Skip to main content
    • Aa
    • Aa

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

  • Sameer Patel (a1), Timothy Landers (a2), Elaine Larson (a3), Theoklis Zaoutis (a4), Patricia Delamora (a5), David A. Paul (a6) (a7), Jennifer Wong-McLoughlin (a3), Yu-hui Ferng (a3) and Lisa Saiman (a1) (a8)...

To use clinical vignettes to understand antimicrobial prescribing practices in neonatal intensive care units (NICUs).


Vignette-based survey.


Four tertiary care NICUs.


Antibiotic prescribers in NICUs.


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.


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).


The survey provides insight into antibiotic prescribing practices and informs the development of future antibiotic stewardship interventions for NICUs.

Corresponding author
622 West 168th Street, PH 4W-475, New York, NY 10032 (
Hide All
1. AS Kiefer , AC Wickremasinghe , JN Johnson , et al.Medical management of extremely low-birth-weight infants in the first week of life: a survey of practices in the United States. Am J Perinatal 2009;26:407418.

2. LG Rubin , PJ Sánchez , J Siegel , et al.Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neo-natologists practices. Pediatrics 2002;110:e42.

3. JW Peabody , J Luck , P Glassman , TR Dressemaus , M Lee . Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA 2000;283:17151722.

4. JW Peabody , J Liuck , P Glassman , et al.Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med 2004;141:771780.

5. BE Landon , JD Reschovsky , M Reed , D Blumenthal . Personal, organizational and market level influences on physicians' practice patterns: results of a national survey of primary care physicians. Med Care 2001;39:889905.

7. SS Rathore , JD Ketcham , GC Alexander , AJ Epstein . Influence of patient race on physician prescribing decisions: a randomized online experiment. J Gen Intern Med 2009;24:11831191.

9. SJ Patel , P Delamora , T Zaoutis , et al.Antibiotic use in neonatal intensive care units and adherence with the Centers for Disease Control and Prevention 12-Step Campaign to Prevent Antimicrobial Resistance. Pediatr Infect Dis J 2009;28:10471051.

10. E Ibia , M Sheridan , R Schwartz . Knowledge of the principles of judicious antibiotic use for upper respiratory infections: a survey of senior medical students. South Med J 2005;98:889895.

11. PL Lin , RJ Oram , DS Lauderdale , R Dean , RS Daum . Knowledge of Centers for Disease Control and Prevention guidelines for the use of vancomycin at a large tertiary care children's hospital. J Pediatr 2000;137:694700.

13. JA Finkelstein , RF Davis , SF Dowell , et al.Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 2001;108:17.

14. EO Doyne , MP Alfaro , RM Siegel , et al.A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med 2004;158:577583.

15. CL Cheng , YH Yang , SJ Lin , CH Lin , YJ Lin . Compliance with dosing recommendations from common References in prescribing antibiotics for preterm neonates. Pharmacoepidemiol Surg Saf 2010;19:5158.

16. Ji Velosk , S Tai , AS Evans , DB Nash . Clinical vignette-based surveys: a tool for assessing physician practice variation. Am Journal Med Qual 2005;20:151157.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 3 *
Loading metrics...

Abstract views

Total abstract views: 311 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th October 2017. This data will be updated every 24 hours.