Skip to main content Accessibility help
×
Home

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...

Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Observational cohort study.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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

Copyright

Corresponding author

Address correspondence to Christoph Härtel, Department of Paediatrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany (christoph.haertel@uksh.de).

References

Hide All
1. Vergnano, S, Menson, E, Kennea, N, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011;96:F9F14.
2. Boghossian, NS, Page, GP, Bell, EF, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr 2013;162:11201124.
3. Cantey, JB, Patel, SJ. Antimicrobial stewardship in the NICU. Infect Dis Clin North Am 2014;28:247261.
4. Greenhow, TL, Hung, YY, Herz, AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics 2012;129:e590e596.
5. Kermorvant-Duchemin, E, Laborie, S, Rabilloud, M, Lapillonne, A, Claris, O. Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med 2008;9:186191.
6. Gastmeier, P, Loui, A, Stamm-Balderjahn, S, et al. Outbreaks in neonatal intensive care units—they are not like others. Am J Infect Control 2007;35:172176.
7. Härtel, C, Faust, K, Avenarius, S, et al. Epidemic microclusters of blood-culture proven sepsis in very-low-birth weight infants: experience of the German Neonatal Network. PLoS One 2012;7:e38304.
8. Gastmeier, P. Serratia marcescens: an outbreak experience. Front Microbiol 2014;5:81.
9. Gortner, L. Nosocomial infections in very preterm neonates—improvements by further scientific research or discussions in talk shows? Klin Padiatr 2013;225:5556.
10. Bhakdi, S, Kramer, I, Siegel, E, et al. Use of quantitative microbiological analyses to trace origin of contamination of parenteral nutrition solutions. Med Microbiol Immunol 2012;201:231237.
11. Tuffs, A. Poor hospital hygiene is blamed for deaths of three babies in Bremen. BMJ 2011;343:d7396.
12. Tuffs, A. Neonatal ward in Bremen is closed down again after two more deaths of babies. BMJ 2012;344:e1680.
13. Stone, PW, Gupta, A, Loughrey, M, et al. Attributable costs and length of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:601606.
14. Cotten, CM, McDonald, S, Stoll, B, et al. The association of third-generation cephalosporin use and invasive candidiasis in extremely-low-birth-weight infants. Pediatrics 2006;118:717722.
15. Liem, TB, Krediet, TG, Fleer, A, et al. Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother 2010;65:12701275.
16. Simon, A, Tenenbaum, T. Surveillance of multidrug-resistant Gram-negative pathogens in high-risk neonates—does it make a difference? Pediatr Infect Dis J 2013;32:407409.
17. Haase, R, Worlitzsch, D, Schmidt, F, et al. Colonization and infection due to multi-resistant bacteria in neonates: a single center analysis. Klin Padiatr 2014;226:812.
18. Anderson, B, Nicholas, S, Sprague, B, et al. Molecular and descriptive epidemiology of multidrug-resistant Enterobacteriaceae in hospitalized infants. Infect Control Hosp Epidemiol 2008;29:250255.
19. Domke, D, Shah, DV, Wackman, DB. Media priming effects: accessibility, association and activation. Int J Publ Opin Res 1998;10:5175.
20. Chan, P, Dipper, A, Kelsey, P, et al. Newspaper reporting of methicillin-resistant Staphylococcus aureus and ‘the dirty hospital’. J Hosp Infect 2010;75:318322.
21. Carl, MA, Ndao, IM, Springman, AC, et al. Sepsis from the gut: the enteric habitat of bacteria that cause late-onset neonatal bloodstream infections. Clin Infect Dis 2014;58:12111218.
22. Harbarth, S, Sudre, P, Dharan, S, et al. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598603.
Type Description Title
WORD
Supplementary materials

Härtel supplementary material
Härtel supplementary material 1

 Word (23 KB)
23 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed