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
51 to 75 of 253 Research Studies DisplayedVaughn VM, Gandhi TN, Hofer TP
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Researchers sought to improve antibiotic duration for community-acquired pneumonia (CAP) across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). They found that, across diverse hospitals, HMS participation was associated with more appropriate use of short-course therapy and fewer adverse events in hospitalized patients with uncomplicated CAP.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Hofer TP .
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Clin Infect Dis 2022 Aug 31;75(3):460-67. doi: 10.1093/cid/ciab950..
Keywords: Community-Acquired Infections, Pneumonia, Antibiotics, Antimicrobial Stewardship, Medication, Respiratory Conditions
Prescott HC, Seelye S, Wang XQ
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
This study examined whether the push to administer antimicrobials to prevent sepsis has increased antimicrobial use in general. This observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018 looked at almost 1.6 million patients (81% male), admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. From 2013 to 2018 first antimicrobial administration to patients with sepsis decreased by 37 minutes. At the same time, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with systemic inflammatory response syndrome (SIRS). This may have caused a decrease in in-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity over the study period among both patients with sepsis and those with SIRS. For the overall hospital population there was no evidence that increasing antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship.
AHRQ-funded; HS026725.
Citation: Prescott HC, Seelye S, Wang XQ .
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
JAMA Intern Med 2022 Aug;182(8):805-13. doi: 10.1001/jamainternmed.2022.2291..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Sepsis, Inpatient Care, Hospitals
Keller SC, Cosgrove SE, Miller MA
AHRQ Author: Miller MA
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
This article used lessons learned from AHRQ’s Safety Program for Improving Antibiotic Use in Ambulatory Care to describe a step-by-step framework that assists practices with establishing antibiotic stewardship in outpatient settings. These steps include: obtaining support from practice leadership; establishing antibiotic stewardship teams; garnering support from practice members; building communication skills around antibiotic use; implementing educational content around an infectious syndrome; accessing and monitoring antibiotic prescribing data; and implementing a sustainability plan.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Cosgrove SE, Miller MA .
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
Antimicrob Steward Healthc Epidemiol 2022 Jul 4;2(1):e109. doi: 10.1017/ash.2022.258..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Patient Safety
Keller SC, Caballero TM, Tamma PD
AHRQ Author: Miller MA
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD .
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Uribe-Cano D, Bahranian M, Jolles SA
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Researchers studied the extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes. Using a cross-sectional chart review in 5 Wisconsin nursing homes, they found that levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections, fair for skin and soft-tissue infections, and slight for respiratory tract infections. They concluded that agreement between the revised McGeer and Loeb criteria is limited, and that nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes.
AHRQ-funded; HS022465.
Citation: Uribe-Cano D, Bahranian M, Jolles SA .
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Infect Control Hosp Epidemiol 2022 Jul;43(7):860-63. doi: 10.1017/ice.2021.221..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Antimicrobial Stewardship, Medication
Flannery DD, Passarella M, Mukhopadhyay S
Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit.
The purpose of this retrospective observational study was to determine antibiotic use for Neonatal Intensive Care Unit (NICU) Infants in the first 3 years after birth hospital discharge. Using data for 667,541 newborns discharged from 2007-2011 from Medicaid Analytic Extract, the researchers assessed the relationships between NICU admission and antibiotic prescription. The study reported that 596,999 infants received one or more antibiotics, with a media of 4 prescriptions across 3 person-years. NICU infants (N = 81 314) received more antibiotic prescriptions compared to non-NICU infants. The study concluded that compared to non-NICU infants, antibiotic utilization in early childhood was higher among infants discharged from NICUs.
AHRQ-funded; HS027468.
Citation: Flannery DD, Passarella M, Mukhopadhyay S .
Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit.
J Perinatol 2022 Jul;42(7):953-58. doi: 10.1038/s41372-022-01380-y..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Antibiotics, Medication
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
AHRQ-funded; HS026530.
Citation: Giesler DL, Krein S, Brancaccio A .
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Vaughn VM, Hersh AL, Spivak ES
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
In this review, the authors discussed what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge. They introduced an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Hersh AL, Spivak ES .
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
Clin Infect Dis 2022 May 3;74(9):1696-702. doi: 10.1093/cid/ciab842..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Hospitals
Butler AM, Durkin MJ, Keller MR
Association of adverse events with antibiotic treatment for urinary tract infection.
The purpose of this study was to compare the risk of relative harms associated with different antibiotics prescribed for the treatment of uncomplicated urinary tract infection (UTI). The researchers identified 1,169,033 healthy, nonpregnant women between the ages of 18 to 44 who had an uncomplicated UTI and who initiated an oral antibiotic regimen for the treatment of common uropathogens between July 2006 and September 2015. The study found that of the two first-line treatments, the drug trimethoprim-sulfamethoxazole (versus nitrofurantoin) was associated with a higher risk of adverse drug-related events including: hypersensitivity, acute renal failure, skin rash, urticaria, abdominal pain, and nausea/ vomiting, but a similar risk of adverse possible microbiome-related events. When researchers compared non-first line drugs with nitrofurantoin, the non-first line drugs were associated with a greater risk of adverse drug events and possible microbiome-related adverse events including non-Clostridium difficile diarrhea, C. difficile infection, vaginitis/vulvovaginal candidiasis, and pneumonia. The duration of the treatment influenced the risk of possible microbiome-related adverse events. The study concluded that the risk of adverse events differs widely by both antibiotic drug and duration of regimen.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Association of adverse events with antibiotic treatment for urinary tract infection.
Clin Infect Dis 2022 Apr 28;74(8):1408-18. doi: 10.1093/cid/ciab637..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Adverse Drug Events (ADE), Adverse Events, Clostridium difficile Infections
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
AHRQ-funded; HS026393.
Citation: Chiotos K, Fitzgerald JC, Hayes M .
Improving vancomycin stewardship in critically ill children.
Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
AHRQ-funded; HS026995.
Citation: Sharara SL, Arbaje AI, Cosgrove SE .
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Sun DS, Kissler SM, Kanjilal S
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
The purpose of this study was to evaluate the relationship between the seasonal use of 5 classes of antibiotics (penicillins, macrolides, quinolones, tetracyclines, and nitrofurans) and antibiotic resistance across 3 species of bacteria: Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The study found seasonal peaks in use which varied by class, with resistance in all 9 species-antibiotic combinations peaking in the spring and winter. Resistance to all antibiotic classes had the highest correlation with the use of the macrolides and penicillins which were the winter peaking classes. The researchers concluded that antibiotic use strategies will not be equally effective across all species and all antibiotics, but instead selection for resistance across antibiotic classes may be governed by penicillins and macrolides, the most commonly prescribed classes of antibiotics.
AHRQ-funded; HS027841.
Citation: Sun DS, Kissler SM, Kanjilal S .
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
PLoS Biol 2022 Mar;20(3):e3001579. doi: 10.1371/journal.pbio.3001579..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication
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
Isserman RS, Cheung J , Varallo D
Increasing cefazolin use for perioperative antibiotic prophylaxis in penicillin-allergic children.
The purpose of this quality improvement initiative was to increase the percentage of pediatric patients with non-severe penicillin-class allergies who receive cefazolin for antibiotic prophylaxis. The researchers included approximately 400 children in their multidisciplinary education-focused interventions, and through the initiative were able to increase the percent of eligible patients receiving cefazolin for antibiotic prophylaxis to 80%. The increase lasted through the project, and in the final month the study exceeded the study goal of 85%m with 90% of eligible patients receiving cefazolin. The researchers concluded that the initiative resulted in a considerable increase in the use of cefazolin for perioperative antibiotic prophylaxis in pediatric patients with penicillin allergies.
AHRQ-funded; HS026393.
Citation: Isserman RS, Cheung J , Varallo D .
Increasing cefazolin use for perioperative antibiotic prophylaxis in penicillin-allergic children.
Pediatrics 2022 Mar;149(3). doi: 10.1542/peds.2021-050694..
Keywords: Children/Adolescents, Antibiotics, Medication, Prevention
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation: Olsen MA, Greenberg JK, Peacock K .
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords: Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
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
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Nielsen TB, Santarossa M, Probst B
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
This study’s objective was to determine attitudes of prescribers of antimicrobials to help establish an antimicrobial stewardship program in the outpatient setting. Participants included prescribers at Loyola University Health System, an academic teaching healthcare system with 19 primary care and 3 intermediate- and urgent-care clinics. A voluntary survey was developed using SurveyMonkey and was distributed via email. Data were conducted anonymously. Three metrics were assessed for rates of compliance and included: (1) avoidance of antibiotics in adult acute bronchitis and appropriate antibiotic treatment in (2) patients tested for pharyngitis and (3) children with upper respiratory tract infections. Prescribers were very knowledgeable about what constitutes appropriate prescribing, but fewer than half believed antibiotics were overprescribed in their office. The respondents reported that 74% received intense pressure from patients to prescribe antimicrobials inappropriately. Intermediate- and urgent-care prescribers had higher rates of compliance than primary-care prescribers. However, the latter group responded well to monthly reports and online educational resources.
AHRQ-funded; HS025690.
Citation: Nielsen TB, Santarossa M, Probst B .
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
Antimicrob Steward Healthc Epidemiol 2022;2(1):e9. doi: 10.1017/ash.2021.228..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Sarfani S, Stone CA, Murphy GA
Understanding penicillin allergy, cross-reactivity, and antibiotic selection in the preoperative setting.
This study provided a review of the prevalence of penicillin allergy label (PAL), the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool were proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.
AHRQ-funded; HS026395.
Citation: Sarfani S, Stone CA, Murphy GA .
Understanding penicillin allergy, cross-reactivity, and antibiotic selection in the preoperative setting.
J Am Acad Orthop Surg 2022 Jan;30(1):e1-e5. doi: 10.5435/jaaos-d-21-00422..
Keywords: Antibiotics, Medication, Medication: Safety
Li LX, Szymczak JE, Keller SC
Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm.
This article discusses using the core elements for outpatient antibiotic stewardship as a framework for direct-to-consumer (DTC) telemedicine. There is limited scholarship regarding adapting and implementing antibiotic stewardship principles in this setting. The authors discussed utilizing the core elements for outpatient antibiotic stewardship as a framework for efforts moving forward.
AHRQ-funded; HS027819.
Citation: Li LX, Szymczak JE, Keller SC .
Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm.
J Antimicrob Chemother 2021 Dec 24;77(1):13-15. doi: 10.1093/jac/dkab371..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Telehealth, Health Information Technology (HIT)
Vaughn VM, Gandhi TN, Chopra V
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Antibiotics are commonly prescribed to patients as they leave the hospital. In this study, the investigators aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions. The investigators concluded that antibiotic overuse after discharge was common and varied widely between hospitals.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Chopra V .
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Clin Infect Dis 2020 Dec 6;73(11):e4499-e506. doi: 10.1093/cid/ciaa1372..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Moehring RW, Ashley ESD, Davis AE
Development of an electronic definition for de-escalation of antibiotics in hospitalized patients.
The authors defined antibiotic de-escalation as reduction in either the number of antibiotics or spectrum rank and performed a retrospective study among 5 hospitals. They found that their electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. They suggested that their metric may be useful for assessing stewardship opportunities and impact.
AHRQ-funded; HS023866.
Citation: Moehring RW, Ashley ESD, Davis AE .
Development of an electronic definition for de-escalation of antibiotics in hospitalized patients.
Clin Infect Dis 2021 Dec 6;73(11):e4507-e14. doi: 10.1093/cid/ciaa932..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Inpatient Care
Goodman KE, Pineles L, Magder LS
Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities.
This study’s goal was to identify comorbidities causally related to appropriate antibiotic use and to compare seven models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. Subjects included adults discharged from Premier Database hospitals in 2016-2017. Findings showed that adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals' utilization rankings.
AHRQ-funded; HS026205.
Citation: Goodman KE, Pineles L, Magder LS .
Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities.
Clin Infect Dis 2021 Dec 6;73(11):e4484-e92. doi: 10.1093/cid/ciaa1127..
Keywords: Antibiotics, Antimicrobial Stewardship, Hospitals
Sankar A, Swanson KM, Zhou J
Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration.
This study examined the association of black box warnings in 2013 and 2016 with prescribing rates for fluoroquinolone. This cross-sectional study used Medicare fee-for-service beneficiaries and OneKey data on physicians and their organizations from 2011 through 2017. Sample eligibility was restricted to outpatient visits for sinusitis, bronchitis, and uncomplicated urinary tract infections. Prescription rates were compared with the prewarning period (baseline period), before and after the 2013 warning (postwarning period 1), and before and after the 2016 warning (postwarning period 2). The sample consisted of 1,238,397 unique patients with a total of 2,720,071 outpatient acute care visits. The immediate prescribing levels in postwarning period 1 increased by 3.42 percentage points and declined by -0.77 percentage points in postwarning period 2. In postwarning period 1, prescribing levels for physicians who were affiliated with hospitals with a top 10th percentile case mix index compared to those without an affiliation decreased by -1.13 percentage points, whereas the levels for primary care physicians declined by -1.34 percentage points compared with non-primary care physicians in postwarning period 2. Physicians at teaching hospitals were the only clinicians who showed a decline in postwarning period 1.
AHRQ-funded; HS025164; HS025402.
Citation: Sankar A, Swanson KM, Zhou J .
Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration.
JAMA Netw Open 2021 Dec;4(12):e2136662. doi: 10.1001/jamanetworkopen.2021.36662..
Keywords: Antibiotics, Medication, Practice Patterns