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Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis.

CPQCC Publication
TitleVignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis.
Publication TypeJournal Article
Year of Publication2021
AuthorsPayton KSE, Wirtschafter D, Bennett MV, Benitz WE, Lee HC, Kristensen-Cabrera A, Nisbet CC, Gould J, Parker C, Sharek PJ
JournalHosp Pediatr
Date Published2021 07
KeywordsAnti-Bacterial Agents, Antimicrobial Stewardship, Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Neonatal Sepsis, Pregnancy, Sepsis

BACKGROUND AND OBJECTIVES: There is widespread unwarranted antibiotic use and large individual provider variation in antibiotic use in NICUs. Vignette-based research methodology offers a unique method of studying variation in individual provider decisions. The objective with this study was to use a vignette-based survey to identify specific areas of provider antibiotic use variation in newborns being evaluated for early onset sepsis.

METHODS: This study was undertaken as part of a statewide multicenter neonatal antibiotic stewardship quality improvement project led by a perinatal quality improvement collaborative. A web-based vignette survey was administered to identify variation in decisions to start and discontinue antibiotics in cases of early onset sepsis.

RESULTS: The largest variation was noted in 3 of the 6 vignette cases. These cases highlighted variation in (1) decisions to start antibiotics in a case describing a well-appearing newborn with risk factors and an elevated C-reactive protein, (2) decisions to start antibiotics in the case of a newborn with risk factors plus mild respiratory signs at birth, and (3) decisions to stop antibiotics in the case of the newborn with a history of sepsis risk factors and mild clinical respiratory signs that resolved after 72 hours.

CONCLUSIONS: Clinical vignette assessment identified specific areas of variation in individual provider antibiotic use decisions in cases of suspected early onset sepsis. Vignettes are a valuable method of describing individual provider variation and highlighting antibiotic stewardship improvement opportunities in NICUs.

Alternate JournalHosp Pediatr
PubMed ID34083354