{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:43:01Z","timestamp":1785426181046,"version":"3.56.0"},"reference-count":100,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:00:00Z","timestamp":1675814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Neonatal sepsis is an important cause of neonatal morbidity and mortality. A significant proportion of bacteria causing neonatal sepsis is resistant to multiple antibiotics, not only to the usual empirical first-line regimens, but also to second- and third-line antibiotics in many neonatal intensive care units (NICUs). NICUs have unique antimicrobial stewardship goals. Apart from antimicrobial resistance, NICUs have to deal with another problem, namely biofilm infections, since neonates often have central and peripheral lines, tracheal tubes and other foreign bodies for a prolonged duration. The aim of this review is to describe traditional and novel ways to fight antibiotic-resistant bacteria and biofilm infections in NICUs. The topics discussed will include prevention and control of the spread of infection in NICUs, as well as the wise use of antimicrobial therapy and ways to fight biofilm infections.<\/jats:p>","DOI":"10.3390\/antibiotics12020352","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T02:32:07Z","timestamp":1675909927000},"page":"352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Antibiotic Resistance and Biofilm Infections in the NICUs and Methods to Combat It"],"prefix":"10.3390","volume":"12","author":[{"given":"Maria","family":"Baltogianni","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Giapros","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1244-375X","authenticated-orcid":false,"given":"Chrysoula","family":"Kosmeri","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/INF.0b013e318223bad2","article-title":"The burden of invasive early-onset neonatal sepsis in the United States, 2005\u20132008","volume":"30","author":"Weston","year":"2011","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1542\/peds.2010-2217","article-title":"Early onset neonatal sepsis: The burden of group B Streptococcal and E. coli disease continues","volume":"127","author":"Stoll","year":"2011","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000-15: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016","journal-title":"Lancet"},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2023, February 02). Antibiotic Resistance Threats in the United States, Available online: https:\/\/www.cdc.gov\/drugresistance\/pdf\/threats-report\/2019-ar-threats-report-508.pdf."},{"key":"ref_5","first-page":"173","article-title":"Dissemination of Antimicrobial Resistance in Microbial Ecosystems through Horizontal Gene Transfer","volume":"7","author":"Penders","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1038\/s41564-021-00870-7","article-title":"Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries","volume":"6","author":"Sands","year":"2021","journal-title":"Nat. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1093\/jac\/dkv418","article-title":"The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children","volume":"71","author":"Versporten","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"694093","DOI":"10.3389\/fcimb.2021.694093","article-title":"Emerging Threat of Multidrug Resistant Pathogens From Neonatal Sepsis","volume":"11","author":"Zou","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e752","DOI":"10.1016\/S2214-109X(16)30148-6","article-title":"Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: A cohort study","volume":"4","author":"Agarwal","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3233\/NPM-1765","article-title":"Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis","volume":"11","author":"Bandyopadhyay","year":"2018","journal-title":"J. Neonatal. Perinatal. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.1016\/j.ajic.2007.10.007","article-title":"2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings","volume":"35","author":"Siegel","year":"2007","journal-title":"Am. J. Infect. Control."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2174\/1573396315666190118101953","article-title":"Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update","volume":"15","author":"Gkentzi","year":"2019","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00431-012-1910-6","article-title":"Clinical signs to identify late-onset sepsis in preterm infants","volume":"172","author":"Bekhof","year":"2013","journal-title":"Eur. J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1097\/01.PCC.0000161583.34305.A0","article-title":"Physicians\u2019 ability to diagnose sepsis in newborns and critically ill children","volume":"6","author":"Fischer","year":"2005","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000346057","article-title":"Antibiotic use in newborns with transient tachypnea of the newborn","volume":"103","author":"Weintraub","year":"2013","journal-title":"Neonatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1651-2227.2007.00571.x","article-title":"Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome","volume":"97","author":"Shani","year":"2008","journal-title":"Acta Paediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"285","DOI":"10.3389\/fped.2018.00285","article-title":"Culture-Negative Early-Onset Neonatal Sepsis\u2014At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship","volume":"6","author":"Klingenberg","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_18","first-page":"659","article-title":"Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units","volume":"26","author":"Branstetter","year":"2021","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e1015","DOI":"10.1542\/peds.2013-3413","article-title":"MRSA colonization and risk of infection in the neonatal and pediatric ICU: A meta-analysis","volume":"133","author":"Zervou","year":"2014","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.ajic.2017.10.002","article-title":"Journal Club: Commentary on \u201cRisk factors for MRSA colonization in the neonatal ICU: A systematic review and meta-analysis\u201d","volume":"45","author":"Gilmartin","year":"2017","journal-title":"Am. J. Infect. Control."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1542\/neo.20-3-e135","article-title":"Antibiotic Resistance in the Neonatal Intensive Care Unit","volume":"20","author":"Ramirez","year":"2019","journal-title":"Neoreviews"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/CCM.0000000000003868","article-title":"Hand Hygiene Compliance in the ICU: A Systematic Review","volume":"47","author":"Lambe","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1542\/peds.110.2.285","article-title":"Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network","volume":"110","author":"Stoll","year":"2002","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1056\/NEJMoa061115","article-title":"An intervention to decrease catheter-related bloodstream infections in the ICU","volume":"355","author":"Pronovost","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1038\/jp.2009.172","article-title":"A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections","volume":"30","author":"Wirtschafter","year":"2010","journal-title":"J. Perinatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.clp.2010.01.014","article-title":"Decreasing central line associated bloodstream infection in neonatal intensive care","volume":"37","author":"Powers","year":"2010","journal-title":"Clin. Perinatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0022-3476(96)70254-8","article-title":"Volume of blood required to detect common neonatal pathogens","volume":"129","author":"Schelonka","year":"1996","journal-title":"J. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.clp.2021.03.009","article-title":"Antibiotic Stewardship for the Neonatologist and Perinatologist","volume":"48","author":"Katz","year":"2021","journal-title":"Clin. Perinatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1001\/jamapediatrics.2019.5669","article-title":"Assessment of C-Reactive Protein Diagnostic Test Accuracy for Late-Onset Infection in Newborn Infants: A Systematic Review and Meta-analysis","volume":"174","author":"Brown","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/s13054-018-2236-1","article-title":"The combination of procalcitonin and C-reactive protein or presepsin alone improves the accuracy of diagnosis of neonatal sepsis: A meta-analysis and systematic review","volume":"22","author":"Ruan","year":"2018","journal-title":"Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000241296","article-title":"Use of procalcitonin-guided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis: Prospective randomized intervention trial","volume":"97","author":"Stocker","year":"2010","journal-title":"Neonatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S0140-6736(17)31444-7","article-title":"Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: A multicentre, randomised controlled trial (NeoPIns)","volume":"390","author":"Stocker","year":"2017","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"840778","DOI":"10.3389\/fped.2022.840778","article-title":"Reliability of Interleukin-6 Alone and in Combination for Diagnosis of Early Onset Neonatal Sepsis: Systematic Review","volume":"10","author":"Eichberger","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13146","DOI":"10.1097\/MD.0000000000013146","article-title":"Interleukin-6 for early diagnosis of neonatal sepsis with premature rupture of the membranes: A meta-analysis","volume":"97","author":"Qiu","year":"2018","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1542\/peds.2013-1689","article-title":"Stratification of risk of early-onset sepsis in newborns \u2265 34 weeks\u2019 gestation","volume":"133","author":"Escobar","year":"2014","journal-title":"Pediatrics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e1155","DOI":"10.1542\/peds.2010-3464","article-title":"Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors","volume":"128","author":"Puopolo","year":"2011","journal-title":"Pediatrics"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1001\/jamapediatrics.2019.2825","article-title":"Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis","volume":"173","author":"Achten","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"105331","DOI":"10.1016\/j.earlhumdev.2021.105331","article-title":"A comparison between risk-factor guidance for neonatal early-onset sepsis and Kaiser Permanente sepsis risk calculator in a Greek cohort","volume":"155","author":"Rallis","year":"2021","journal-title":"Early Hum. Dev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.earlhumdev.2018.01.008","article-title":"Vital signs analysis algorithm detects inflammatory response in premature infants with late onset sepsis and necrotizing enterocolitis","volume":"117","author":"Mithal","year":"2018","journal-title":"Early Hum. Dev."},{"key":"ref_41","first-page":"321","article-title":"Pilot study of a new mathematical algorithm for early detection of late-onset sepsis in very low-birth-weight infants","volume":"32","author":"Gur","year":"2015","journal-title":"Am. J. Perinatol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sofouli, G.A., Kanellopoulou, A., Vervenioti, A., Dimitriou, G., and Gkentzi, D. (2022). Predictive Scores for Late-Onset Neonatal Sepsis as an Early Diagnostic and Antimicrobial Stewardship Tool: What Have We Done So Far?. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070928"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1097\/00003246-200207000-00010","article-title":"Internal and external validation of the NOSEP prediction score for nosocomial sepsis in neonates","volume":"30","author":"Mahieu","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1038\/sj.jp.7211404","article-title":"A bedside prediction-scoring model for late-onset neonatal sepsis","volume":"25","author":"Okascharoen","year":"2005","journal-title":"J. Perinatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1038\/sj.jp.7211767","article-title":"External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis","volume":"27","author":"Okascharoen","year":"2007","journal-title":"J. Perinatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1055\/s-0039-1697669","article-title":"Quantifying Medication Exposure in Very Low Birth Weight Neonates","volume":"38","author":"Davis","year":"2021","journal-title":"Am. J. Perinatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1055\/s-0033-1361933","article-title":"Medication use in the neonatal intensive care unit","volume":"31","author":"Hsieh","year":"2014","journal-title":"Am. J. Perinatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1542\/peds.2012-0541","article-title":"Management of neonates with suspected or proven early-onset bacterial sepsis","volume":"129","author":"Polin","year":"2012","journal-title":"Pediatrics"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1093\/jac\/dkq107","article-title":"Variation in antibiotic use in neonatal intensive care units in the Netherlands","volume":"65","author":"Liem","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"F293","DOI":"10.1136\/archdischild-2018-315024","article-title":"Epidemiology of infections and antimicrobial use in Greek Neonatal Units","volume":"104","author":"Gkentzi","year":"2019","journal-title":"Arch. Dis. Child. Fetal. Neonatal. Ed."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e185","DOI":"10.1097\/INF.0000000000000719","article-title":"Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units: How Much and How Good?","volume":"34","author":"Osowicki","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_52","first-page":"997","article-title":"Current management of late onset neonatal bacterial sepsis in five European countries","volume":"173","author":"Lutsar","year":"2014","journal-title":"Eur. J. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/INF.0000000000000542","article-title":"Prospective surveillance of antibiotic use in the neonatal intensive care unit: Results from the SCOUT study","volume":"34","author":"Cantey","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S0140-6736(00)90015-1","article-title":"An antibiotic policy to prevent emergence of resistant bacilli","volume":"355","author":"Verhoeven","year":"2000","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1542\/peds.2005-2677","article-title":"The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants","volume":"118","author":"Cotten","year":"2006","journal-title":"Pediatrics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/INF.0b013e3182011d12","article-title":"Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit","volume":"30","author":"Chiu","year":"2011","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"F454","DOI":"10.1136\/archdischild-2012-303350","article-title":"Update on the management of Candida infections in preterm neonates","volume":"100","author":"Manzoni","year":"2015","journal-title":"Arch. Dis. Child. Fetal. Neonatal. Ed."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e20182894","DOI":"10.1542\/peds.2018-2894","article-title":"Management of Neonates Born at \u226535 0\/7 Weeks\u2019 Gestation With Suspected or Proven Early-Onset Bacterial Sepsis","volume":"142","author":"Puopolo","year":"2018","journal-title":"Pediatrics"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1089\/sur.2016.163","article-title":"Variability in Antibiotic Regimens for Surgical Necrotizing Enterocolitis Highlights the Need for New Guidelines","volume":"18","author":"Blackwood","year":"2017","journal-title":"Surg. Infect."