National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (1)
- Ambulatory Care and Surgery (3)
- (-) Antibiotics (51)
- Antimicrobial Stewardship (20)
- Caregiving (1)
- Care Management (2)
- Children/Adolescents (9)
- Chronic Conditions (2)
- Clostridium difficile Infections (1)
- Community-Acquired Infections (5)
- Comparative Effectiveness (2)
- Critical Care (3)
- Dental and Oral Health (1)
- Diagnostic Safety and Quality (2)
- Education: Patient and Caregiver (1)
- Elderly (4)
- Electronic Health Records (EHRs) (1)
- Emergency Department (2)
- Evidence-Based Practice (3)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (9)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Health Literacy (1)
- Health Services Research (HSR) (1)
- Home Healthcare (1)
- Hospitalization (3)
- Hospitals (3)
- Infectious Diseases (10)
- Injuries and Wounds (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (1)
- Long-Term Care (2)
- Medication (40)
- Medication: Safety (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (3)
- Mortality (3)
- Newborns/Infants (2)
- Nursing (1)
- Nursing Homes (3)
- Outcomes (2)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Safety (11)
- Pneumonia (4)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (8)
- Prevention (6)
- Primary Care (1)
- Provider (1)
- Provider: Physician (1)
- Quality Improvement (2)
- Quality of Care (3)
- Respiratory Conditions (4)
- Risk (4)
- Sepsis (5)
- Shared Decision Making (3)
- Skin Conditions (2)
- Surgery (1)
- Urinary Tract Infection (UTI) (5)
- Women (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 25 of 51 Research Studies DisplayedRIchmond J, Mangrum R, Wang G
An informed public's views on reducing antibiotic overuse.
The purpose of this study was to understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). The investigators concluded that when informed about individual and social consequences of antibiotic overuse, patients may be more receptive to antibiotic prescription limits. They suggest that community-physician-government partnerships are needed to create solutions.
AHRQ-funded; 290201000005C.
Citation: RIchmond J, Mangrum R, Wang G .
An informed public's views on reducing antibiotic overuse.
Health Serv Res 2019 Dec;54(6):1283-94. doi: 10.1111/1475-6773.13175..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Health Literacy, Education: Patient and Caregiver
Chiotos K, Rock C, Schweizer ML
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
This survey compares results with a similar 2013 survey that characterizes contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities. There was decreased frequency of active surveillance for MRSA, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
AHRQ-funded; HS026393.
Citation: Chiotos K, Rock C, Schweizer ML .
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
Infect Control Hosp Epidemiol 2019 Sep;40(9):1046-49. doi: 10.1017/ice.2019.172.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Practice Patterns
Yarrington ME, Anderson DJ, Dodds Ashley E
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
This study’s objective was the quantify the effect of the 2016 FDA “black box” update on the use of fluoroquinolone antibiotics among a cohort of southeastern US hospitals. Fluoroquinolone was given a black box warning after many serious adverse events were reported. Antibiotic use data from 29 southeastern US hospitals over a 5-year period was analyzed. Fluoroquinolone use declined both and before after the FDA advisory update in 2016.
AHRQ-funded; HS023866.
Citation: Yarrington ME, Anderson DJ, Dodds Ashley E .
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1297-300. doi: 10.1017/ice.2019.247..
Keywords: Antibiotics, Medication, Practice Patterns, Healthcare Utilization, Hospitals, Adverse Drug Events (ADE), Adverse Events
Spellberg B, Nielsen TB, Gilbert DN
Ensuring sustainability of needed antibiotics: aiming for the DART Board.
In this article, the authors propose the establishment of a new Developing Antibiotics for Resistant Targets (DART) Board to improve the targeting of incentives for antibiotic development. The DART Board, which would comprise clinical experts, patient advocates, and representatives from government, industry, and nonprofit organizations, would establish and regularly update an official list that restricts which pathogens can be targeted by publicly funded incentives.
AHRQ-funded; HS025690.
Citation: Spellberg B, Nielsen TB, Gilbert DN .
Ensuring sustainability of needed antibiotics: aiming for the DART Board.
Ann Intern Med 2019 Oct 15;171(8):580-82. doi: 10.7326/m19-1893..
Keywords: Antibiotics, Medication
Khamash DF, Voskertchian A, Tamma PD
Increasing clindamycin and trimethoprim-sulfamethoxazole resistance in pediatric Staphylococcus aureus Infections.
This retrospective observational study looked at pediatric clinical cultures between 2005 and 2017 that grew Staphylococcus aureus culture and their trends in antibiotic resistance. Methicillin resistance declined but clindamycin and trimethoprim-sulfamethoxazole resistance increased significantly.
AHRQ-funded; HS022872.
Citation: Khamash DF, Voskertchian A, Tamma PD .
Increasing clindamycin and trimethoprim-sulfamethoxazole resistance in pediatric Staphylococcus aureus Infections.
J Pediatric Infect Dis Soc 2019 Sep 25;8(4):351-53. doi: 10.1093/jpids/piy062..
Keywords: Children/Adolescents, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA)
Obodozie-Ofoegbu OO, Teng C, Mortensen EM
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This population-based retrospective cohort study compared all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. The investigators found that older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy.
AHRQ-funded; HS022418.
Citation: Obodozie-Ofoegbu OO, Teng C, Mortensen EM .
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Am J Infect Control 2019 Sep;47(9):1053-58. doi: 10.1016/j.ajic.2019.02.018..
Keywords: Antibiotics, Community-Acquired Infections, Elderly, Infectious Diseases, Medication, Pneumonia, Risk
Khamash DF, Voskertchian A, Tamma PD
Increasing clindamycin and trimethoprim-sulfamethoxazole resistance in pediatric Staphylococcus aureus Infections.
This retrospective observational study looked at pediatric clinical cultures between 2005 and 2017 that grew Staphylococcus aureus culture and their trends in antibiotic resistance. Methicillin resistance declined but clindamycin and trimethoprim-sulfamethoxazole resistance increased significantly.
AHRQ-funded; HS022872.
Citation: Khamash DF, Voskertchian A, Tamma PD .
Increasing clindamycin and trimethoprim-sulfamethoxazole resistance in pediatric Staphylococcus aureus Infections.
J Pediatric Infect Dis Soc 2019 Sep 25;8(4):351-53. doi: 10.1093/jpids/piy062..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Antibiotics, Medication
Desai S, Aronson PL, Shabanova V
Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections.
This study compared rates of recurring bacteremic urinary tract infections (UTIs) among hospitalized infants who received parenteral antibiotics 7 days or less compared with infants who received long-term treatment defined as greater than 7 days. Among 115 infants with bactermic UTI, half received short-course parenteral antibiotics and no difference in 30-day UTI recurrence was found.
AHRQ-funded; HS026006.
Citation: Desai S, Aronson PL, Shabanova V .
Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections.
Pediatrics 2019 Sep;144(3). doi: 10.1542/peds.2018-3844..
Keywords: Newborns/Infants, Antibiotics, Urinary Tract Infection (UTI), Medication, Inpatient Care, Hospitalization, Outcomes, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Goldstein E, Olesen SW, Karaca Z
AHRQ Author: Karaca Z
Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.
The authors related state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization in several age groups of adults. They found positive associations between the rates of prescribing for penicillins and the rates of hospitalization with septicemia in US adults aged 50-84 years and recommended further studies.
AHRQ-authored.
Citation: Goldstein E, Olesen SW, Karaca Z .
Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.
BMC Public Health 2019 Aug 19;19(1):1138. doi: 10.1186/s12889-019-7431-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Antibiotics, Antimicrobial Stewardship, Sepsis, Medication, Hospitalization
Anderson DJ, Watson S, Moehring RW
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Watson S, Moehring RW .
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Hospitals, Infectious Diseases, Medication, Patient Safety
Wang HH, Kurtz M, Logvinenko T
Why does prevention of recurrent urinary tract infection not result in less renal scarring? A deeper dive into the RIVUR trial.
The RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux) trial reported that antibiotic prophylaxis reduced recurrent urinary tract infection but antibiotic prophylaxis was not associated with decreased new renal scarring. However, the original reports did not assess the relationship among recurrent urinary tract infection, new renal scarring and antibiotic prophylaxis in detail. Therefore, this study investigated the relationship among these issues.
AHRQ-funded; HS000063.
Citation: Wang HH, Kurtz M, Logvinenko T .
Why does prevention of recurrent urinary tract infection not result in less renal scarring? A deeper dive into the RIVUR trial.
J Urol 2019 Aug;202(2):400-05. doi: 10.1097/ju.0000000000000292..
Keywords: Newborns/Infants, Urinary Tract Infection (UTI), Antibiotics, Medication, Prevention
Weinberger J, Rhee C, Klompas M
A critical analysis of the literature on time-to-antibiotics in suspected sepsis.
The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. An accurate understanding of the precise relationship between time-to-antibiotics and mortality for patients with possible sepsis is therefore critical. In this study, the investigators elaborate on potential sources of bias and try to distill a better understanding of what the true relationship between time-to-antibiotics and mortality may be for patients with suspected sepsis or septic shock.
AHRQ-funded; HS025008.
Citation: Weinberger J, Rhee C, Klompas M .
A critical analysis of the literature on time-to-antibiotics in suspected sepsis.
J Infect Dis 2020 Jul 21;222(Suppl 2):S110-s18. doi: 10.1093/infdis/jiaa146..
Keywords: Sepsis, Antibiotics, Medication, Antimicrobial Stewardship, Quality Improvement, Quality of Care, Mortality
Tandan M, Sloane PD, Ward K
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
This study evaluated the impact of a two-year antimicrobial stewardship intervention program at 27 nursing homes. The objective was to identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures. All urine cultures were audited during the time period, and out of 6,718 total urine cultures collected, 68% were positive for potentially antimicrobial resistant bacteria. Most of the bacteria identified were E. coli, Proteus spp, and Klebsiella pneumonia. During the 2-year program there was a significant decrease in nitrofurantoin resistance among E. coli and ciprofloxacin resistant among Proteus spp, but carbanepem resistance increased for Proteus spp. Overall, while there was some reduction in antibiotic resistance, the reductions were too small and scattered to conclude the intervention made a big impact.
AHRQ-funded; HS022846.
Citation: Tandan M, Sloane PD, Ward K .
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
Infect Control Hosp Epidemiol 2019 Jul;40(7):780-86. doi: 10.1017/ice.2019.108..
Keywords: Antibiotics, Antimicrobial Stewardship, Elderly, Long-Term Care, Medication, Nursing Homes
Goldstein E, MacFadden DR, Karaca Z
AHRQ Author: Karaca Z Steiner CA
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Researchers studied the relation between the prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes. They found that, among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for individuals aged over 50 years, and with sepsis mortality rates for individuals aged 18-84 years. They also found a number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults.
AHRQ-authored.
Citation: Goldstein E, MacFadden DR, Karaca Z .
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Int J Antimicrob Agents 2019 Jul;54(1):23-34. doi: 10.1016/j.ijantimicag.2019.03.004..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare Cost and Utilization Project (HCUP), Hospitals, Hospitalization, Medication, Mortality, Sepsis
Ren Z, Laumann AE, Silverberg JI
Association of dermatomyositis with systemic and opportunistic infections in the United States.
This study examined whether dermatomyositis is associated with opportunistic and antibiotic-resistant infections. Data was analyzed from the Nationwide Inpatient Sample from 2002 to 2012 with a cross-sectional representative 20% sample of all hospitalizations in the US. There was an association found with serious infections in adults and children, with more associated with adults. Infections were found in the skin, bone, joints, brain, heart, lungs, and gastrointestinal system. Predictors of infections included non-white race/ethnicity, insurance status, history of long-term corticosteroid usage, Cushing’s syndrome, diabetes and cancer. This in turn caused higher odds, costs, and inpatient mortality from these infections.
AHRQ-funded; HS023011.
Citation: Ren Z, Laumann AE, Silverberg JI .
Association of dermatomyositis with systemic and opportunistic infections in the United States.
Arch Dermatol Res 2019 Jul;311(5):377-87. doi: 10.1007/s00403-019-01913-0..
Keywords: Antibiotics, Healthcare Cost and Utilization Project (HCUP), Infectious Diseases, Risk, Skin Conditions
Briscoe CC, Reich P, Fritz S
Staphylococcus aureus antibiotic susceptibility patterns in pediatric atopic dermatitis.
Researchers characterized Staphylococcus aureus strains recovered from pediatric atopic dermatitis patients with clinically apparent bacterial skin infections treated in an academic medical center. They conducted a five-year retrospective study to characterize the S aureus strains; patient demographics and dilute bleach bath usage were assessed to determine whether these factors were correlated with methicillin resistance. Culture results from the cohort were compared to those from pediatric patients presenting to a children's hospital emergency department with S aureus skin abscesses. The researchers concluded that first-generation cephalosporins remains an appropriate empiric therapy for most pediatric atopic dermatitis patients.
AHRQ-funded; HS021736; HS024269.
Citation: Briscoe CC, Reich P, Fritz S .
Staphylococcus aureus antibiotic susceptibility patterns in pediatric atopic dermatitis.
Pediatr Dermatol 2019 Jul;36(4):482-85. doi: 10.1111/pde.13867..
Keywords: Antibiotics, Children/Adolescents, Medication, Skin Conditions
Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
The authors sought to develop a model to predict the probability of recurrent urinary tract infection associated vesicoureteral reflux in children after an initial urinary tract infection. Their predictive model provided a promising performance to facilitate individualized treatment of children with an initial urinary tract infection and to identify those most likely to benefit from voiding cystourethrogram after the initial urinary tract infection. They conclude that this model would allow for more selective test application and increase yield while minimizing overuse.
AHRQ-funded; HS000063.
Citation: Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group .
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
J Urol 2019 Jul;202(1):144-52. doi: 10.1097/ju.0000000000000186..
Keywords: Antibiotics, Care Management, Children/Adolescents, Guidelines, Medication, Urinary Tract Infection (UTI)
Ulrich RJ, McClung D, Wang BR
Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease.
This study measured the amount of procalcitonin testing (PCT) done for hospital inpatients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). PCT tests for presence of bacterial infection, which the majority of AECOPD inpatients did not have. Out of 238 AECOPD admissions, 31% had PCT performed. The patients who were tested were more likely to meet systemic inflammatory response syndrome (SIRS) criteria, require intensive-care unit (ICU)-level care, and have a longer length of stay compared with those not tested. However, testing was not associated with a decrease in total antibiotic days of therapy.
AHRQ-funded.
Citation: Ulrich RJ, McClung D, Wang BR .
Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease.
Infect Dis 2019 Jun 12;12:1178633719852626. doi: 10.1177/1178633719852626..
Keywords: Antibiotics, Chronic Conditions, Respiratory Conditions, Medication
Chiotos K, Tamma PD, Gerber JS
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
This study examined unique considerations and knowledge gaps in antibiotic stewardship intervention in the intensive care unit (ICU). There is limited data available, but the available data was summarized and included the impact of prospective audit and feedback, diagnostic test stewardship, rapid molecular diagnostic tests, and procalcitonin-guided algorithms for antibiotic discontinuation.
AHRQ-funded; HS026393.
Citation: Chiotos K, Tamma PD, Gerber JS .
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
Infect Control Hosp Epidemiol 2019 Jun;40(6):693-98. doi: 10.1017/ice.2019.74..
