National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (18)
- Adverse Events (16)
- Ambulatory Care and Surgery (16)
- (-) Antibiotics (253)
- Antimicrobial Stewardship (119)
- Asthma (3)
- Cancer (3)
- Cancer: Breast Cancer (1)
- Cardiovascular Conditions (2)
- Caregiving (1)
- Care Management (3)
- Case Study (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Children/Adolescents (41)
- Chronic Conditions (6)
- Clinical Decision Support (CDS) (7)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (12)
- Communication (1)
- Community-Acquired Infections (13)
- Comparative Effectiveness (8)
- COVID-19 (3)
- Critical Care (11)
- Dental and Oral Health (5)
- Diagnostic Safety and Quality (9)
- Digestive Disease and Health (2)
- Ear Infections (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (2)
- Elderly (20)
- Electronic Health Records (EHRs) (2)
- Emergency Department (9)
- Evidence-Based Practice (13)
- Genetics (2)
- Guidelines (8)
- Healthcare-Associated Infections (HAIs) (33)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (5)
- Healthcare Utilization (5)
- Health Information Technology (HIT) (7)
- Health Insurance (2)
- Health Literacy (2)
- Health Services Research (HSR) (2)
- Heart Disease and Health (1)
- Home Healthcare (2)
- Hospital Discharge (7)
- Hospitalization (6)
- Hospital Readmissions (1)
- Hospitals (11)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (2)
- Implementation (2)
- Infectious Diseases (25)
- Injuries and Wounds (4)
- Inpatient Care (7)
- Intensive Care Unit (ICU) (14)
- Kidney Disease and Health (1)
- Labor and Delivery (1)
- Long-Term Care (15)
- Maternal Care (2)
- Medicaid (3)
- Medication (206)
- Medication: Safety (9)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (9)
- Mortality (6)
- Neonatal Intensive Care Unit (NICU) (2)
- Neurological Disorders (1)
- Newborns/Infants (12)
- Nursing (1)
- Nursing Homes (18)
- Obesity (1)
- Opioids (1)
- Outcomes (7)
- Palliative Care (2)
- Patient-Centered Outcomes Research (10)
- Patient and Family Engagement (1)
- Patient Safety (32)
- Patient Self-Management (1)
- Pneumonia (16)
- Policy (1)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (38)
- Pregnancy (3)
- Prevention (23)
- Primary Care (7)
- Primary Care: Models of Care (1)
- Provider (4)
- Provider: Clinician (1)
- Provider: Nurse (2)
- Provider: Pharmacist (1)
- Provider: Physician (3)
- Public Health (1)
- Quality Improvement (6)
- Quality of Care (8)
- Racial and Ethnic Minorities (3)
- Respiratory Conditions (28)
- Risk (14)
- Screening (1)
- Sepsis (20)
- Sexual Health (1)
- Shared Decision Making (13)
- Sickle Cell Disease (1)
- Skin Conditions (10)
- Surgery (15)
- Telehealth (2)
- Tools & Toolkits (1)
- Transitions of Care (3)
- Treatments (2)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urinary Tract Infection (UTI) (19)
- Women (6)
- Workflow (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 253 Research Studies DisplayedKadri SS, Lai YL, Warner S
Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals.
Researchers sought to establish the population-level burden, predictors, and mortality risk of in-vitro susceptibility-discordant empirical antibiotic therapy among patients with bloodstream infections. They found that approximately one in five patients with bloodstream infections in US hospitals received discordant empirical antibiotic therapy, receipt of which was closely associated with infection with antibiotic-resistant pathogens. Receiving discordant empirical antibiotic therapy was associated with increased odds of mortality overall, even in patients without sepsis. They concluded that early identification of bloodstream pathogens and resistance will probably improve population-level outcomes.
AHRQ-funded.
Citation: Kadri SS, Lai YL, Warner S .
Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals.
Lancet Infect Dis 2021 Feb;21(2):241-51. doi: 10.1016/s1473-3099(20)30477-1..
Keywords: Antibiotics, Medication, Sepsis, Antimicrobial Stewardship, Mortality, Risk
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
In this paper, the authors describe The Four Moments of Antibiotic Decision Making. The Four Moments were conceived as part of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use. The Four Moments provide a pragmatic approach to the core principle of antibiotic stewardship – ensuring patients who require antibiotic therapy promptly receive regimens associated with clinical success, while protecting patients from potential harm associated with unnecessary exposure to antibiotics.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
Ann Am Thorac Soc 2021 Feb;18(2):200-03. doi: 10.1513/AnnalsATS.202005-484IP..
Keywords: Sepsis, Antibiotics, Antimicrobial Stewardship, Medication, Shared Decision Making, Medication: Safety, Patient Safety
Alvarez-Arango S, Yerneni S, Tang O
Vancomycin hypersensitivity reactions documented in electronic health records.
This study’s objective is to describe vancomycin hypersensitivity reaction (HSR) epidemiology in hospitals documented in electronic health records. Vancomycin is the most commonly prescribed antimicrobial in US hospitals. A cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems was conducted. Prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype was determined. Out of almost 4.5 million patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions. Out of those 18,761 vancomycin HSRs, 42.1% were immediate phenotypes and 20.7% were delayed phenotypes. Common reactions were rash and red man syndrome (RMS). Anaphylaxis occurred in 6% of HSRs. RMS reaction was more likely for males and less likely for Blacks.
AHRQ-funded; HS025375.
Citation: Alvarez-Arango S, Yerneni S, Tang O .
Vancomycin hypersensitivity reactions documented in electronic health records.
J Allergy Clin Immunol Pract 2021 Feb;9(2):906-12. doi: 10.1016/j.jaip.2020.09.027..
Keywords: Antibiotics, Medication, Medication: Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Truitt KN, Brown T, Lee JY
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
The proportion of sinusitis visits that meet antibiotic prescribing criteria is unknown. In this cross-sectional study the authors investigated the appropriateness of antibiotic prescribing for acute sinusitis in primary care. The investigators found that of 425 randomly selected sinusitis visits, 50% met antibiotic prescribing criteria.
AHRQ-funded; HS024930; 233201500020I; HS026506.
Citation: Truitt KN, Brown T, Lee JY .
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
Clin Infect Dis 2021 Jan 15;72(2):311-14. doi: 10.1093/cid/ciaa736..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Primary Care, Respiratory Conditions, Practice Patterns
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P .
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Shared Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Shared Decision Making
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Shared Decision Making, Diagnostic Safety and Quality
Gross AE, Suda KJ, Zhou J
Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States.
The majority of antibiotics prescribed before a dental visit are considered unnecessary (80.9%). This study characterized adverse effects related to unnecessary dental prophylaxis. This retrospective cohort study used data from dental visits between 2011 and 2015 from the IBM Watson Health Marketscan Commercial Claims/Encounters, Medicare Supplemental, Coordination of Benefits Research databases. Antibiotics prescribed included amoxicillin (67.9%), clindamycin (15.5%), cephalexin (8.6%), azithromycin (2.8%), and penicillin (1.5). Antibiotic adverse effects (AAEs) were found in 1.4% of unnecessary prescriptions. The most common AAEs were emergency department (ED) visits, allergic reactions, 14 cases of C. difficile infection, and 5 anaphylactic reactions. AAEs were more common with clindamycin than amoxicillin.
AHRQ-funded; HS025177.
Citation: Gross AE, Suda KJ, Zhou J .
Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States.
Infect Control Hosp Epidemiol 2021 Jan;42(1):110-12. doi: 10.1017/ice.2020.1261..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Dental and Oral Health, Adverse Drug Events (ADE), Adverse Events
Stone CA, Trubiano JA, Phillips EJ
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
Although 1% to 2% of the general population carries a cephalosporin allergy label (CAL), there is a lack of validated testing strategies and predictors of true allergy. The objective of this study was to identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL. The investigators found that cephalosporin cross-reactivity was based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predicted a lower likelihood of cephalosporin STP.
AHRQ-funded; HS026395.
Citation: Stone CA, Trubiano JA, Phillips EJ .
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
J Allergy Clin Immunol Pract 2021 Jan;9(1):435-44e13. doi: 10.1016/j.jaip.2020.07.056..
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events, Skin Conditions, Diagnostic Safety and Quality
Daniel VT, Francalancia S, Amir NS
Upper gastrointestinal perforations: a possible danger of antibiotic overuse.
Investigators conducted a retrospective case-control study to examine the relationship between antibiotic exposure and upper gastrointestinal (UGI) perforations in a national sample. A 5% random sample of Medicare were queried to identify patients at least 65 years old who were hospitalized with stomach or small intestine UGI perforations using International Classification of Diseases diagnosis codes; Cases with UGI perforations were matched with 4 controls based on age and sex. The investigators concluded that recent outpatient antibiotic use, in particular in the preceding 30 days, is associated with UGI perforation among Medicare beneficiaries. They recommended minimizing exposure to antibiotics in the outpatient setting.
AHRQ-funded; HS022694.
Citation: Daniel VT, Francalancia S, Amir NS .
Upper gastrointestinal perforations: a possible danger of antibiotic overuse.
J Gastrointest Surg 2020 Dec;24(12):2730-36. doi: 10.1007/s11605-019-04473-w..
Keywords: Digestive Disease and Health, Antimicrobial Stewardship, Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events
Miller BJ, Carson KA, Keller S
Educating patients on unnecessary antibiotics: personalizing potential harm aids patient understanding.
Antibiotic resistance is a public health emergency fueled by inappropriate antibiotic use. Public education campaigns often focus on global antibiotic resistance or societal harm of antibiotic misuse. In this study, the investigators administered a survey at a primary care clinic in Baltimore, MD. A total of 250 participants rated 18 statements about potential harm from antibiotics on how each statement changed their likelihood to request antibiotics for an upper respiratory tract infection.
AHRQ-funded; HS025782.
Citation: Miller BJ, Carson KA, Keller S .
Educating patients on unnecessary antibiotics: personalizing potential harm aids patient understanding.
J Am Board Fam Med 2020 Nov-Dec;33(6):969-77. doi: 10.3122/jabfm.2020.06.200210..
Keywords: Antimicrobial Stewardship, Antibiotics, Education: Patient and Caregiver, Medication, Respiratory Conditions, Health Literacy
Coleman DT, Stone CA, Wei WQ
Penicillin allergy labels drive perioperative prophylactic antibiotic selection in orthopedic procedures.
This retrospective chart review was conducted to study prophylactic antibiotic selection in patients with penicillin allergy labels (PALs) during and after orthopedic surgical procedures. Generally, PALs are associated with surgical site infections (SSIs). Most orthopedic surgeries use a first-generation cephalosporin such as cefazolin due to decreased costs and lower SSI rates. PAL surgical patients more often receive vancomycin and clindamycin over cefazolin for concern of penicillin and cephalosporin cross-reactivity. This study used iterative natural language processing (NLP) and manual chart review to examine Vanderbilt University Medical Center’s deidentified patient data. Perioperative antibiotic selection data were available to review for 9300 surgeries, of whom 1412 (15.2%) were patients with PALs. Surgeries in patients with PALs used cefazolin less frequently than patients without PALs, and were more frequently prescribed clindamycin. PALs patients were more frequently female and white. The first pull with NLP found a much larger number of cases where non-PAL patients used clindamycin than expected. However, after manual chart review, 550 of these cases were found to be patients with PALS who had PAL free-text inputs missed by their initial NLP protocol.
AHRQ-funded; HS026395.
Citation: Coleman DT, Stone CA, Wei WQ .
Penicillin allergy labels drive perioperative prophylactic antibiotic selection in orthopedic procedures.
J Allergy Clin Immunol Pract 2020 Nov-Dec;8(10):3634-36e1. doi: 10.1016/j.jaip.2020.07.007..
Keywords: Antibiotics, Medication, Surgery, Practice Patterns
Ramly E, Tong M, Bondar S
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, the investigators analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. They found that such strategies included structured information tools, nurse and prescriber education, and organizational improvement.
AHRQ-funded; HS022465.
Citation: Ramly E, Tong M, Bondar S .
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
J Am Geriatr Soc 2020 Oct;68(10):2222-31. doi: 10.1111/jgs.16632..
Keywords: Workflow, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Antimicrobial Stewardship, Practice Patterns
Patterson ES, DiLoreto GN, Vanam R
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
This paper describes a multi-method approach to improve clinical decision support (CDS) for antibiotic stewardship. A heuristic review was employed to generate recommendations to improve the usability of a prototype CDS in the hospital setting. The authors then engaged in a design improvement cycle in collaboration with software programmers that enhanced their prototype. The revised prototype was then demonstrated to physician and pharmacist subject matter experts in three walkthrough interviews. These interviews generated recommendations to improve the interface, functionality, and tailoring for groups of users. Common elements for the recommendations are discussed for models for using clinical decision support in general.
AHRQ-funded; HS024379.
Citation: Patterson ES, DiLoreto GN, Vanam R .
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
Proc Int Symp Hum Factors Ergon Healthc 2020 Sep;9(1):61-65. doi: 10.1177/2327857920091034..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Antimicrobial Stewardship, Antibiotics, Medication
Tischendorf J, Brunner M, Knobloch MJ
Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: a mixed-methods study.
In this study, the investigators conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers. The authors concluded that Fluoroquinolones can be safely restricted even among high-risk patients without negatively impacting length of stay, readmissions or mortality. Their study provides a framework for successful antimicrobial stewardship interventions informed by perceptions of front line providers.
AHRQ-funded; HS026226.
Citation: Tischendorf J, Brunner M, Knobloch MJ .
Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: a mixed-methods study.
PLoS One 2020 Aug 25;15(8):e0237987. doi: 10.1371/journal.pone.0237987..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Risk
Beltran Ale G, Benscoter D, Hossain MM
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
This study examined whether positive viral infection results stops antibiotic use in children who require chronic positive pressure ventilation (CPPV) who are frequently hospitalized with acute respiratory infections. A retrospective cohort study was conducted with 118 children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. A viral pathogen was identified in 46.5% of the cases, with rhinovirus the most frequently identified. Antibiotic de-escalation occurred in only 33% of admissions and did not seem to impact antibiotic prescribing for hospitalized children on CPPV.
AHRQ-funded; HS012538.
Citation: Beltran Ale G, Benscoter D, Hossain MM .
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
Pediatr Pulmonol 2020 Aug;55(8):2150-55. doi: 10.1002/ppul.24884..
Keywords: Children/Adolescents, Respiratory Conditions, Antibiotics, Medication, Chronic Conditions
Lake JG, Miller LG, Fritz SA
Antibiotic duration, but not abscess size, impacts clinical cure of limited skin and soft tissue infection after incision and drainage.
Antibiotics are frequently prescribed following incision and drainage of cutaneous abscesses. In subgroup analyses from a recent clinical trial, the investigators observed higher likelihood of cure with antibiotic courses beyond 5 or 7 days (up to 10). They concluded that antibiotic duration, but not abscess size, impacted clinical cure of limited skin and soft tissue infection after incision and drainage.
AHRQ-funded; HS021736; HS024269.
Citation: Lake JG, Miller LG, Fritz SA .
Antibiotic duration, but not abscess size, impacts clinical cure of limited skin and soft tissue infection after incision and drainage.
Clin Infect Dis 2020 Jul 27;71(3):661-63. doi: 10.1093/cid/ciz1129..
Keywords: Antibiotics, Injuries and Wounds, Medication
Zetts RM, Stoesz A, Garcia AM
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.
AHRQ-funded; HS026506; HS024930; 233201500020I.
Citation: Zetts RM, Stoesz A, Garcia AM .
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
BMJ Open 2020 Jul 14;10(7):e034983. doi: 10.1136/bmjopen-2019-034983..
Keywords: Primary Care, Antimicrobial Stewardship, Antibiotics, Medication, Provider: Physician, Provider
Nace DA, Hanlon JT, Crnich CJ
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
This study describes the result of implementing a multifaceted antimicrobial stewardship program to reduce antibiotic use in nursing homes for urinary tract infections that are unlikely cystitis. Reduction in antibiotic use decreases incidence of Clostridioides difficile (C difficile) infections, as well as adverse drug reactions and antimicrobial drug resistance. This one-year case-control study included 12 intervention nursing homes and 13 control group nursing homes. The intervention nursing homes received a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Additionally, they received a monthly coaching call as well as a quarterly feedback report. In the intervention nursing homes, fewer unlikely cystitis cases were treated with antibiotics and C difficile infection rates were also lower. There was no increase in all-cause hospitalizations or deaths due to the intervention.
AHRQ-funded; HS023779.
Citation: Nace DA, Hanlon JT, Crnich CJ .
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
JAMA Intern Med 2020 Jul;180(7):944-51. doi: 10.1001/jamainternmed.2020.1256..
Keywords: Antimicrobial Stewardship, Antibiotics, Nursing Homes, Elderly, Quality Improvement, Quality of Care, Medication
Thomson J, Hall M, Ambroggio L
Antibiotics for aspiration pneumonia in neurologically impaired children.
The objective of the study was to compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). The investigators concluded that anaerobic therapy appeared to be important in the treatment of aspiration pneumonia in children with NI. They suggested that while Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.
