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

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.