Keywords: Antimicrobial Stewardship, Antibiotics, Intensive Care Unit (ICU), Critical Care, Antibiotics
Gong CL, Zangwill KM, Hay JW
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
Researchers sought to determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). Provider education on guidelines for the appropriate ARI treatment is compared with suggested alternatives, which use computerized clinical decision support to suggest non-antibiotic treatment choices; accountable justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and peer comparison. The authors concluded that behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
AHRQ-funded; HS019913.
Citation: Gong CL, Zangwill KM, Hay JW .
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
J Gen Intern Med 2019 Jun;34(6):846-54. doi: 10.1007/s11606-018-4467-x..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Practice Patterns, Healthcare Costs, Respiratory Conditions
Caroff DA, Menchaca JT, Zhang Z
Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses.
This study’s goal was to determine if giving hospitalized patients oral vancomycin along with systematic antibiotics prevents relapse of Cloistridioides difficile infection (CDI). The results show that the outcome was not statistically significant, although it may help patients who have only had 1 prior CDI episode.
AHRQ-funded; HS025008.
Citation: Caroff DA, Menchaca JT, Zhang Z .
Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses.
Infect Control Hosp Epidemiol 2019 Jun;40(6):662-67. doi: 10.1017/ice.2019.88..
Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Medication, Prevention
Schmajuk G, Jafri K, Evans M
Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs.
This study examined the use of prophylactic drugs used to prevent Pneumocystis jirovecii pneumonia (PJP), a rare condition sometimes caused by use of high risk immunosuppressants. This disease has a high rate of mortality. The study authors followed 316 patients for about 1-2 years who had high risk conditions such as vasculitis, myositis, or systemic lupus erythematosus. Overall, 39% of patients received prophylactic antibiotics. However, at least 25% of the patients with the highest risk conditions (vasculitis) or highest risk for immunosuppressants did not receive PJP prophylaxis. During the study period, no cases of PJP ever occurred among any of the study group.
AHRQ-funded; HS023558; HS024412.
Citation: Schmajuk G, Jafri K, Evans M .
Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs.
Semin Arthritis Rheum 2019 Jun;48(6):1087-92. doi: 10.1016/j.semarthrit.2018.10.018..
Keywords: Antibiotics, Medication, Prevention, Risk
Pepper DJ, Sun J, Rhee C
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
This study is a systematic review and meta-analysis on survival outcomes of using procalcitonin (PCT)-guided antibiotic discontinuation on critically ill adults. The study quality was assessing with the Cochrane risk of bias tool, and GRADEpro was used to grade evidence. PCT-guided discontinuation was associated with decreased mortality, but there was a high risk of bias in many of the studies reviewed with a low certainty of evidence. The authors suggest properly designed studies with mortality as the primary outcome is needed to further answer this question.
AHRQ-funded; HS025008.
Citation: Pepper DJ, Sun J, Rhee C .
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
Chest 2019 Jun;155(6):1109-18. doi: 10.1016/j.chest.2018.12.029..
Keywords: Antibiotics, Critical Care, Evidence-Based Practice, Medication, Mortality, Outcomes, Sepsis
Ban KA, Gibbons MM, Ko CY
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving
This evidence review was conducted for AHRQ in partnership with the American College of Surgeons and the Johns Hopkins Armstrong Institute for Patient Safety and Quality who have developed the Safety Program for Improving Surgical Care and Recovery (ISCR). This national effort will disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. This evidence-based review is focused on improving patient safety of anesthesiology for colorectal (CR) surgery. Components reviewed included carbohydrate loading, reduced fasting, multimodal preanesthesia medicine, antibiotic prophylaxis, normothermia, blood transfusion, intraoperative fluid management/goal-directed fluid therapy, a standardized intraoperative anesthesia pathway, and standard postoperative multimodal analgesic regiments. The results of this review will be used to develop an evidence-based CR protocol for implementation.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving
Anesth Analg 2019 May;128(5):879-89. doi: 10.1213/ane.0000000000003366..
Keywords: Evidence-Based Practice, Surgery, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Antibiotics, Medication, Medication: Safety
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis