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Clinical Vignettes Provide an Understanding of Antibiotic Prescribing Practices in Neonatal Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Sameer Patel ,
Timothy Landers ,
Elaine Larson ,
Theoklis Zaoutis ,
Patricia Delamora ,
David A. Paul ,
Jennifer Wong-McLoughlin ,
Yu-hui Ferng  and
Lisa Saiman
Sameer Patel*
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Timothy Landers
Affiliation:
College of Nursing, Ohio State University, Columbus, Ohio
Elaine Larson
Affiliation:
School of Nursing, Columbia University, New York, New York
Theoklis Zaoutis
Affiliation:
Department of Infection Prevention and Control, Children‘s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Patricia Delamora
Affiliation:
Department of Pediatrics, Cornell University, New York, New York
David A. Paul
Affiliation:
Department of Pediatrics, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania Department of Pediatrics and Neonatology, Christiana Care Health Services, Christiana Hospital, Wilmington, Delaware
Jennifer Wong-McLoughlin
Affiliation:
School of Nursing, Columbia University, New York, New York
Yu-hui Ferng
Affiliation:
School of Nursing, Columbia University, New York, New York
Lisa Saiman
Affiliation:
Department of Pediatrics, Columbia University, New York, New York Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
*
622 West 168th Street, PH 4W-475, New York, NY 10032 (sp2172@columbia.edu)
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Abstract

Objective.

To use clinical vignettes to understand antimicrobial prescribing practices in neonatal intensive care units (NICUs).

Design.

Vignette-based survey.

Setting.

Four tertiary care NICUs.

Participants.

Antibiotic prescribers in NICUs.

Methods.

Clinicians from 4 tertiary care NICUs completed an anonymous survey containing 12 vignettes that described empiric, targeted, or prophylactic antibiotic use. Responses were compared with Centers for Disease Control and Prevention guidelines for appropriate use.

Results.

Overall, 161 (59% of 271 eligible respondents) completed the survey, 37% of whom had worked in NICUs for 7 or more years. Respondents were more likely to appropriately identify use of targeted therapy for methicillin-susceptible Staphylococcus aureus, that is, use of oxacillin rather than vancomycin, than for Escherichia coli, that is, use of first-generation rather than third-generation cephalosporin, (P < .01). Increased experience significantly predicted appropriate prescribing (P = .02 ). The proportion of respondents choosing appropriate duration of postsurgical prophylaxis (P < .01) and treatment for necrotizing enterocolitis differed by study site (P = .03).

Conclusions.

The survey provides insight into antibiotic prescribing practices and informs the development of future antibiotic stewardship interventions for NICUs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 6 , June 2011 , pp. 597 - 602
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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