Case-Based Vignettes Help Advance Antibiotic Stewardship in NICUs

Factorial vignettes describe suspected early onset sepsis practice variation in a multicenter NICU antibiotic stewardship collaborative https://pubmed.ncbi.nlm.nih.gov/40461770/ There is both widespread variation in antibiotics use and antibiotics overuse in neonatal intensive care units (NICUs). However, case-based vignettes that demonstrate safe antibiotics prescribing practices in specific patient scenarios can help promote more antibiotic stewardship–friendly practices in NICU settings, according to an AHRQ-funded study published in the Journal of Perinatology. The authors surveyed clinicians at 31 NICUs participating in the Optimizing Antibiotic Stewardship in California NICUs (OASCN) collaborative to learn how they would evaluate and manage early-onset sepsis in newborns before and after a 12-month collaborative intervention. The study found that clinicians in NICUs were less likely to order laboratory testing and more likely to follow stewardship-friendly practices after the intervention. For example, when given test results for a well-appearing infant that could be associated with a bacterial infection at 12 hours of life, 26 percent of clinicians were likely or very likely at baseline to start antibiotics; this decreased to 14 percent at followup. In addition to validating the use of case-based vignettes to optimize prescribing practices, the study suggested targeting specific antibiotic use practices in the NICU setting.