title: 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).
  
  
  METHODS
  Vignette-based survey.
  
  
  METHODS
  Four tertiary care NICUs.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York, USA. sp2172@columbia.edu
authors.forename: Sameer
authors.initials: S
authors.lastname: Patel
authors.forename: Timothy
authors.initials: T
authors.lastname: Landers
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.forename: Patricia
authors.initials: P
authors.lastname: Delamora
authors.forename: David A
authors.initials: DA
authors.lastname: Paul
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wong-McLoughlin
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Ferng
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods; D024881:Drug Resistance, Bacterial; D020445:Hospitalists; D006801:Humans; D015931:Intensive Care, Neonatal; D009722:Nurse Practitioners; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents