title: Media Stories on NICU Outbreaks Lead to an Increased Prescription Rate of Third-Line Antibiotics in the Community of Neonatal Care.
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.
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Hartz
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Bahr
authors.affiliation: Department of Neonatology University of Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gille
authors.affiliation: Department of Pediatrics at Saar University, Homburg, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.affiliation: Department of Pediatrics at Saar University, Homburg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.affiliation: Department of Pediatrics, University of Aachen, Aachen, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Orlikowsky
authors.affiliation: Department of Pediatrics, University of Bonn, Bonn, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.affiliation: Children's Hospital Links der Weser, Bremen, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Körner
authors.affiliation: Center for Pediatrics and Adolescent Medicine and Center for Chronic Immunodeficiency, University Medical Center, Freiburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Henneke
authors.affiliation: Department of Pediatrics, University of Halle, Halle, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Haase
authors.affiliation: Department of Pediatrics, University of Marburg, Marburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zemlin
authors.affiliation: Department of Neonatology, Hanover Medical School, Hanover, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Viemann
authors.affiliation: Department of Pediatrics, University of Leipzig, Leipzig, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Gebauer
authors.affiliation: Department of Pediatrics, University of Leipzig, Leipzig, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Thome
authors.affiliation: Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany.|Center for Clinical Trials, University of Lübeck, Lübeck, Germany.|School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ziegler
authors.affiliation: Division of Molecular and Clinical Infectious Diseases, University of Lübeck, Lübeck, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Rupp
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.affiliation: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D008402:Mass Media; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents