National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (18)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
226 to 250 of 253 Research Studies DisplayedAnesi JA, Lautenbach E, Nachamkin I
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
The objective of this paper was to evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. The investigators found that use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI, with a high prevalence of CTX-M among their community isolates.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
Infect Control Hosp Epidemiol 2016 Dec;37(12):1433-39. doi: 10.1017/ice.2016.225.
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Keywords: Antibiotics, Community-Acquired Infections, Patient Safety, Urinary Tract Infection (UTI)
Burnham CA, Hogan PG, Wallace MA
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
The authors compared microbial communities and levels of richness and diversity in community-dwelling subjects and in intensive care unit patients before and after the use of topical decolonization protocols. They found a reduction in S. aureus without eradicating endogenous microbiota.
AHRQ-funded; HS021736; HS024269.
Citation: Burnham CA, Hogan PG, Wallace MA .
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
Antimicrob Agents Chemother 2016 Dec;60(12):7303-12. doi: 10.1128/aac.01289-16.
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Keywords: Antimicrobial Stewardship, Antibiotics, Infectious Diseases, Prevention, Patient Safety
Piper Jenks N, Pardos de la Gandara M, D'Orazio BM
Differences in prevalence of community-associated MRSA and MSSA among U.S. and non-U.S. born populations in six New York community health centers.
As part of a research collaborative, 6 New York City-area community health centers recruited patients with Skin and Soft Tissue Infections (SSTIs). This study found that although not statistically significant, immigrants had lower rates of Methicillin-Resistant Staphylococcus aureus (MRSA) infections than did native-born participants, and immigrants showed significantly higher rates of Methicillin-Susceptible Staphylococcus aureus (MSSA) wound cultures.
AHRQ-funded; HS021667.
Citation: Piper Jenks N, Pardos de la Gandara M, D'Orazio BM .
Differences in prevalence of community-associated MRSA and MSSA among U.S. and non-U.S. born populations in six New York community health centers.
Travel Med Infect Dis 2016 Nov - Dec;14(6):551-60. doi: 10.1016/j.tmaid.2016.10.003.
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Keywords: Community-Acquired Infections, Methicillin-Resistant Staphylococcus aureus (MRSA), Injuries and Wounds, Practice-Based Research Network (PBRN), Antibiotics
Bartsch SM, Huang SS, Wong KF
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
The authors used their Regional Healthcare Ecosystem Analyst (RHEA) simulation model and found that the 32-month delay in changing carbapenem-resistant Enterobacteriaceae (CRE) breakpoints might have resulted in 1,821 additional carriers in Orange County, CA. They recommend that policymakers aim to minimize the delay in the adoption of new breakpoints for antimicrobials against emerging pathogens when containment of spread is paramount, ideally less than 1.5 years.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Huang SS, Wong KF .
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
J Clin Microbiol 2016 Nov;54(11):2757-62. doi: 10.1128/jcm.00635-16.
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Keywords: Infectious Diseases, Antibiotics, Antimicrobial Stewardship
Cunha CB, D'Agata EM
Implementing an antimicrobial stewardship program in out-patient dialysis units.
The purpose of this review is to highlight the key elements and interventions of antimicrobial stewardship programs (ASP). The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
AHRQ-funded; HS021666.
Citation: Cunha CB, D'Agata EM .
Implementing an antimicrobial stewardship program in out-patient dialysis units.
Curr Opin Nephrol Hypertens 2016 Nov;25(6):551-55. doi: 10.1097/mnh.0000000000000281.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery, Kidney Disease and Health, Chronic Conditions
Haggerty CL, Totten PA, Tang G
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
The authors examined the relationship between select novel bacteria, pelvic inflammatory disease (PID), and long-term sequelae. They demonstrated that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID and suggested that optimal antibiotic regimens for PID may require coverage of novel bacterial vaginosis-associated microbes.
AHRQ-funded; HS008358.
Citation: Haggerty CL, Totten PA, Tang G .
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
Sex Transm Infect 2016 Sep;92(6):441-6. doi: 10.1136/sextrans-2015-052285.
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Keywords: Antibiotics, Care Management, Medication, Women
Gidengil CA, Mehrotra A, Beach S
What drives variation in antibiotic prescribing for acute respiratory infections?
This study sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings. The investigators concluded that poor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Mehrotra A, Beach S .
What drives variation in antibiotic prescribing for acute respiratory infections?
J Gen Intern Med 2016 Aug;31(8):918-24. doi: 10.1007/s11606-016-3643-0..
Keywords: Antibiotics, Medication, Respiratory Conditions, Practice Patterns
Belforti RK, Lagu T, Haessler S
Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia.
The objective of this study was to compare outcomes of hospitalized patients with community-acquired pneumonia receiving intravenous vs oral respiratory fluoroquinolones. The authors concluded that there was no association between initial route of administration and outcomes.
AHRQ-funded; HS018723.
Citation: Belforti RK, Lagu T, Haessler S .
Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia.
Clin Infect Dis 2016 Jul 1;63(1):1-9. doi: 10.1093/cid/ciw209.
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Keywords: Community-Acquired Infections, Pneumonia, Comparative Effectiveness, Patient-Centered Outcomes Research, Antibiotics
Wares JR, Lawson B, Shemin D
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
The researchers hypothesized that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of multidrug-resistant organisms (MDRO) and further that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. They found that reducing antimicrobial treatment markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. They suggested that improving the environmental decontamination efficacy between patient dialysis treatments as an effective method for reducing colonization and contamination rates.
AHRQ-funded; HS021666.
Citation: Wares JR, Lawson B, Shemin D .
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
PLoS One 2016 May 19;11(5):e0153820. doi: 10.1371/journal.pone.0153820.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Prevention, Ambulatory Care and Surgery, Infectious Diseases
Zimmerman S, Cohen LW, Scales K
Pneumonia identification using nursing home records.
The researchers compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes. They found that recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research.
AHRQ-funded; HS022298.
Citation: Zimmerman S, Cohen LW, Scales K .
Pneumonia identification using nursing home records.
Res Gerontol Nurs 2016 May 1;9(3):109-14. doi: 10.3928/19404921-20151218-01.
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Keywords: Antibiotics, Elderly, Diagnostic Safety and Quality, Nursing Homes, Pneumonia
Tischendorf J, de Avila RA, Safdar N
Risk of infection following colonization with carbapenem-resistant Enterobactericeae: a systematic review.
The authors examined the risk of developing infection among those colonized with carbapenem-resistant enterobacteriaceae (CRE). They found an overall 16.5% risk of infection with CRE, with the most common site of infection being the lung. They concluded that, given the high mortality rate observed with CRE infection and the difficulty in treating these infections, research to investigate and develop strategies to eliminate the colonization state are needed.
AHRQ-funded; HS023791; HS024039.
Citation: Tischendorf J, de Avila RA, Safdar N .
Risk of infection following colonization with carbapenem-resistant Enterobactericeae: a systematic review.
Am J Infect Control 2016 May;44(5):539-43. doi: 10.1016/j.ajic.2015.12.005.
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Keywords: Antibiotics, Healthcare-Associated Infections (HAIs), Patient Safety, Risk, Risk
Heid C, Knobloch MJ, Schulz LT
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
The authors identified themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. They found that general medicine inpatients receiving at least one anti-infective medication recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Few participants reported being offered the opportunity to engage in shared decision making while hospitalized. The researchers concluded that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act.
AHRQ-funded; HS023791.
Citation: Heid C, Knobloch MJ, Schulz LT .
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
Infect Control Hosp Epidemiol 2016 May;37(5):576-82. doi: 10.1017/ice.2015.342.
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Keywords: Critical Care, Antimicrobial Stewardship, Antibiotics, Patient and Family Engagement, Patient Safety
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Ismail MD, Luo T, McNamara S
Long-term carriage of ciprofloxacin-resistant Escherichia coli Isolates in high-risk nursing home residents.
This paper's objective was to characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in nursing homes and to identify those in the O25b-ST131 lineage. The authors found that CipREc occurred frequently in nursing home residents and is carried for long durations, and that reacquisition following clearance is common.
AHRQ-funded; HS019979.
Citation: Ismail MD, Luo T, McNamara S .
Long-term carriage of ciprofloxacin-resistant Escherichia coli Isolates in high-risk nursing home residents.
Infect Control Hosp Epidemiol 2016 Apr;37(4):440-7. doi: 10.1017/ice.2015.326.
