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AHRQ Research Studies Date
Topics
- Antibiotics (5)
- Antimicrobial Stewardship (1)
- Children/Adolescents (3)
- Clostridium difficile Infections (1)
- (-) Community-Acquired Infections (12)
- Comparative Effectiveness (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (1)
- Heart Disease and Health (1)
- Imaging (1)
- Infectious Diseases (1)
- Injuries and Wounds (1)
- Medication (3)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Pneumonia (8)
- Practice-Based Research Network (PBRN) (1)
- Respiratory Conditions (4)
- Risk (2)
- Sepsis (2)
- Urinary Tract Infection (UTI) (1)
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
1 to 12 of 12 Research Studies DisplayedDeshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Deshpande A, Klompas M, Guo N
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
The purpose of this retrospective cohort study was to examine clinical practice guidelines which recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. The researchers conducted a study of adults admitted with CAP from 2010 through 2015 and initially treated with IV antibiotics at 642 US hospitals. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. The study found that of 78,041 CAP patients, 6% were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a greater mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, less than 15% of very low-risk patients were switched early.
AHRQ-funded; HS029477; HS025026.
Citation: Deshpande A, Klompas M, Guo N .
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
Clin Infect Dis 2023 Jul 26; 77(2):174-85. doi: 10.1093/cid/ciad196..
Keywords: Antibiotics, Community-Acquired Infections, Pneumonia, Respiratory Conditions, Medication
Geanacopoulos AT, Neuman MI, Lipsett SC
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
This study’s objective was to evaluate the association of performing a chest radiograph (CXR) with 7-day hospitalization after emergency department (ED) discharge among pediatric patients with community-acquired pneumonia (CAP). This retrospective cohort study included 206,694 children aged 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. Secondary outcomes included 7-day ED revisits and a 7-day hospitalization with severe CAP. Among these children diagnosed with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs 1.7%). CXR performance varied somewhat between EDs (median 91.5%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%), ED revisits (8.5% vs 9.4%), and hospitalizations for severe CAP (0.3% vs 0.5%) as compared to EDs with the lowest quartile of CXR utilization.
AHRQ-funded; HS026503.
Citation: Geanacopoulos AT, Neuman MI, Lipsett SC .
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
Hosp Pediatr 2023 Jul; 13(7):614-23. doi: 10.1542/hpeds.2023-007142..
Keywords: Children/Adolescents, Imaging, Pneumonia, Respiratory Conditions, Community-Acquired Infections
Rothberg MB, Haessler S, Deshpande A
Derivation and validation of a risk assessment model for drug-resistant pathogens in hospitalized patients with community-acquired pneumonia.
The purpose of this study was to develop and validate a model for risk of resistance to first-line community-acquired pneumonia (CAP) therapy. The study was conducted using data for adults hospitalized for CAP from 177 Premier Healthcare database hospitals and 11 Cleveland Clinic hospitals. The study found that among 138,762 eligible patients in the Premier database, 8.8% had positive cultures and 3.8% had organisms resistant to CAP therapy. The strongest predictor of resistance was infection with a resistant organism in the previous year. Markers of acute illness such as receipt of mechanical ventilation or vasopressors, and chronic illness such as pressure ulcer or paralysis were also related with resistant infections. The study model outperformed the Drug Resistance in Pneumonia (DRIP) model in the Premier holdout sample, the Cleveland Clinic hospitals sample. Clinicians at Premier facilities utilized broad-spectrum antibiotics for 20%-30% of their patients. In discriminating between patients with and without resistant infections, physician judgment slightly outperformed the DRIP instrument but not the study model.
AHRQ-funded; HS024277.
Citation: Rothberg MB, Haessler S, Deshpande A .
Derivation and validation of a risk assessment model for drug-resistant pathogens in hospitalized patients with community-acquired pneumonia.
Infect Control Hosp Epidemiol 2023 Jul; 44(7):1143-50. doi: 10.1017/ice.2022.229..