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1055\/s-0039-1693429","article-title":"Antibiotic Treatments and Patient Outcomes in Necrotizing Enterocolitis","volume":"37","author":"Murphy","year":"2020","journal-title":"Am. J. Perinatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1016\/j.jpedsurg.2014.09.018","article-title":"Multi-institutional practice patterns and outcomes in uncomplicated gastroschisis: A report from the University of California Fetal Consortium (UCfC)","volume":"49","author":"Lusk","year":"2014","journal-title":"J. Pediatr. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1542\/peds.2007-3423","article-title":"Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants","volume":"123","author":"Cotten","year":"2009","journal-title":"Pediatrics"},{"key":"ref_63","first-page":"227","article-title":"Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit","volume":"6","author":"Patel","year":"2017","journal-title":"J. Pediatric. Infect. Dis. Soc."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1093\/cid\/cir840","article-title":"Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia","volume":"54","author":"Aliberti","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1097\/INF.0b013e3181b12484","article-title":"Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance","volume":"28","author":"Patel","year":"2009","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ccc.2010.09.009","article-title":"Antibiotic de-escalation","volume":"27","author":"Masterton","year":"2011","journal-title":"Crit. Care Clin."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00134-013-3077-7","article-title":"De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock","volume":"40","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/PCC.0000000000002198","article-title":"Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children","volume":"21","author":"Weiss","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e20180115","DOI":"10.1542\/peds.2018-0115","article-title":"Variations in Neonatal Antibiotic Use","volume":"142","author":"Schulman","year":"2018","journal-title":"Pediatrics"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/INF.0000000000000906","article-title":"Early-onset Sepsis and Antibiotic Exposure in Term Infants: A Nationwide Population-based Study in Norway","volume":"35","author":"Fjalstad","year":"2016","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Kopsidas, I., Tsopela, G.C., Molocha, N.M., Bouza, E., Chorafa, E., Chorianopoulou, E., Giapros, V., Gkentzi, D., Gkouvas, T., and Kapetanaki, A. (2021). Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A \u201cLow-Hanging Fruit\u201d Approach. Antibiotics, 10.","DOI":"10.3390\/antibiotics10030275"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/S1473-3099(16)30205-5","article-title":"Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): A prospective interrupted time-series study","volume":"16","author":"Cantey","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1093\/ofid\/ofw172.1482","article-title":"Antibiotic Therapy in Patients with Necrotizing Enterocolitis in the Neonatal Intensive Care Unit: A Quality Improvement Project","volume":"3","author":"Lance","year":"2016","journal-title":"Open Forum Infect. Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.clp.2014.10.007","article-title":"Antibiotic stewardship: Reassessment of guidelines for management of neonatal sepsis","volume":"42","author":"Cotten","year":"2015","journal-title":"Clin. Perinatol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1542\/peds.2014-0360","article-title":"The conundrum of early-onset sepsis","volume":"133","author":"Polin","year":"2014","journal-title":"Pediatrics"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1038\/sj.jp.7200416","article-title":"Neonatal pneumonia: Comparison of 4 vs 7 days of antibiotic therapy in term and near-term infants","volume":"20","author":"Engle","year":"2000","journal-title":"J. Perinatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1086\/502270","article-title":"Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants","volume":"24","author":"Cordero","year":"2003","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/sj.jp.7211252","article-title":"Practice variation in suspected neonatal sepsis: A costly problem in neonatal intensive care","volume":"25","author":"Spitzer","year":"2005","journal-title":"J. Perinatol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1093\/jac\/dkq309","article-title":"European Surveillance of Antibiotic Consumption (ESAC) point prevalence survey 2008: Paediatric antimicrobial prescribing in 32 hospitals of 21 European countries","volume":"65","author":"Amadeo","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/INF.0000000000002867","article-title":"Antibiotic Utilization and Infection Among Infants with Abdominal Wall Defects","volume":"39","author":"Ravikumar","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1053\/j.sempedsurg.2019.01.009","article-title":"A standardized guideline for antibiotic prophylaxis in surgical neonates","volume":"28","author":"Laituri","year":"2019","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"a010306","DOI":"10.1101\/cshperspect.a010306","article-title":"Bacterial biofilms: Development, dispersal, and therapeutic strategies in the dawn of the postantibiotic era","volume":"3","author":"Kostakioti","year":"2013","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13756-019-0533-3","article-title":"Antibiotics versus biofilm: An emerging battleground in microbial communities","volume":"8","author":"Sharma","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"676458","DOI":"10.3389\/fmicb.2021.676458","article-title":"Bacterial Biofilm Inhibition: A Focused Review on Recent Therapeutic Strategies for Combating the Biofilm Mediated Infections","volume":"12","author":"Srinivasan","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jcma.2017.07.012","article-title":"Bacterial biofilm and associated infections","volume":"81","author":"Jamal","year":"2018","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/ijos.2014.65","article-title":"Strategies for combating bacterial biofilm infections","volume":"7","author":"Wu","year":"2015","journal-title":"Int. J. Oral Sci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.ijantimicag.2009.12.011","article-title":"Antibiotic resistance of bacterial biofilms","volume":"35","author":"Bjarnsholt","year":"2010","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0140-6736(01)05321-1","article-title":"Antibiotic resistance of bacteria in biofilms","volume":"358","author":"Stewart","year":"2001","journal-title":"Lancet"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/mdr.2015.0124","article-title":"Effect of Antibiotics and Antibiofilm Agents in the Ultrastructure and Development of Biofilms Developed by Nonpigmented Rapidly Growing Mycobacteria","volume":"22","author":"Esteban","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Egea, M.C., Garc\u00eda-Pedrazuela, M., Mahillo, I., and Esteban, J. (2015). Effect of ciprofloxacin in the ultrastructure and development of biofilms formed by rapidly growing mycobacteria. BMC Microbiol., 15.","DOI":"10.1186\/s12866-015-0359-y"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Subhadra, B., Kim, D.H., Woo, K., Surendran, S., and Choi, C.H. (2018). Control of Biofilm Formation in Healthcare: Recent Advances Exploiting Quorum-Sensing Interference Strategies and Multidrug Efflux Pump Inhibitors. Materials, 11.","DOI":"10.3390\/ma11091676"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.3390\/s90402538","article-title":"Advances in microbial biofilm prevention on indwelling medical devices with emphasis on usage of acoustic energy","volume":"9","author":"Dror","year":"2009","journal-title":"Sensors"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/BF01569996","article-title":"Prevention of biofilm formation by polymer modification","volume":"15","author":"Jansen","year":"1995","journal-title":"J. Ind. Microbiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/jac\/45.2.221","article-title":"Antibacterial activity of antibiotic-soaked polyvinylpyrrolidone-grafted silicon elastomer hydrocephalus shunts","volume":"45","author":"Boelens","year":"2000","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1089\/end.2007.9904","article-title":"Antibiotic pretreatment of hydrogel ureteral stent","volume":"21","author":"John","year":"2007","journal-title":"J. Endourol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.biomaterials.2016.06.050","article-title":"Superhydrophobic materials for biomedical applications","volume":"104","author":"Falde","year":"2016","journal-title":"Biomaterials"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s12275-017-7274-x","article-title":"Antibiofilm agents: A new perspective for antimicrobial strategy","volume":"55","author":"Li","year":"2017","journal-title":"J. Microbiol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1128\/JB.01214-08","article-title":"A fatty acid messenger is responsible for inducing dispersion in microbial biofilms","volume":"191","author":"Davies","year":"2009","journal-title":"J. Bacteriol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"7333","DOI":"10.1128\/JB.00975-09","article-title":"Nitric oxide signaling in Pseudomonas aeruginosa biofilms mediates phosphodiesterase activity, decreased cyclic di-GMP levels, and enhanced dispersal","volume":"191","author":"Barraud","year":"2009","journal-title":"J. Bacteriol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"18488","DOI":"10.3390\/ijms140918488","article-title":"Novel strategies for the prevention and treatment of biofilm related infections","volume":"14","author":"Chen","year":"2013","journal-title":"Int. J. Mol. Sci."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:28:32Z","timestamp":1760120912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,8]]},"references-count":100,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["antibiotics12020352"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12020352","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,8]]}}}