National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- (-) Antibiotics (25)
- (-) Antimicrobial Stewardship (25)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (2)
- Communication (1)
- Community-Acquired Infections (1)
- COVID-19 (1)
- Dental and Oral Health (1)
- Diagnostic Safety and Quality (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Costs (1)
- Health Information Technology (HIT) (2)
- Health Insurance (1)
- Hospital Discharge (1)
- Hospitalization (1)
- Hospitals (4)
- Implementation (1)
- Infectious Diseases (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (2)
- Long-Term Care (1)
- Medicaid (1)
- Medication (23)
- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
- Nursing Homes (1)
- Patient Safety (2)
- Pneumonia (1)
- Practice Patterns (4)
- Prevention (1)
- Primary Care (1)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (3)
- Risk (1)
- Sepsis (2)
- Shared Decision Making (4)
- Surgery (1)
- Telehealth (1)
- Urinary Tract Infection (UTI) (2)
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 25 of 25 Research Studies DisplayedLi 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
Clark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
AHRQ-funded; HS019455.
Citation: Clark AW, Durkin MJ, Olsen MA .
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Moehring RW, Yarrington ME, Davis AE
Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation.
The authors investigated expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP) in hospitals. They found that network hospitals increased ASP activities and demonstrated decline in antimicrobial use over the 42-month study period. They concluded that their collaborative, consultative network proved a unique model in which hospitals can access ASP implementation expertise to support long-term program growth.
AHRQ-funded; HS023866.
Citation: Moehring RW, Yarrington ME, Davis AE .
Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation.
Clin Infect Dis 2021 Nov 2;73(9):1656-63. doi: 10.1093/cid/ciab356..
Keywords: Antimicrobial Stewardship, Antibiotics, Hospitals, Implementation, Medication
Richards AR, Linder JA
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Behavioral economics recognizes that contextual, psychological, social, and emotional factors powerfully influence decision-making. Behavioral economics has the potential to provide a better understanding of, and, through subtle environmental changes, or "nudges," improve persistent quality-of-care challenges, like ambulatory antibiotic overprescribing. In this study, the investigators conducted a Medline search and performed a narrative review that examined the use of behavioral economics to understand the rationale for, and improvement of, ambulatory antibiotic prescribing.
AHRQ-funded; 2332015000201; HS026506; HS028127.
Citation: Richards AR, Linder JA .
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Clin Ther 2021 Oct;43(10):1654-67. doi: 10.1016/j.clinthera.2021.08.004..
Keywords: Antimicrobial Stewardship, Antibiotics, Practice Patterns, Respiratory Conditions
Fischer MA, Mahesri M, Lii J
Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018.
Ambulatory antibiotic prescriptions without a clinic visit or without documentation of infection could represent overuse and contribute to adverse outcomes. We aim to describe US ambulatory antibiotic prescribing, including those without an associated visit or infection diagnosis. The investigators conducted an observational cohort study using data of all patients receiving antibacterial, antibiotic prescriptions from 04/01/2016 to 06/30/2018 in a large US private health insurance plan. They concluded that over half of ambulatory antibiotic use was either non-visit-based or non-infection-related.
AHRQ-funded; HS02493.
Citation: Fischer MA, Mahesri M, Lii J .
Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018.
Open Forum Infect Dis 2021 Sep;8(9):ofab412. doi: 10.1093/ofid/ofab412..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Chua KP, Linder JA .
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
Goodman KE, Cosgrove SE, Pineles L
Significant regional differences in antibiotic use across 576 US hospitals
This study’s objective was to examine adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. Findings showed that adult inpatient antibiotic use remained high, driven predominantly by broad-spectrum agents. Recommendations included better understanding of the reasons for interhospital usage differences, including by region and teaching status, in order to inform efforts to reduce inappropriate antibiotic prescribing.
AHRQ-funded; HS026205.
Citation: Goodman KE, Cosgrove SE, Pineles L .
Significant regional differences in antibiotic use across 576 US hospitals
Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016-2017..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospitals
Carayon P, Thuemling T, Parmasad V
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
In this study, researchers conducted an in-depth analysis of an intervention aimed at limiting ICU prescriber access to fluoroquinolones (FQ) in the ICUs of two hospitals. Their results showed some differences in the implementation of the FQ intervention between the two studied ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped quickly to identify problems with the intervention and to ensure that changes were made in a just-in-time manner. Despite their organizational differences, both sites developed strategies to implement the FQ intervention successfully.
AHRQ-funded; HS026226.
Citation: Carayon P, Thuemling T, Parmasad V .
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
J Patient Saf Risk Manag 2021 Jul;26(4):161-71..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Safdar N, Parmasad V, Brown R
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the USA, having high incidence in intensive care units (ICU). Antibiotic use increases risk of CDI, with fluoroquinolones (FQs) particularly implicated. In healthcare settings, antibiotic stewardship (AS) and infection control interventions are effective in CDI control, but there is little evidence regarding the most effective AS interventions. In this paper the investigators describe their multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial.
AHRQ-funded; R01 HS026226.
