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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedDhudasia MB, Benitz WE, Flannery DD
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
This study’s objective was to determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP in infants in the neonatal intensive care unit (NICU). This retrospective cohort study looked at infants admitted to 2 NICUs from 2009 to 2014. During the time period, 10,134 infants were admitted, 89.9% had CRP, and 74.5% had blood culture obtained within 3 days of birth. CRP obtained plus/minus 4 hours had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72 hours after blood culture, sensitivity of CRP increased significantly (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n = 4977) and without (n = 5135) routine use of CRP, the authors observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period.
AHRQ-funded; HS027468.
Citation: Dhudasia MB, Benitz WE, Flannery DD .
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
J Pediatr 2023 May; 256:98-104.e6. doi: 10.1016/j.jpeds.2022.12.007..
Keywords: Newborns/Infants, Sepsis, Diagnostic Safety and Quality
Flannery DD, Puopolo KM, Hansen NI
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
This retrospective review examined antimicrobial susceptibility of infants ≥22 weeks' gestation who were cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptibility was defined as intermediate or resistant on treatment results. The authors identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data was available for 79.1% of isolates. All 81 Gram-positive isolates with ampicillin and gentamicin were susceptible in vitro. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 76.6% isolates were nonsusceptible to ampicillin, 8.5% nonsusceptible to gentamicin, and 7.3% isolates were nonsusceptible to both. The authors estimated that overall 8% of EOS cases were caused by isolates nonsceptible to ampicillin and gentamicin and were most likely to occur among preterm, very-low birth weight infants.
AHRQ-funded; HS027468.
Citation: Flannery DD, Puopolo KM, Hansen NI .
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
Pediatr Infect Dis J 2022 Mar;41(3):263-71. doi: 10.1097/inf.0000000000003380..
Keywords: Newborns/Infants, Sepsis, Antibiotics, Medication
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Flannery DD, Edwards EM, Puopolo KM
Early-onset sepsis among very preterm infants.
The purpose of this study was to determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants. Findings showed that, in a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Further, three-quarters of all infected infants either died or survived with a major medical morbidity. Recommendations included the need for novel preventive strategies.
AHRQ-funded; HS027468.
Citation: Flannery DD, Edwards EM, Puopolo KM .
Early-onset sepsis among very preterm infants.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2021-052456..
Keywords: Newborns/Infants, Sepsis
Schafer R, Phillippi JC
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. This article used a case study approach to discuss evidence-based, patient-centered care for group B streptococcal bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
AHRQ-funded; HS024733.
Citation: Schafer R, Phillippi JC .
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
J Midwifery Womens Health 2020 May;65(3):376-81. doi: 10.1111/jmwh.13085..
Keywords: Infectious Diseases, Pregnancy, Women, Patient-Centered Healthcare, Evidence-Based Practice, Newborns/Infants, Sepsis, Case Study