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Media Stories on NICU Outbreaks Lead to an Increased Prescription Rate of Third-Line Antibiotics in the Community of Neonatal Care

  • Christoph Härtel (a1), Annika Hartz (a1), Lina Bahr (a1), Christian Gille (a2), Ludwig Gortner (a3), Arne Simon (a3), Thorsten Orlikowsky (a4), Andreas Müller (a5), Thorsten Körner (a6), Philipp Henneke (a7), Roland Haase (a8), Michael Zemlin (a9), Dorothee Viemann (a10), Corinna Gebauer (a11), Ulrich Thome (a11), Andreas Ziegler (a12) (a13) (a14), Jan Rupp (a15), Egbert Herting (a1), Wolfgang Göpel (a1) and for the German Neonatal Network...



Between 2010 and 2012, 3 outbreaks of nosocomial infections in German neonatal intensive care units (NICUs) attracted considerable public interest. Headlines on national television channels and in newspapers had important consequences for the involved institutions and a negative impact on the relationship between families and staff in many German NICUs.


To determine whether NICU outbreaks reported in the media influenced provider behavior in the community of neonatal care and led to more third-line antibiotic prescribing.


Observational cohort study.


To investigate secular trends, we evaluated data for very-low-birth-weight infants (VLBWIs, birth weight <1,500 g) enrolled in the German Neonatal Network (GNN) between 2009 and 2014 (N=10,253). For outbreak effects, we specifically analyzed data for VLBWIs discharged 6 months before (n=2,428) and 6 months after outbreaks (n=2,508).


The exposure of all VLBWIs to third-line antibiotics increased after outbreaks (19.4% before vs 22.5% after; P=.007). This trend particularly affected male infants (4.6% increase; P=.005) and infants with a birth weight between 1,000 and 1,499 g (3.5% increase; P=.001)

In a logistic regression analysis, month of discharge as linear variable of time was associated with increased exposure to third-line antibiotics (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.009–1.014; P<.001), and discharge within the 6-month period after outbreak reports independently contributed to this long-term trend (OR, 1.14; 95% CI, 1.017–1.270; P=.024).


Media reports directly affect medical practice, eg, overuse of third-line antibiotics. Future communication and management strategies must be based on objective dialogues between the scientific community and investigative journalists.

Infect Control Hosp Epidemiol 2016;37:924–930


Corresponding author

Address correspondence to Christoph Härtel, Department of Paediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany (


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