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Epidemiology of infections and antimicrobial use in Greek Neonatal Units
  1. Despoina Gkentzi1,
  2. Christina Kortsalioudaki2,
  3. Benjamin Campbell Cailes2,
  4. Theoklis Zaoutis3,
  5. John Kopsidas3,
  6. Maria Tsolia4,
  7. Nikos Spyridis4,
  8. Soultana Siahanidou5,
  9. Kosmas Sarafidis6,
  10. Paul T Heath2,
  11. Gabriel Dimitriou1
  12. on behalf of the Neonatal Infection Surveillance Network in Greece
    1. 1 Department of Paediatrics, Patras Medical School, University Hospital of Patras, Patras, Greece
    2. 2 Paediatric Infectious Diseases Research Group, St George’s University of London, London, UK
    3. 3 The Stavros Niarchos Foundation-Collaborative Centre for Clinical Epidemiology and Outcomes Research, School of Medicine, University of Athens, Athens, Greece
    4. 4 Paediatric Infectious Diseases Unit, Aglaia Kyriakou Children’s Hospital, Athens, Greece
    5. 5 Neonatal Unit, First Department of Pediatrics, Athens University Medical School, Athens, Greece
    6. 6 1st Department of Neonatology and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
    1. Correspondence to Dr Despoina Gkentzi, Department of Paediatrics, Patras Medical School, University Hospital of Patras, Patras, Greece; gkentzid{at}


    Objective To describe the epidemiology of neonatal infections and of antimicrobial use in Greek Neonatal Units (NNUs) in order to develop national, evidence-based guidelines on empiric antimicrobial use for neonatal sepsis in Greece.

    Design Retrospective analysis of prospectively collected infection surveillance data from 2012 to 2015, together with a Point Prevalence Survey (PPS) on antimicrobial use and the collection of data on local empiric antimicrobial policies.

    Setting 16 NNUs in Greece participating in the neonIN infection surveillance network

    Patients Newborns in participating NNUs who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of antibiotics.

    Results 459 episodes were recorded in 418 infants. The overall incidence of infection was 50/1000 NNU-admissions. The majority of episodes were late-onset sepsis (LOS) (413, 90%). Coagulase-negative Staphylococci (80%) were the most common Gram-positive organisms causing LOS and Klebsiella spp (39%) the most common Gram-negative. Nearly half (45%) of the Klebsiella spp were resistant to at least one aminoglycoside. The PPS revealed that 196 of 484 (40%) neonates were on antimicrobials. The survey revealed wide variation in empiric antimicrobial policies for LOS.

    Conclusions This is the largest collection of data on the epidemiology of neonatal infections in Greece and on neonatal antimicrobial use. It provides the background for the development of national evidence-based guidelines. Continuous surveillance, the introduction of antimicrobial stewardship interventions and evidence-based guidelines are urgently required.

    • neonatal infections
    • greece
    • epidemiology
    • antimicrobial use

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    • Contributors DG drafted the manuscript and revised it according to feedback from coauthors. DG, CK and BCC contributed to the design of the analysis and conducted the analysis of the data. PTH and DG developed the neonIN network in Greece, designed the current analysis and provided critical appraisal as well as final approval of the manuscript. TZ, NS, MT, KS, SS and JK made substantial contributions to the acquisition of data for the analysis, critically revised the manuscript and provided final approval for the version to be submitted.

    • Funding This work was supported by the European Society of Paediatric Infectious Diseases (Small Grant Award 2014 and 2015).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The neonIN database received ethics approval from the London-Surrey Borders Research Ethics Committee in April 2005 (05/Q0806/34) and this was extended in December 2013 (05/Q0806/34+5) for a period of five years. Each participating NNU in Greece received separate approval from the local ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators NeonIN Surveillance Network in Greece: Korina Karachristou, Eleni Bouza, Niki Lipsou, Fani Anatolitou, Zelina Stratiki, Georgios Baroutis, Georgia Nyktari, Vassiliki Peristeri, Maria Lithoxopoulou, Antonia Charitou, Ioanna Spanopoulou, Antonia Manoura, Marianna Skordala, Basilis Giapros, Vassiliki Agakidou-Drossou, Margarita Tzaki, Lida Michalodimitraki, Georgios Mavrogeorgos, Aikaterini Avgeri.