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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedAzimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Flannery DD, Zevallos Barboza A, Mukhopadhyay S
Antibiotic use among infants admitted to neonatal intensive care units.
The purpose of this cross-sectional study was to examine antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the U.S. Data for almost 1.4 million infants were taken from the Premier Healthcare Database. The most common antibiotics prescribed during the study period were ampicillin, gentamicin, vancomycin, and cefotaxime. Antibiotic use declined substantially over time, primarily because of reductions in ampicillin and gentamicin. The authors noted that these findings probably reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies; shortage and subsequent discontinuation of cefotaxime may have played a role in the sharp decline in its use and the related increase in ceftazidime use.
AHRQ-funded; HS027468.
Citation: Flannery DD, Zevallos Barboza A, Mukhopadhyay S .
Antibiotic use among infants admitted to neonatal intensive care units.
JAMA Pediatr 2023 Dec; 177(12):1354-56. doi: 10.1001/jamapediatrics.2023.3664..
Keywords: Newborns/Infants, Antibiotics, Medication, Intensive Care Unit (ICU), Critical Care
Sikora A, Rafiei A, Rad MG
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may provide the needed infrastructure to clinicians and researchers to support artificial intelligence analysis of medication-related outcomes and healthcare costs. The purpose of this study was to identify novel patterns of medication clusters (termed 'pharmacophenotypes') correlated with ICU adverse events (e.g., fluid overload) and patient-centered outcomes (e.g., mortality). The researchers conducted a retrospective, observational cohort study of 991 critically ill adults with a total of 30,550 medication orders. To identify pharmacophenotypes, unsupervised machine learning analysis with automated feature learning was performed on the medication administration records of each patient during the first 24 hours of their stay in the intensive care unit. Five unique patient clusters and six unique pharmacophenotypes were identified. For patient outcomes, compared to patients in Clusters 1 and 3, patients in Cluster 5 had a significantly shorter duration of mechanical ventilation and ICU length of stay; for medications, Cluster 5 had a higher distribution of Pharmacophenotype 1 and a smaller distribution of Pharmacophenotype 2, compared to Clusters 1 and 3. For outcomes, patients in Cluster 2 had the highest severity of illness and greatest medication regimen complexity, but they also had the lowest overall mortality; for medications, Cluster 2 also had a higher distribution of Pharmacophenotype 6.
AHRQ-funded; HS028485.
Citation: Sikora A, Rafiei A, Rad MG .
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
Crit Care 2023 May 2; 27(1):167. doi: 10.1186/s13054-023-04437-2..
Keywords: Medication, Intensive Care Unit (ICU)
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
Chiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)