Keywords: Community-Acquired Infections, Pneumonia, Risk
Patel P, Deshpande A, Yu PC
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
The purpose of this study was to explore the relationships between the antibiotic regimens of empiric therapy with a respiratory fluoroquinolone or cephalosporin plus macrolide combination and the development of hospital-onset Clostridioides difficile infection (CDI). The researchers used data from 638 United States hospitals and included adults admitted with pneumonia and discharged from July 2010 through June 2015 with a pneumonia diagnosis code who received 3 or more days of either antibiotic regimen. The study sample included 58,060 patients treated with either cephalosporin plus macrolide (36,796 patients) or a fluoroquinolone alone (21,264 patients). 0.35% of patients who received cephalosporin plus macrolide and 0.31% who received a fluoroquinolone developed CDI, making CDI risks similar for fluoroquinolones versus cephalosporin plus macrolide.
AHRQ-funded; HS024277.
Citation: Patel P, Deshpande A, Yu PC .
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
Infect Control Hosp Epidemiol 2023 Jan; 44(1):47-54. doi: 10.1017/ice.2022.60..
Keywords: Pneumonia, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Medication, Infectious Diseases, Community-Acquired Infections
Gurigis FW, Donnelly JP, Dodani S
Cholesterol levels and long-term rates of community-acquired sepsis.
The researchers sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis. They found that low low-density lipoprotein cholesterol (LDL-C) was associated with higher long-terms rates of community-acquired sepsis. High-density lipoprotein cholesterol (HDL-C) level was not associated with long-term sepsis rates.
AHRQ-funded; HS013852.
Citation: Gurigis FW, Donnelly JP, Dodani S .
Cholesterol levels and long-term rates of community-acquired sepsis.
Crit Care 2016 Dec 23;20(1):408. doi: 10.1186/s13054-016-1579-8.
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Keywords: Heart Disease and Health, Community-Acquired Infections, Sepsis
Anesi 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)
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
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
Wang HE, Donnelly JP, Griffin R
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
The researchers derived and internally validated a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults. They concluded that the Sepsis Risk Score and Severe Sepsis Risk Score predict 10-year sepsis and severe sepsis risk among community-dwelling adults and may aid in sepsis prevention or mitigation efforts.
AHRQ-funded; HS013852.
Citation: Wang HE, Donnelly JP, Griffin R .
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
Crit Care Med 2016 Jul;44(7):1285-94. doi: 10.1097/ccm.0000000000001666.
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Keywords: Community-Acquired Infections, Risk, Risk, Sepsis
Parikh K, Hall M, Blaschke AJ
Aggregate and hospital-level impact of national guidelines on diagnostic resource utilization for children with pneumonia at children's hospitals.
Researchers sought to evaluate the temporal trends in diagnostic testing associated with guideline implementation among children with community-acquired pneumonia (CAP). They concluded that publication of national pneumonia guidelines in 2011 was associated with modest changes in diagnostic testing for children with CAP. However, the changes varied across hospitals, and the financial impact was modest.
AHRQ-funded; HS022342.
Citation: Parikh K, Hall M, Blaschke AJ .
Aggregate and hospital-level impact of national guidelines on diagnostic resource utilization for children with pneumonia at children's hospitals.
J Hosp Med 2016 May;11(5):317-23. doi: 10.1002/jhm.2534.
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Keywords: Children/Adolescents, Community-Acquired Infections, Guidelines, Pneumonia
Self WH, Williams DJ, Zhu Y
Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia.
The researchers conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. They concluded that the probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus.
AHRQ-funded; HS022342.
Citation: Self WH, Williams DJ, Zhu Y .
Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia.
J Infect Dis 2016 Feb 15;213(4):584-91. doi: 10.1093/infdis/jiv323.
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Keywords: Children/Adolescents, Community-Acquired Infections, Pneumonia, Respiratory Conditions