title: Prevalence, Characteristics, and Perception of Nursery Antibiotic Stewardship Coverage in the United States.
abstract: BACKGROUND
  Prolonged or unnecessary antibiotic use is associated with adverse outcomes in infants. Antibiotic stewardship programs (ASPs) aim to prevent these adverse outcomes and optimize antibiotic prescribing. However, data evaluating ASP coverage of nurseries are limited. The objectives of this study were to describe the characteristics of nurseries with and without ASP coverage and to determine perceptions of and barriers to nursery ASP coverage.
  
  
  METHODS
  The 2014 American Hospital Association annual survey was used to randomly select a level III neonatal intensive care unit from all 50 states. A level I and level II nursery from the same city as the level III nursery were then randomly selected. Hospital, nursery, and ASP characteristics were collected. Nursery and ASP providers (pharmacists or infectious disease providers) were interviewed using a semistructured template. Transcribed interviews were analyzed for themes.
  
  
  RESULTS
  One hundred forty-six centers responded; 104 (71%) provided nursery ASP coverage. In multivariate analysis, level of nursery, university affiliation, and number of full-time equivalent ASP staff were the main predictors of nursery ASP coverage. Several themes were identified from interviews: unwanted coverage, unnecessary coverage, jurisdiction issues, need for communication, and a focus on outcomes. Most providers had a favorable view of nursery ASP coverage.
  
  
  CONCLUSIONS
  Larger, higher-acuity nurseries in university-affiliated hospitals are more likely to have ASP coverage. Low ASP staffing and a perceived lack of importance were frequently cited as barriers to nursery coverage. Most nursery ASP coverage is viewed favorably by providers, but nursery providers regard it as less important than ASP providers.
authors.affiliation: Department of Pediatrics, Divisions of Neonatal/Perinatal Medicine.|Pediatric Infectious Diseases, Texas A&M Health Science Center, Temple.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Cantey
authors.affiliation: Department of Pediatrics, Divisions of Neonatal/Perinatal Medicine.
authors.forename: Niraj
authors.initials: N
authors.lastname: Vora
authors.affiliation: Department of Pediatrics, Divisions of Neonatal/Perinatal Medicine.
authors.forename: Mridula
authors.initials: M
authors.lastname: Sunkara
mesh_terms: D000900:Anti-Bacterial Agents / Q000592:standards / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards / Q000706:statistics & numerical data; D000073602:Antimicrobial Stewardship / Q000592:standards / Q000706:statistics & numerical data; D003141:Communicable Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal; D015999:Multivariate Analysis; D010465:Perception; D017410:Practice Guidelines as Topic; D015995:Prevalence; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: NICU; antibiotic; neonate; nursery; stewardship