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Antibiotic use in Greek Pediatric Hematology-Oncology and Bone Marrow Transplantation units
  • +16
  • Elpis Mantadakis,
  • Ioannis Kopsidas,
  • Susan Coffin,
  • Gabriel Dimitriou ,
  • Despoina Gkentzi,
  • Emmanuel Hatzipantelis,
  • Aikaterini Kaisari,
  • Antonis Kattamis,
  • Eleni Kourkouni,
  • Smaragda Papachristidou,
  • Eugenia Papakonstantinou,
  • Sophia Polychronopoulou,
  • Emmanuel Roilides,
  • Nikos Spyridis,
  • Sotirios Tsiodras,
  • Maria Tsolia,
  • Grammatiki-Christina Tsopela,
  • Theoklis Zaoutis,
  • Athanasios Tragiannidis
Elpis Mantadakis
Democritus University of Thrace

Corresponding Author:[email protected]

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Ioannis Kopsidas
Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
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Susan Coffin
The Children's Hospital of Philadelphia
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Gabriel Dimitriou
Patras Medical School, University General Hospital of Patras, Patra, Greece
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Despoina Gkentzi
Patras Medical School, University General Hospital of Patras, Patra, Greece
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Emmanuel Hatzipantelis
Aristotle University of Thessaloniki Faculty of Health Sciences
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Aikaterini Kaisari
Agia Sofia Children's Hospital
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Antonis Kattamis
Aghia Sophia Children's Hospital
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Eleni Kourkouni
Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
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Smaragda Papachristidou
Oncology Department, "P & A Kyriakou" Children's Hospital, Athens, Greece
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Eugenia Papakonstantinou
Ippokratio General Hospital
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Sophia Polychronopoulou
Agia Sophia Childrens' Hospital
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Emmanuel Roilides
ippokratio
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Nikos Spyridis
Infectious Diseases Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
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Sotirios Tsiodras
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Maria Tsolia
Aglaia Kiriakou Children's Hospital
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Grammatiki-Christina Tsopela
Center for Clinical Epidemiology and Outcomes Research (CLEO)
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Theoklis Zaoutis
Center for Clinical Epidemiology and Outcomes Research (CLEO) / Infectious Diseases Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
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Athanasios Tragiannidis
ARISTOTLE UNIVERSITY OF THESSALONIKI
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Abstract

Background: Pediatric hematology-oncology (PHO) and bone marrow transplantation (BMT) units have high use of antimicrobials. Objectives: To survey antimicrobials used in Greek PHO and BMT units before and after an intervention involving education on the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem cell transplant recipients. Methods: Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, education for the CPG took place and antibiotic prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy and length of therapy were calculated. Results: Five of six PHO units and the single pediatric BMT unit covering >92% of children with hematologic and oncologic diseases in Greece participated. Administration of ≥ 4 antibiotics simultaneously and of antibiotics with overlapping activity for ≥ 2 days was significantly more common in PHO units located in general compared to pediatric hospitals. Use of at least one antifungal was recorded in approximately 47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (p=0.032). Although the number of patients requiring support in the intensive care unit for sepsis did not change, a significant drop was noted in all-cause mortality after the intervention (p=0.008). Conclusion: Our surveillance was able to accurately document the antibiotic prescribing practices of Greek PHO and BMT units. Moreover, it identified areas in immediate need for improvement in antibiotic stewardship.