Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a “low-hanging fruit” approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016–06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase (p = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend (p = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days (p = 0.001, 95%CI [−45.33, −12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a “low-hanging fruit” approach. In resource-limited settings, similar targeted stewardship interventions can be applied.

INTRODUCTION Vaccination against the flu is the best method for the prevention of illness by influenza viruses. The objective of this study was to assess the impact of the COVID-19 pandemic on the seasonal influenza vaccination attitudes in Greece and to identify factors associated with a positive change in participants' choice to vaccinate against the flu. METHODS This is a sub-analysis of a cross-sectional nationwide survey (n=1004) that was conducted between 28 April and 3 May 2020 using a mixed methodology for data collection: computer assisted telephone interviewing (CATI) and computer assisted web interviewing (CAWI). Sampling followed a proportionate, stratified by region, systematic procedure to ensure a nationally representative sample of the urban/rural population. Data were collected using a structured questionnaire consisting of four parts: 1) demographics; 2) knowledge about COVID-19; 3) attitudes toward COVID-19; and 4) practices to control COVID-19 and vaccination against the flu. RESULTS Of the respondents, 66.3% (n=665) had not been vaccinated for seasonal influenza during the 2019-2020 season, the period prior to the COVID-19 pandemic. However, of those, 21.8% showed willingness to receive the vaccine (n=145) the upcoming flu season 2020-2021. Factors independently associated with increased intention to vaccinate in those that had not been vaccinated the previous flu season included: age ≥65 years; the belief that vaccination against the flu is considered preventive against the spread of the coronavirus; not believing that coronavirus was man-made in a laboratory; and not believing that the pandemic will end once a large percentage of the population is infected. CONCLUSIONS Factors that shift public opinion in favor of seasonal flu vaccination can be utilized to design effective strategies to increase vaccination uptake.

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