Infection Control & Hospital Epidemiology

Original Articles

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

Sameer Patela1 c1, Timothy Landersa2, Elaine Larsona3, Theoklis Zaoutisa4, Patricia Delamoraa5, David A. Paula6a7, Jennifer Wong-McLoughlina3, Yu-hui Fernga3 and Lisa Saimana1a8

a1 Department of Pediatrics, Columbia University, New York, New York

a2 College of Nursing, Ohio State University, Columbus, Ohio

a3 School of Nursing, Columbia University, New York, New York

a4 Department of Infection Prevention and Control, Children‘s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

a5 Department of Pediatrics, Cornell University, New York, New York

a6 Department of Pediatrics, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania

a7 Department of Pediatrics and Neonatology, Christiana Care Health Services, Christiana Hospital, Wilmington, Delaware

a8 Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York


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.

(Received November 12 2010)

(Accepted January 03 2011)


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