AHRQ-funded; HS025138.
Citation: Thomson J, Hall M, Ambroggio L .
Antibiotics for aspiration pneumonia in neurologically impaired children.
J Hosp Med 2020 Jul;15(7):395-402. doi: 10.12788/jhm.3338..
Keywords: Children/Adolescents, Pneumonia, Respiratory Conditions, Neurological Disorders, Antibiotics, Medication, Outcomes
Abreo A, Wu P, Donovan BM
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
This study looked at infant respiratory syncytial virus (RSV) bronchiolitis and its association with increased odds of pneumonia, otitis media, and antibiotic utilization in infants 7-12 months. The data suggested the potential value of future RSV vaccination programs on subsequent respiratory health.
AHRQ-funded; HS026395.
Citation: Abreo A, Wu P, Donovan BM .
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
Clin Infect Dis 2020 Jun 24;71(1):211-14. doi: 10.1093/cid/ciz1033..
Keywords: Newborns/Infants, Antibiotics, Medication, Respiratory Conditions, Pneumonia
Stone CA, Stollings JL, Lindsell CJ
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Patients admitted to a medical ICU (MICU) often have chronic illnesses or altered immunity, increasing their need for immediate antibiotic use. In this study, the investigators sought to determine whether MICU patients with low-risk penicillin allergy history could be challenged directly with amoxicillin to have their allergy label safely removed during an acute inpatient stay.
Citation: Stone CA, Stollings JL, Lindsell CJ .
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Am J Respir Crit Care Med 2020 Jun 15;201(12):1572-75. doi: 10.1164/rccm.202001-0089LE..
Keywords: Intensive Care Unit (ICU), Antibiotics, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Risk, Diagnostic Safety and Quality
Fritz SA, Shapiro DJ, Hersh AL
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
This study looked at national trends in the incidence of outpatient visits for skin infections from 2000-2015, which peaked in 2010-2013, followed by a plateau in 2014 and 2015. Cephalexin was the most frequently prescribed antibiotic at the beginning of the study, with trimethoprim-sulfamethoxazole then becoming the most frequently prescribed by the end of the study period.
AHRQ-funded; HS021736; HS024269.
Citation: Fritz SA, Shapiro DJ, Hersh AL .
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
Clin Infect Dis 2020 Jun 10;70(12):2715-18. doi: 10.1093/cid/ciz977..
Keywords: Skin Conditions, Ambulatory Care and Surgery, Emergency Department, Antibiotics, Medication
Liao CY, Nace DA, Crnich CJ
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
The purpose of this study was to evaluate the impact of a stewardship intervention, promoting the use of antibiotic time-outs (ATOs) on the frequency and types of antibiotic change events (ACEs) in nursing homes. Data on antibiotic prescriptions in 11 nursing homes were collected over 25 months and categorized as early discontinuation, class modification, or administration modification ACEs. Findings showed that the impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. Recommendations include further research on the potential value of ATO interventions in nursing homes.
AHRQ-funded; HS022465.
Citation: Liao CY, Nace DA, Crnich CJ .
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
Infect Control Hosp Epidemiol 2020 Jun;41(6):635-40. doi: 10.1017/ice.2020.75..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly
Edwards RL, Heueck I, Lee SG
Potent, specific MEPicides for treatment of zoonotic staphylococci.
In this study, researchers demonstrated that fosmidomycin (FSM) inhibited the first step of the isoprenoid biosynthetic pathway catalyzed by deoxyxylulose phosphate reductoisomerase (DXR) in staphylococci. They synthesized a series of lipophilic ester prodrugs (termed MEPicides) structurally related to FSM, and their data indicated that the presence of the prodrug moiety not only substantially increased potency of the inhibitors against staphylococci but also bypassed the need for GlpT-mediated cellular transport. They concluded that their data indicated that the prodrug MEPicides selectively and robustly inhibited DXR in zoonotic staphylococci, and, further, that DXR represented a promising, druggable target for future development.
AHRQ-funded; HS021736; HS024269.
Citation: Edwards RL, Heueck I, Lee SG .
Potent, specific MEPicides for treatment of zoonotic staphylococci.
PLoS Pathog 2020 Jun;16(6):e1007806. doi: 10.1371/journal.ppat.1007806..
Keywords: Infectious Diseases, Antibiotics, Medication, Genetics