Download PDF
Am J Perinatol 2023; 40(08): 893-897
DOI: 10.1055/s-0041-1732418
Original Article

Knowledge, Attitudes, and Perceptions about Antibiotic Stewardship Programs among Neonatology Trainees

Ibukunoluwa C. Kalu 
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
Sagori Mukhopadhyay
2   Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Dmitry Dukhovny
3   Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
,
Rebecca Young
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
Judith A. Guzman-Cottrill
4   Division of Pediatric Infectious Disease, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective Antibiotic stewardship should be an essential component of neonatology training as neonatal intensive care units (NICU) have unique stewardship needs. Our aim was to assess neonatology fellowship trainees' knowledge, attitudes, and perceptions about antibiotic stewardship to inform sustainable curriculum development.

Study Design We distributed an electronic survey to neonatology fellows in the United States over 4 months (January–April 2018) via Accreditation Council for Graduate Medical Education program directors.

Results Of 99 programs in the United States with an estimated 700 fellows, 159 (23%) fellows from 52 training programs (53%) responded to the survey and 139 (87%) provided analyzed responses. Majority of respondents were training in southern (59; 42%) and northeastern (43; 31%) regions and were equally spread across all 3 years of training. One hundred (72%) respondents reported an antibiotic stewardship program (ASP) in their institution. While 86% (120/139) were able to identify the components of an ASP, 59% (82/139) either did not or were unsure if they had received antibiotic stewardship training during fellowship.

Furthermore, while answering case studies, 124 (89%) respondents identified the optimal antibiotic for methicillin susceptible Staphylococcus aureus (MSSA) infection and 69 (50%) respondents chose appropriate empiric antibiotics for neonatal meningitis. Notably, fellowship training year was not significantly related to the proportion of incorrect knowledge responses (p = 0.40). Most survey respondents (81; 59%) identified small group sessions as the most useful teaching format, while others chose audit and feedback of individual prescribing behavior (52; 38%) and didactic lectures (52; 38%). Finally, ninety-five (69%) respondents preferred trainee-led ASP interventions targeting focal areas such as antifungal and surgical prophylaxis.

Conclusion Antibiotic stewardship is a critical part of neonatology training. Neonatology fellows report variation in access to ASP during their training. Fellows prefer dedicated trainee-led interventions and stewardship curriculum taught within small group settings to promote targeted NICU ASP.

Key Points

  • Most neonatology programs expose trainees to internal or external antibiotic stewardship programs.

  • Over half of fellow trainees are unsure about receiving targeted antibiotic stewardship training.

  • Most neonatology fellows prefer a trainee-led antibiotic stewardship intervention.

Keywords

antibiotic resistance - neonates - curriculum development

Note

This project was previously presented at IDWeek 2019


Supplementary Material



Publication History

Received: 31 December 2020

Accepted: 01 June 2021

Article published online:
19 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Silverberg SL, Zannella VE, Countryman D. et al. A review of antimicrobial stewardship training in medical education. Int J Med Educ 2017; 8: 353-374
    CrossrefPubMedGoogle Scholar
  • 2 Ohl CA, Luther VP. Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin North Am 2014; 28 (02) 177-193
    CrossrefPubMedGoogle Scholar
  • 3 Charani E, Cooke J, Holmes A. Antibiotic stewardship programmes--what's missing?. J Antimicrob Chemother 2010; 65 (11) 2275-2277
    CrossrefPubMedGoogle Scholar
  • 4 Cummings CL, Geis GM, Kesselheim JC, Sayeed S. Ethics and professionalism education during neonatal-perinatal fellowship training in the United States. J Perinatol 2015; 35 (10) 875-879
    CrossrefPubMedGoogle Scholar
  • 5 Pisano J, Pettit N, Bartlett A. et al. Social media as a tool for antimicrobial stewardship. Am J Infect Control 2016; 44 (11) 1231-1236
    CrossrefPubMedGoogle Scholar
  • 6 Nzegwu NI, Rychalsky MR, Nallu LA. et al. Implementation of an antimicrobial stewardship program in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2017; 38 (10) 1137-1143
    CrossrefPubMedGoogle Scholar
  • 7 Dukhovny D, Buus-Frank ME, Edwards EM. et al. A collaborative multicenter QI initiative to improve antibiotic stewardship in newborns. Pediatrics 2019; 144 (06) e20190589
    CrossrefPubMedGoogle Scholar
  • 8 Ho T, Buus-Frank ME, Edwards EM. et al. Adherence of newborn-specific antibiotic stewardship programs to CDC recommendations. Pediatrics 2018; 142 (06) e20174322
    CrossrefPubMedGoogle Scholar
  • 9 Cantey JB, Patel SJ, Flenady V. Antimicrobial stewardship in the NICU. Infect Dis Clin North Am 2014; 28 (02) 247-261
    CrossrefPubMedGoogle Scholar
  • 10 Ting JY, Synnes A, Roberts A. et al; Canadian Neonatal Network Investigators. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis. JAMA Pediatr 2016; 170 (12) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 11 Cantey JB, Pyle AK, Wozniak PS, Hynan LS, Sánchez PJ. Early antibiotic exposure and adverse outcomes in preterm, very low birth weight infants. J Pediatr 2018; 203: 62-67
    CrossrefPubMedGoogle Scholar