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Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Ambulatory Care and Surgery (3)
- (-) Antibiotics (38)
- Antimicrobial Stewardship (10)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Children/Adolescents (5)
- Chronic Conditions (1)
- Clostridium difficile Infections (4)
- Community-Acquired Infections (5)
- Comparative Effectiveness (3)
- Critical Care (2)
- Decision Making (1)
- Diagnostic Safety and Quality (2)
- Elderly (7)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Evidence-Based Practice (2)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (9)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (1)
- Hospitalization (1)
- Infectious Diseases (3)
- Injuries and Wounds (3)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Long-Term Care (4)
- Medicaid (1)
- Medication (15)
- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
- Nursing Homes (6)
- Outcomes (1)
- Palliative Care (1)
- Patient-Centered Outcomes Research (5)
- Patient and Family Engagement (1)
- Patient Safety (10)
- Pneumonia (3)
- Policy (1)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (7)
- Prevention (7)
- Primary Care (3)
- Provider (1)
- Provider: Nurse (1)
- Quality of Care (1)
- Respiratory Conditions (5)
- Risk (2)
- Skin Conditions (1)
- Surgery (2)
- Urinary Tract Infection (UTI) (4)
- 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 38 Research Studies DisplayedMcElligott M, Welham G, Pop-Vicas A
Antibiotic stewardship in nursing facilities.
The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
AHRQ-funded; HS022465.
Citation: McElligott M, Welham G, Pop-Vicas A .
Antibiotic stewardship in nursing facilities.
Antibiotics, Elderly, Nursing Homes, Patient Safety, Provider Practice Patterns.
Keywords: Antibiotics, Elderly, Nursing Homes, Patient Safety, Practice Patterns
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Jump RLP, Gaur S, Katz MJ
Template for an antibiotic stewardship policy for post-acute and long-term care settings.
To support compliance with Centers for Medicare and Medicaid services (CMS) requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at the American Medical Directors Association -The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the long-term care setting. This paper describes that policy template.
AHRQ-funded; HS022465; HS023779.
Citation: Jump RLP, Gaur S, Katz MJ .
Template for an antibiotic stewardship policy for post-acute and long-term care settings.
J Am Med Dir Assoc 2017 Nov;18(11):913-20. doi: 10.1016/j.jamda.2017.07.018..
Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Policy, Prevention
Haessler S, Lagu T, Lindenauer PK
Treatment trends and outcomes in healthcare-associated pneumonia.
This retrospective cohort study assessed changes in hospital rates of concordant antibiotic use over time and their correlation with outcomes related to management of healthcare-associated pneumonia (HCAP). The study concluded that only 1 in 5 patients with risk factors for HCAP received treatment that was fully in accordance with guidelines, and many received community-acquired pneumonia (CAP) therapy instead.
AHRQ-funded; HS018723.
Citation: Haessler S, Lagu T, Lindenauer PK .
Treatment trends and outcomes in healthcare-associated pneumonia.
J Hosp Med 2017 Nov;12(11):886-91. doi: 10.12788/jhm.2877..
Keywords: Antibiotics, Elderly, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Pneumonia
Linder JA, Meeker D, Fox CR
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
This study examines the persistence of effects 12 months after stopping behavioral interventions on inappropriate antibiotic prescribing. In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increased relative to control practices—whose inappropriate prescribing rates continued to decrease.
AHRQ-funded; HS019913.
Citation: Linder JA, Meeker D, Fox CR .
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
JAMA 2017 Oct 10;318(14):1391-92. doi: 10.1001/jama.2017.11152.
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Keywords: Antibiotics, Practice Patterns, Primary Care, Comparative Effectiveness, Respiratory Conditions
Olsen MA, Nickel KB, Fraser VJ
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
This study determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. The study conclude that prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. The authors recommended stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
AHRQ-funded; HS019455.
Citation: Olsen MA, Nickel KB, Fraser VJ .
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1048-54. doi: 10.1017/ice.2017.128.
