Reducing Harms from Unsafe Use of Antibiotics and Preventing the Spread of Antibiotic Resistance
Barbara Wells Trautner, M.D., Ph.D.
Professor of Infectious Diseases and Health Services Research
Michael E. DeBakey VA Medical Center
Baylor College of Medicine
“Without funding from agencies such as AHRQ, I could not conduct this kind of research on antibiotic stewardship. AHRQ’s focus on the delivery of healthcare is unique among funding agencies.”
Unnecessary antibiotic use is a threat to public health. Barbara Wells Trautner, M.D., Ph.D., a professor of Infectious Diseases and Health Services Research at Baylor College of Medicine, believes that antibiotics are often used excessively and unsafely. Unsafe antibiotic use includes obtaining and using prescription antibiotics without a prescription, using another person's antibiotics, or using one's own stored antibiotics for a reason other than originally prescribed. Taking prescription antibiotics without a prescription increases the risk of antibiotic resistance, adverse drug reactions, damage to the microbiome, and other harms.
Dr. Trautner’s research focuses on infection prevention and antibiotic stewardship. She received a 5-year AHRQ grant in 2019 to explore why non-prescription antibiotic use occurs. The research has three aims: to assess how the patient, healthcare system, and factors of the clinical encounter are associated with non-prescription antibiotic use in low-income patients; to explore patient perspectives and experiences with non-prescription antibiotic use among racially/ethnically diverse respondents; and to develop a communication tool for clinics to help steer patients toward safer antibiotic use and healthcare options. Dr. Trautner expects this research to help the field understand the disparities in the use of antibiotics and help develop interventions to reduce harms associated with non-prescription use, such as the spread of antibiotic-resistant bacteria. This grant is expected to end April 30, 2024.
In 2020, Dr. Trautner received a 2-year AHRQ grant to study the prevalence and predictors of antibiotic use without a prescription in children. “Non-prescription antibiotic use in children is an understudied problem,” said Dr. Trautner. Her study surveyed a diverse sample of 322 caregivers of children under 18 years old at two safety net clinics in Texas. She found that approximately 21 percent of caregivers surveyed stored antibiotics, such as amoxicillin and penicillin, at home, with younger caregivers more likely to store and use these antibiotics. These findings are guiding the development of an educational intervention to decrease non-prescription antibiotic use.
Dr. Trautner received another 5-year AHRQ grant in 2022 to randomize Veterans Administration (VA) healthcare facilities to two different approaches for implementing antibiotic stewardship—a virtual learning collaborative (group learning opportunities) versus technical assistance (individualized support available on request). This project focused on antibiotic stewardship to decrease overtreatment of asymptomatic bacteriuria (ASB). ASB, common in catheterized hospital patients and nursing home residents, often is confused with a urinary tract infection, but ASB is clinically insignificant and should not be treated with antibiotics. Treatment of ASB is a major driver of unnecessary antibiotic use in hospitals and nursing homes. Dr. Trautner’s project will add to the knowledge base by investigating which implementation strategy may be more effective in bringing clinical change through decreased urine cultures and antibiotic use. Currently 40 sites are enrolled and carrying out the intervention. Her project is expected to end April 30, 2027.
She also is a co-principal investigator on a five-year AHRQ grant awarded in 2023 to her colleague, Larissa Grigoryan, M.D., Ph.D. The aim of the project is to design and test a bilingual educational video and flyer to reduce urine contamination in a diverse patient population visiting safety net primary care clinics. The project will end May 31, 2028.
Dr. Trautner is an investigator for the Center for Innovations in Quality, Effectiveness and Safety, which is a joint initiative of the Michael E. DeBakey VA Medical Center and Baylor College of Medicine. She has served as a primary care physician for more than two decades in her weekly clinic for veterans living with HIV.
From 2012 to 2014, Dr. Trautner served as an expert on AHRQ’s Technical Expert Panel of the National Implementation of the Comprehensive Unit-Based Safety Program to Reduce Catheter-Associated Urinary Tract Infections. She attended national meetings of the investigators, AHRQ, and key stakeholders; reviewed data; and offered advice on project direction.
Dr. Trautner is currently co-chair of the Infectious Diseases Society of America urinary tract infection clinical practice guidelines update.
Principal Investigator: Barbara Wells Trautner, M.D., Ph.D.
Institutions: Michael E. DeBakey VA Medical Center; Baylor College of Medicine
Grantee Since: 2019
Type of Grant: Various
Related AHRQ Resources
- Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities.
- Toolkit for Reducing CAUTI in Hospitals.
- Toolkit for Preventing CLABSI and CAUTI in ICUs.
- Toolkit To Improve Antibiotic Use in Acute Care Hospitals.
- Toolkit To Improve Antibiotic Use in Long-Term Care.
- Toolkit To Improve Antibiotic Use in Ambulatory Care.
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.