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Keywords: Nursing Homes, Long-Term Care, Elderly, Antibiotics, Patient Safety
Downes KJ, Goldstein SL, Vinks AA
Increased vancomycin exposure and nephrotoxicity in children: therapeutic does not mean safe.
The authors argue that a tenuous balance exists between the successful treatment of infection and the safe administration of vancomycin in the most vulnerable patients. Furthermore, prospective controlled trials are needed to identify and validate the optimal pharmacokinetic/pharmacodynamic (PK/PD) targets for vancomycin in children. Also, infectious diseases specialists need to be cognizant of the untoward effects of nephrotoxic acute kidney injury in children.
AHRQ-funded; HS021114.
Citation: Downes KJ, Goldstein SL, Vinks AA .
Increased vancomycin exposure and nephrotoxicity in children: therapeutic does not mean safe.
J Pediatric Infect Dis Soc 2016 Mar;5(1):65-7. doi: 10.1093/jpids/piu122.
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Keywords: Adverse Drug Events (ADE), Antibiotics, Children/Adolescents, Medication, Medication: Safety
Kronman MP, Hersh AL, Gerber JS
Identifying antimicrobial stewardship targets for pediatric surgical patients.
The authors examined the collective pool of all systemic antibiotics prescribed to children hospitalized for surgical conditions and identified common surgical conditions with highly variable and potentially unnecessary antibiotic use. They concluded that the use of vancomycin for pediatric cardiothoracic and neurosurgical patients, and broad-spectrum antipseudomonal agents for gastrointestinal surgery patients, represent potentially high-yield targets for stewardship efforts to reduce unnecessary antimicrobial use.
AHRQ-funded; HS023320.
Citation: Kronman MP, Hersh AL, Gerber JS .
Identifying antimicrobial stewardship targets for pediatric surgical patients.
J Pediatric Infect Dis Soc 2015 Dec;4(4):e100-8. doi: 10.1093/jpids/piv022.
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Keywords: Antibiotics, Antimicrobial Stewardship, Children/Adolescents, Children/Adolescents, Surgery
Slayton RB, Toth D, Lee BY
Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States.
The researchers analyzed data from CDC's National Healthcare Safety Network and Emerging Infections Program to project the number of health care-associated infections (HAIs) from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. They found that, with effective action now, more than half a million antibiotic-resistant HAIs could be prevented over 5 years and that a coordinated approach to interrupting transmission is more effective than historical independent facility-based efforts.
AHRQ-funded; HS023317.
Citation: Slayton RB, Toth D, Lee BY .
Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States.
MMWR Morb Mortal Wkly Rep 2015 Aug 7;64(30):826-31.
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Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Mody L, Crnich C
Effects of excessive antibiotic use in nursing homes.
This research commentary discussed effects of excessive antibiotic use in nursing homes (NH), including Clostridium difficile infection, adverse drug reactions, and an increased risk of colonization and infection with multidrug-resistant organisms. The authors recommended that antibiotic improvement teams tailor their improvement efforts based on a locally generated needs assessment.
AHRQ-funded; HS022465.
Citation: Mody L, Crnich C .
Effects of excessive antibiotic use in nursing homes.
JAMA Intern Med 2015 Aug;175(8):1339-41. doi: 10.1001/jamainternmed.2015.2774.
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Keywords: Adverse Drug Events (ADE), Antibiotics, Practice Patterns, Nursing Homes, Healthcare-Associated Infections (HAIs)
Mehrotra A, Gidengil CA, Setodji CM
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
The authors compared antibiotic prescribing among retail clinics, primary care practices, and emergency departments (EDs) for acute respiratory infections (ARIs): antibiotics-may-be-appropriate ARIs and antibiotics-never-appropriate ARIs. They found that, compared with primary care practices and EDs, there was no difference at retail clinics in overall ARI antibiotic prescribing, which was more diagnosis-appropriate.
AHRQ-funded; HS018419.
Citation: Mehrotra A, Gidengil CA, Setodji CM .
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
Am J Manag Care 2015 Apr;21(4):294-302.
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Keywords: Antibiotics, Emergency Department, Provider: Pharmacist, Primary Care, Respiratory Conditions
Hersh AL, Gerber JS, Hicks LA
Lessons learned in antibiotic stewardship: fluoroquinolone use in pediatrics.
For adults, fluoroquinolones are the leading class of antibiotics prescribed in ambulatory care visits, whereas, in children, they are the least frequently prescribed class. This paper highlights the impact of physicians' perception of direct patient harm in antibiotic decision making which has implications for antibiotic stewardship.
AHRQ-funded; HS020921.
Citation: Hersh AL, Gerber JS, Hicks LA .
Lessons learned in antibiotic stewardship: fluoroquinolone use in pediatrics.
J Pediatric Infect Dis Soc 2015 Mar;4(1):57-9. doi: 10.1093/jpids/piu044.
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Keywords: Antibiotics, Children/Adolescents, Medication, Children/Adolescents, Practice Patterns
Linder JA
Sore throat: avoid overcomplicating the uncomplicated.
In this editorial, the author described issues involving sore throat diagnosis and delineated various points concerning an article within the same journal issue, concluding that physicians should remember that the prevalence of group A streptococcus in adults with a sore throat is approximately 10%; and that they should use the Centor scoring criteria; selectively use rapid antigen-detection testing; limit antibiotic treatment to patients most likely to have group A streptococcus; and most of the time when prescribing antibiotics, use penicillin.
AHRQ-funded; HS018419.
Citation: Linder JA .
Sore throat: avoid overcomplicating the uncomplicated.
Ann Intern Med 2015 Feb 17;162(4):311-2. doi: 10.7326/m14-2899.
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Keywords: Antibiotics, Diagnostic Safety and Quality, Infectious Diseases, Medication, Pneumonia, Respiratory Conditions, Practice Patterns
Ostrowsky B, Ruiz R, Brown S
Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.
The researchers sought to determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates. They found that decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, but many valuable lessons were learned.
AHRQ-funded; 290200600012I.
Citation: Ostrowsky B, Ruiz R, Brown S .
Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S86-95. doi: 10.1086/677828.
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Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety
Fierro JL, Prasad PA, Localio AR
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
The researchers compared practice patterns regarding the diagnosis and management of streptococcal pharyngitis across 25 pediatric primary care practices sharing an electronic health record. They found that only 18 of 222 clinicians wrote 50 percent of all broad-spectrum antibiotic prescriptions for children with group a streptococcus pharyngitis. They suggested targeted interventions to improve adherence to prescribing guidelines.
AHRQ-funded; 290200710013
Citation: Fierro JL, Prasad PA, Localio AR .
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S79-85. doi: 10.1086/677820..
Keywords: Antibiotics, Children/Adolescents, Diagnostic Safety and Quality, Primary Care, Practice Patterns
Pakyz AL, Ozcan YA
Use of data envelopment analysis to quantify opportunities for antibacterial targets for reduction of health care-associated Clostridium difficile infection.
The authors conducted a cross-sectional study using claims data from 58 hospitals to create a benchmark strategy targeting high-risk antibacterials for C difficile. Seventeen hospitals were identified as best-practice hospitals. They found that the antibacterial classes requiring the greatest percentage reduction in use in non-best-practice hospitals versus best-practice hospitals were clindamycin, β-lactam/β-lactamase combinations, and carbapenems.
AHRQ-funded; HS018578.
Citation: Pakyz AL, Ozcan YA .
Use of data envelopment analysis to quantify opportunities for antibacterial targets for reduction of health care-associated Clostridium difficile infection.
Am J Med Qual 2014 Sep-Oct;29(5):437-44. doi: 10.1177/1062860613502520.
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Keywords: Antibiotics, Clostridium difficile Infections, Guidelines, Healthcare-Associated Infections (HAIs), Practice Patterns
Downes KJ, Rao MB, Kahill L
Daily serum creatinine monitoring promotes earlier detection of acute kidney injury in children and adolescents with cystic fibrosis.
The purpose of this study was to determine the impact of daily serum creatinine (SCr) measurement on amino-glycoside (AG)-associated acute kidney injury detection among patients with cystic fibrosis (CF). The study included 87 patients at a children’s hospital who received a total of 227 AG courses of 3 days or more.
AHRQ-funded; HS021114
Citation: Downes KJ, Rao MB, Kahill L .
Daily serum creatinine monitoring promotes earlier detection of acute kidney injury in children and adolescents with cystic fibrosis.
J Cyst Fibros. 2014 Jul;13(4):435-41. doi: 10.1016/j.jcf.2014.03.005..
Keywords: Adverse Drug Events (ADE), Antibiotics, Children/Adolescents, Medication, Respiratory Conditions