Epidemiology of infections and antimicrobial use in Greek Neonatal Units

Arch Dis Child Fetal Neonatal Ed. 2019 May;104(3):F293-F297. doi: 10.1136/archdischild-2018-315024. Epub 2018 Jun 28.

Abstract

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.

Keywords: antimicrobial use; epidemiology; greece; neonatal infections.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Infective Agents / therapeutic use*
  • Cross Infection / drug therapy*
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Drug Utilization / statistics & numerical data
  • Female
  • Gestational Age
  • Greece / epidemiology
  • Humans
  • Incidence
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Male
  • Microbial Sensitivity Tests / methods
  • Neonatal Sepsis / drug therapy*
  • Neonatal Sepsis / epidemiology*
  • Neonatal Sepsis / microbiology
  • Practice Patterns, Physicians' / statistics & numerical data
  • Retrospective Studies

Substances

  • Anti-Infective Agents