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Keywords: Antibiotics, Healthcare-Associated Infections (HAIs), Medication, Patient Safety, Surgery, Injuries and Wounds, Prevention, Adverse Events, Risk
Mody L, Greene MT, Meddings J
AHRQ Author: Burwen DR, Battles J
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
The researchers developed, implemented, and evaluated an intervention to reduce catheter-associated urinary tract infection (UTI). They found that in a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
AHRQ-authored; AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Meddings J .
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
JAMA Intern Med 2017 Aug;177(8):1154-62. doi: 10.1001/jamainternmed.2017.1689.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Long-Term Care, Nursing Homes, Prevention, Urinary Tract Infection (UTI)
Daum RS, Miller LG, Immergluck L
A placebo-controlled trial of antibiotics for smaller skin abscesses.
The authors evaluated the appropriate management of uncomplicated skin abscesses in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA). They concluded that, compared with incision and drainage alone, clindamycin or TMP-SMX in conjunction with incision and drainage improves short-term outcomes in patients who have a simple abscess. This benefit must be weighed against the known side-effect profile of these antimicrobials.
AHRQ-funded; HS024338.
Citation: Daum RS, Miller LG, Immergluck L .
A placebo-controlled trial of antibiotics for smaller skin abscesses.
N Engl J Med 2017 Jun 29;376(26):2545-55. doi: 10.1056/NEJMoa1607033.
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Keywords: Antibiotics, Community-Acquired Infections, Skin Conditions
Seidelman J, Dicks KV, Durkin MJ
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
The authors of this research brief designed a 2-phase study (1) to define the types of clostridium difficile infections (CDI) that clinicians consider unlikely preventable by inpatient antibiotic stewardship programs and (2) to estimate the relative proportion of inpatient CDI cases at a tertiary-care hospital that belongs to this category of “nonpreventable” CDI.
AHRQ-funded; HS023866.
Citation: Seidelman J, Dicks KV, Durkin MJ .
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
Infect Control Hosp Epidemiol 2017 Jun;38(6):747-49. doi: 10.1017/ice.2017.32..
Keywords: Antibiotics, Antimicrobial Stewardship, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Inpatient Care
Meddings J, Saint S, Krein SL
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
This paper is a systematic literature review of strategies to reduce urinary tract infections (UTIs) in nursing home residents. It concludes that several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or catheter-associated UTI in nursing home residents.
AHRQ-funded; HS019767; HS018334; 290201000025I.
Citation: Meddings J, Saint S, Krein SL .
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
J Hosp Med 2017 May;12(5):356-68. doi: 10.12788/jhm.2724.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Evidence-Based Practice, Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Johnson JK, Robinson GL, Pineles LL
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Carbapenem antibiotics are used as a first line of therapy against ESBL-producing Enterobacteriaceae. The researchers examined a cohort of critical care patients for gastrointestinal colonization with carbapenem-resistant ESBL-producing strains (CR-ESBL strains). They found that 10 percent of the isolates were resistant to at least one carbapenem antibiotic.
AHRQ-funded; HS021068.
Citation: Johnson JK, Robinson GL, Pineles LL .
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Antimicrob Agents Chemother 2017 Apr;61(4):e01718-16. doi: 10.1128/aac.01718-16.
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Keywords: Antibiotics, Critical Care, Medication, Intensive Care Unit (ICU)
Furuno JP, Noble BN, Bearden DT
Feasibility of retrospective pharmacovigilance studies in hospice care: a case study of antibiotics for the treatment of urinary tract infections.
In this letter to the editor, the authors assert that pharmacovigilance may be useful to improve the evidence base for medication use in hospice care and an efficient alternative to expensive and logistically complicated clinical trials. They discuss the feasibility of retrospective pharmacovigilance studies in hospice care and provide a case study of antibiotics for the treatment of urinary tract infections.
AHRQ-funded; HS023366.
Citation: Furuno JP, Noble BN, Bearden DT .
Feasibility of retrospective pharmacovigilance studies in hospice care: a case study of antibiotics for the treatment of urinary tract infections.
J Palliat Med 2017 Apr;20(4):316-17. doi: 10.1089/jpm.2016.0531..
Keywords: Antibiotics, Evidence-Based Practice, Healthcare Utilization, Medication, Palliative Care, Urinary Tract Infection (UTI)
Hersh AL, Kronman MP
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Much work in improving antibiotic prescribing remains to be done, although the authors believe they have the wind at their backs. The work of Handy et al highlights the fact that both clinical and nonclinical factors may contribute to inappropriate prescribing and that all domains of inappropriate antibiotic use must be targeted to achieve national goals for reducing inappropriate use.
AHRQ-funded; HS023320.
Citation: Hersh AL, Kronman MP .
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Pediatrics 2017 Apr;139(4). doi: 10.1542/peds.2017-0027.
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Keywords: Antibiotics, Decision Making, Medication, Practice Patterns
Goldman JL, Richardson T, Newland JG
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
The study’s objective was to characterize outpatient parenteral antimicrobial therapy (OPAT) use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT. It found that ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. An emergency department visit or hospital admission occurred during 38 percent of OPAT episodes, among which 61 percent were OPAT-related.
AHRQ-funded; HS023320.
Citation: Goldman JL, Richardson T, Newland JG .
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
J Pediatric Infect Dis Soc 2017 Mar 1;6(1):65-71. doi: 10.1093/jpids/piv106.
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Keywords: Antibiotics, Children/Adolescents, Medicaid, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Immergluck LC, Jain S, Ray SM
Risk of skin and soft tissue infections among children found to be staphylococcus aureus MRSA USA300 carriers.
The purpose of this study conducted in a pediatric emergency department was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300. It found that children younger than two years were at highest risk for MRSA USA300 carriage. Lower income, recent antibiotic use, and previous or family history of skin and soft tissue infections were risk factors for MRSA USA300 carriage.
AHRQ-funded; HS024338.
Citation: Immergluck LC, Jain S, Ray SM .
Risk of skin and soft tissue infections among children found to be staphylococcus aureus MRSA USA300 carriers.
West J Emerg Med 2017 Feb;18(2):201-12. doi: 10.5811/westjem.2016.10.30483.
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Keywords: Antibiotics, Children/Adolescents, Community-Acquired Infections, Emergency Department, Methicillin-Resistant Staphylococcus aureus (MRSA)
Scales K, Zimmerman S, Reed D
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
The objective of this cross sectional survey was to examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes ( NHs). The investigators concluded that nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.
AHRQ-funded; HS22846.
Citation: Scales K, Zimmerman S, Reed D .
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):165-71. doi: 10.1111/jgs.14504..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Provider: Nurse, Provider
Anesi JA, Lautenbach E, Nachamkin I
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
The objective of this paper was to evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. The investigators found that use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI, with a high prevalence of CTX-M among their community isolates.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
Infect Control Hosp Epidemiol 2016 Dec;37(12):1433-39. doi: 10.1017/ice.2016.225.
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Keywords: Antibiotics, Community-Acquired Infections, Patient Safety, Urinary Tract Infection (UTI)
Burnham CA, Hogan PG, Wallace MA
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
The authors compared microbial communities and levels of richness and diversity in community-dwelling subjects and in intensive care unit patients before and after the use of topical decolonization protocols. They found a reduction in S. aureus without eradicating endogenous microbiota.
AHRQ-funded; HS021736; HS024269.
Citation: Burnham CA, Hogan PG, Wallace MA .
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
Antimicrob Agents Chemother 2016 Dec;60(12):7303-12. doi: 10.1128/aac.01289-16.
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Keywords: Antimicrobial Stewardship, Antibiotics, Infectious Diseases, Prevention, Patient Safety
Piper Jenks N, Pardos de la Gandara M, D'Orazio BM
Differences in prevalence of community-associated MRSA and MSSA among U.S. and non-U.S. born populations in six New York community health centers.
As part of a research collaborative, 6 New York City-area community health centers recruited patients with Skin and Soft Tissue Infections (SSTIs). This study found that although not statistically significant, immigrants had lower rates of Methicillin-Resistant Staphylococcus aureus (MRSA) infections than did native-born participants, and immigrants showed significantly higher rates of Methicillin-Susceptible Staphylococcus aureus (MSSA) wound cultures.
AHRQ-funded; HS021667.
Citation: Piper Jenks N, Pardos de la Gandara M, D'Orazio BM .
Differences in prevalence of community-associated MRSA and MSSA among U.S. and non-U.S. born populations in six New York community health centers.
Travel Med Infect Dis 2016 Nov - Dec;14(6):551-60. doi: 10.1016/j.tmaid.2016.10.003.
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Keywords: Community-Acquired Infections, Methicillin-Resistant Staphylococcus aureus (MRSA), Injuries and Wounds, Practice-Based Research Network (PBRN), Antibiotics
Bartsch SM, Huang SS, Wong KF
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
The authors used their Regional Healthcare Ecosystem Analyst (RHEA) simulation model and found that the 32-month delay in changing carbapenem-resistant Enterobacteriaceae (CRE) breakpoints might have resulted in 1,821 additional carriers in Orange County, CA. They recommend that policymakers aim to minimize the delay in the adoption of new breakpoints for antimicrobials against emerging pathogens when containment of spread is paramount, ideally less than 1.5 years.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Huang SS, Wong KF .
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
J Clin Microbiol 2016 Nov;54(11):2757-62. doi: 10.1128/jcm.00635-16.
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Keywords: Infectious Diseases, Antibiotics, Antimicrobial Stewardship
Cunha CB, D'Agata EM
Implementing an antimicrobial stewardship program in out-patient dialysis units.
The purpose of this review is to highlight the key elements and interventions of antimicrobial stewardship programs (ASP). The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
AHRQ-funded; HS021666.
Citation: Cunha CB, D'Agata EM .
Implementing an antimicrobial stewardship program in out-patient dialysis units.
Curr Opin Nephrol Hypertens 2016 Nov;25(6):551-55. doi: 10.1097/mnh.0000000000000281.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery, Kidney Disease and Health, Chronic Conditions
Haggerty CL, Totten PA, Tang G
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
The authors examined the relationship between select novel bacteria, pelvic inflammatory disease (PID), and long-term sequelae. They demonstrated that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID and suggested that optimal antibiotic regimens for PID may require coverage of novel bacterial vaginosis-associated microbes.
AHRQ-funded; HS008358.
Citation: Haggerty CL, Totten PA, Tang G .
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
Sex Transm Infect 2016 Sep;92(6):441-6. doi: 10.1136/sextrans-2015-052285.
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Keywords: Antibiotics, Care Management, Medication, Women
Gidengil CA, Mehrotra A, Beach S
What drives variation in antibiotic prescribing for acute respiratory infections?
This study sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings. The investigators concluded that poor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Mehrotra A, Beach S .
What drives variation in antibiotic prescribing for acute respiratory infections?
J Gen Intern Med 2016 Aug;31(8):918-24. doi: 10.1007/s11606-016-3643-0..
Keywords: Antibiotics, Medication, Respiratory Conditions, Practice Patterns
Belforti RK, Lagu T, Haessler S
Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia.
The objective of this study was to compare outcomes of hospitalized patients with community-acquired pneumonia receiving intravenous vs oral respiratory fluoroquinolones. The authors concluded that there was no association between initial route of administration and outcomes.
AHRQ-funded; HS018723.
Citation: Belforti RK, Lagu T, Haessler S .
Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia.
Clin Infect Dis 2016 Jul 1;63(1):1-9. doi: 10.1093/cid/ciw209.
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Keywords: Community-Acquired Infections, Pneumonia, Comparative Effectiveness, Patient-Centered Outcomes Research, Antibiotics