Early-onset sepsis (EOS) was defined as occurring within 48 hours of birth. Repeated growth of the same organism within 7 days was considered to be the same episode. We also performed a Point Prevalence Survey (PPS) on antimicrobial use and collected data on empiric antimicrobial policies. Results: 459 episodes (involving 418 infants) were recorded in 16 NNUs in Greece with a median gestational-age of 33.5 (29-38) weeks, median birth-weight of 1910 (1176-3030) grams and an overall incidence of 50/1000 NNU-admissions. The majority of episodes were Late-Onset Sepsis (413, 90%). Coagulase-negative Staphylococci (CoNS) (80%) were the most common Gram-positive organisms causing Late-Onset Sepsis and Klebsiella spp (39%) the most common Gram-negative. Resistance among Enterobacteriaceae to aminoglycoside was 27% (46/172), to 3rd generation cephalosporins 34% (48/143) and to carbapenems 7% (10/147). The PPS revealed that 196 of 484 (40%) neonates were on antimicrobials. High rates and broad spectrum antimicrobial use were generally observed. The survey also revealed wide variation in guidelines, especially for LOS. Conclusions: This is the largest collection of data on the epidemiology of neonatal infections in Greece. Continuous surveillance at a national level will facilitate better understanding of the disease and antibiotic resistance burden. The survey on antimicrobial use identifies areas for quality improvement. The critical approach of all these data will facilitate the introduction of evidence-based guidelines and other antimicrobial stewardship interventions which are urgently required.
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