Citation: Safdar N, Parmasad V, Brown R .
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
BMJ Open 2021 Jun 29;11(6):e046480. doi: 10.1136/bmjopen-2020-046480..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Antimicrobial Stewardship, Antibiotics, Medication, Prevention
Vaughn VM, Gandhi T, Petty LA
Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with COVID-19: a multi-hospital cohort study.
A randomly sampled cohort of 1705 patients hospitalized with COVID-19 was used. Data was collected on early empiric antibacterial therapy within 2 days of hospitalization, empiric antibacterial therapy and community-onset bacterial co-infections. Of the 1705 patients, 56.6% were prescribed early empiric antibacterial therapy, with 3.5% having a confirmed community-onset bacterial infection. Use varied across hospitals, ranging from 27% to 84%. Patients were more likely to receive the therapy if they were older, had more severe illness, had a lobar infiltrate, or were admitted to a for-profit hospital. Over the one-month period empiric antibacterial use decreased.
AHRQ-funded; HS026530; HS026725.
Citation: Vaughn VM, Gandhi T, Petty LA .
Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with COVID-19: a multi-hospital cohort study.
Clin Infect Dis 2021 May 18;72(10):e533-e41. doi: 10.1093/cid/ciaa1239..
Keywords: COVID-19, Infectious Diseases, Community-Acquired Infections, Antimicrobial Stewardship, Antibiotics, Medication, Hospitalization
Ridgway JP, Robicsek A, Shah N
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
The weighted incidence syndromic combination antibiogram (WISCA) is an antimicrobial stewardship tool that utilizes electronic medical record data to provide real-time clinical decision support regarding empiric antibiotic prescription in the hospital setting. The aim of this study was to determine the impact of WISCA utilization for empiric antibiotic prescription on hospital length of stay (LOS).
AHRQ-funded; HS022283.
Citation: Ridgway JP, Robicsek A, Shah N .
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
Clin Infect Dis 2021 May 4;72(9):e265-e71. doi: 10.1093/cid/ciaa1048..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Krah NM, Jones TW, Lake J
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
In this systematic review, the authors aimed to determine how antibiotic allergy labels influenced three domains. They found that antibiotic allergy labels have negative effects on antibiotic use and exposure, clinical outcomes, and economic outcomes in a variety of clinical settings and populations.
AHRQ-funded; HS023320.
Citation: Krah NM, Jones TW, Lake J .
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
Infect Control Hosp Epidemiol 2021 May;42(5):530-48. doi: 10.1017/ice.2020.1229..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Healthcare Costs
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Szymczak JE, Keller SC, Linder JA
"I never get better without an antibiotic": antibiotic appeals and how to respond.
In this paper, the investigators present various scenarios in which patients who do not meet guideline criteria for antibiotic prescribing, appeal to clinicians for antibiotics. The authors discuss the issue of antiobiotic appeals and provide examples of responses for clinicians. They suggest that clinicians should acquire a stock of responses to these appeals grounded in the latest evidence about antibiotics.
AHRQ-funded; 233201500020I; HS026506; HS025782.
Citation: Szymczak JE, Keller SC, Linder JA .
"I never get better without an antibiotic": antibiotic appeals and how to respond.
Mayo Clin Proc 2021 Mar;96(3):543-46. doi: 10.1016/j.mayocp.2020.09.031..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinician-Patient Communication, Communication, Practice Patterns
Malone S, McKay VR, Krucylak C
A cluster randomized stepped-wedge trial to de-implement unnecessary post-operative antibiotics in children: the optimizing perioperative antibiotic in children (OPerAtiC) trial.
This paper describes an upcoming clinical trial to determine best strategies to de-implement inappropriate antibiotic use in pediatric post-operative surgical cases deemed low risk for infection. This study will provide important information on the impact of two potential strategies while assessing important clinical outcomes.
AHRQ-funded; HS026742.
Citation: Malone S, McKay VR, Krucylak C .
A cluster randomized stepped-wedge trial to de-implement unnecessary post-operative antibiotics in children: the optimizing perioperative antibiotic in children (OPerAtiC) trial.
Implement Sci 2021 Mar 19;16(1):29. doi: 10.1186/s13012-021-01096-1..
Keywords: Children/Adolescents, Antimicrobial Stewardship, Antibiotics, Medication, Surgery
Jones TW, Fino N, Olson J
The impact of beta-lactam allergy labels on hospitalized children.
Investigators sought to determine the impact of beta-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Subjects were pediatric patients hospitalized at Intermountain Healthcare facilities from 2007 to 2017 who received one or more 1 dose of an antibiotic during their admission. The researchers found that patients with beta-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients.
AHRQ-funded; HS023320.
Citation: Jones TW, Fino N, Olson J .
The impact of beta-lactam allergy labels on hospitalized children.
Infect Control Hosp Epidemiol 2021 Mar;42(3):318-24. doi: 10.1017/ice.2020.424..
Keywords: Children/Adolescents, Antibiotics, Medication, Antimicrobial Stewardship
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.
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
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
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