Infection Control, Antimicrobial Resistance, Chemoprophylaxis and Antimicrobial Stewardship Prolonged Dual Antibiotic Courses for Culture Positive Neonatal Sepsis in 3 Greek Neonatal Units

I. Kopsidas, L. Lianou, E. Kourkouni, K. Karachristou, E. Stratiki, A. Vintila, D. Karaviti, Z. Kirikas, L. Baglatzi, K. Mougkou, M. Pappa, M. Tsolia, T. Zaoutis, N. Spyridis
33rd Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2015)
Leipzig, Germany, May 12-16, 2015

BACKGROUND AND AIMS: Antimicrobial resistance (AMR) is a major healthcare problem. Antibiotic stewardship programs seek to promote judicious use of antimicrobials. One key element of stewardship interventions is to de-escalate empiric antibiotic therapy following positive culture results.
The aim of this study is to document dual antibiotic therapy in neonates following positive culture results in 3 neonatal units (NNUs) in Greece.

METHODS: These are preliminary results of an ongoing prospective antibiotic use surveillance study conducted in 3 NNUs in Athens, Greece. Data collected between March and September 2014 by indication at initiation of antibiotic administration. Cases with only an indication of sepsis were identified and Length of Therapy (LOT), Days of Therapy (DOT) and DOT/LOT were calculated. DOT/LOT ratio was used as a proxy for estimation of antibiotic de-escalation failure.

RESULTS: We documented 39 cases of neonates treated with the diagnosis of “sepsis”. Median LOT was 7(IQR: 6-10) days and DOT 14(IQR: 12-20) days. Neonates with culture negative sepsis were treated for a median of 7(IQR: 5-7) days vs 10(10-15) for those with culture positive sepsis (p=0.0053) (Table-1). 13 neonates (39%) had positive blood cultures. Redundant dual antibiotic therapy was given to 7/13(54%) following culture results, of which 6/7(86%) were gram positive isolates. Table-2 demonstrates antibiotics and isolates from neonates with positive culture results.

CONCLUSION: We documented prolonged dual antibiotic courses with extensive spectrum in 3 Greek NNUs even in the presence of susceptibility results following positive blood cultures. Narrowing antibiotic regimen is critical especially in neonatal units where broad and prolonged antibiotic courses are often documented.

Table 1 Antibiotic Use in days, Combined and by Culture Result

Length of Therapy (LOT) – the number of days during which at least one dose of any antibiotic was received.
Days of Therapy (DOT) – the aggregate sum of LOT for each antibiotic received

Table 2 Antibiotic Therapy and Isolates of Culture positive cases

(*) Discontinued antibiotics on or before Day 4 of Culture draw and initiation of therapy

Pip/Tazo : Piperacillin/Tazobactam; staph : Staphylococcus
Purple: Antibiotics discontinued before or on the 4^th day
Red: Antibiotic use violation
Green: No violation