National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Antibiotics (15)
- Antimicrobial Stewardship (4)
- Care Management (1)
- Children/Adolescents (1)
- Clostridium difficile Infections (1)
- Community-Acquired Infections (2)
- Comparative Effectiveness (1)
- Decision Making (2)
- Diagnostic Safety and Quality (1)
- Elderly (1)
- Evidence-Based Practice (2)
- Genetics (1)
- Guidelines (1)
- Healthcare Utilization (1)
- Hospital Discharge (1)
- Hospitalization (1)
- Imaging (1)
- Inpatient Care (1)
- Long-Term Care (2)
- (-) Medication (15)
- Newborns/Infants (3)
- Nursing Homes (3)
- Outcomes (2)
- Palliative Care (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Pneumonia (1)
- Practice Patterns (1)
- Prevention (2)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Skin Conditions (1)
- (-) Urinary Tract Infection (UTI) (15)
- 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 15 of 15 Research Studies DisplayedZhang K, Potter RF, Marino J
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
The study explored resistance patterns in Staphylococcus saprophyticus, a common cause of UTIs in women. Genomic analysis linked antibiotic resistance genes to susceptibility, identifying associations with SCCmec configurations and phage elements. This database aids in resistance surveillance for precise diagnosis and treatment, potentially curbing resistance transmission.
AHRQ-funded; HS027621.
Citation: Zhang K, Potter RF, Marino J .
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
mSystems 2023 Dec 21; 8(6):e0069723. doi: 10.1128/msystems.00697-23..
Keywords: Genetics, Antibiotics, Urinary Tract Infection (UTI), Medication
Taylor LN, Wilson BM, Singh M
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
The goal of this survey study was to determine if providing nursing home (NH) clinicians with syndromic antibiograms improves antibiotic treatment urinary tract infections (UTIs). The researchers concluded providing the NH clinicians with urinary antibiograms is associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions.
AHRQ-funded; HS027820.
Citation: Taylor LN, Wilson BM, Singh M .
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
JAMA Netw Open 2023 Dec; 6(12):e2349544. doi: 10.1001/jamanetworkopen.2023.49544..
Keywords: Nursing Homes, Antibiotics, Medication, Urinary Tract Infection (UTI)
Soper NS, Appukutty AJ, Paje D
Antibiotic overuse after discharge from medical short-stay units.
This study investigated antibiotic overuse after discharge from medical short-stay units (SSUs). This cross-sectional study included patients hospitalized in 2 different medical SSUs with a total of 40 beds at a single academic medical center. Eligible adults were discharged with an oral antibiotic from either SSU from May 2018 to September 2019. Of 100 patients discharged from SSUs with antibiotics, 47 had a skin and soft-tissue infection (SSTI), 22 pneumonia, 21 UTI, and 10 had “other” infections. Overall, 78 cases (78%) were defined as overuse, including 39 of 47 of those treated for SSTI, 17 of 21 for UTI, and 14 of 22 for pneumonia. The most common types of overuse were excess duration and guideline discordant selection. Examples of factors influencing overuse included consultant recommendations, miscalculation of duration, and the need for source control procedure.
AHRQ-funded; HS026530.
Citation: Soper NS, Appukutty AJ, Paje D .
Antibiotic overuse after discharge from medical short-stay units.
Nov;43(11):1689-92. doi: 10.1017/ice.2021.346..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Pneumonia, Skin Conditions, Urinary Tract Infection (UTI), Respiratory Conditions, Hospital Discharge
Butler AM, Durkin MJ, Keller MR
Association of adverse events with antibiotic treatment for urinary tract infection.
The purpose of this study was to compare the risk of relative harms associated with different antibiotics prescribed for the treatment of uncomplicated urinary tract infection (UTI). The researchers identified 1,169,033 healthy, nonpregnant women between the ages of 18 to 44 who had an uncomplicated UTI and who initiated an oral antibiotic regimen for the treatment of common uropathogens between July 2006 and September 2015. The study found that of the two first-line treatments, the drug trimethoprim-sulfamethoxazole (versus nitrofurantoin) was associated with a higher risk of adverse drug-related events including: hypersensitivity, acute renal failure, skin rash, urticaria, abdominal pain, and nausea/ vomiting, but a similar risk of adverse possible microbiome-related events. When researchers compared non-first line drugs with nitrofurantoin, the non-first line drugs were associated with a greater risk of adverse drug events and possible microbiome-related adverse events including non-Clostridium difficile diarrhea, C. difficile infection, vaginitis/vulvovaginal candidiasis, and pneumonia. The duration of the treatment influenced the risk of possible microbiome-related adverse events. The study concluded that the risk of adverse events differs widely by both antibiotic drug and duration of regimen.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Association of adverse events with antibiotic treatment for urinary tract infection.
Clin Infect Dis 2022 Apr 28;74(8):1408-18. doi: 10.1093/cid/ciab637..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Adverse Drug Events (ADE), Adverse Events, Clostridium difficile Infections
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
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
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, Decision Making, Diagnostic Safety and Quality
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
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
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)
Anesi JA, Lautenbach E, Nachamkin I
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset
This study found an association between the use of extended-spectrum cephalosporin-resistance (ESC-R) and recurring Enterobacteriacaea urinary tract infections (EB UTIs). There was a significant increase in emergency room visits within 12 months after the first UTI visit.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset
BMC Infect Dis 2019 Feb 14;19(1):163. doi: 10.1186/s12879-019-3804-y..
Keywords: Antibiotics, Community-Acquired Infections, Medication, Urinary Tract Infection (UTI)
Anesi JA, Lautenbach E, Nachamkin I
Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
In this retrospective cohort study, the investigators sought to determine the clinical outcomes associated with community-onset ESC-resistant (ESC-R) EB urinary tract infections (UTIs) in a US health system. The authors found that community-onset UTI due to an ESC-R EB organism was significantly associated with clinical failure, which may be due in part to inappropriate initial antibiotic therapy. They indicate that further studies are needed to determine which patients in the community are at high risk for drug-resistant infection to help inform prompt diagnosis and appropriate antibiotic prescribing for ESC-R EB.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1431-35. doi: 10.1017/ice.2018.254..
Keywords: Antibiotics, Community-Acquired Infections, Medication, Outcomes, Patient Safety, Urinary Tract Infection (UTI)
Varda BK, Finkelstein JB, Wang HH
The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis.
This study examined whether the routine use of continuous antibiotic prophylaxis (CAP) before initial postnatal imaging is effective to prevent urinary tract infection (UTI) in infants with a history of antenatal urinary tract dilation (AUTD). A single-institution, retrospective cohort study of infants with a history of AUTD was conducted. A random sample of 500 infants was selected with six excluded for other congenital anomalies. Of the 494 remaining, 157 (32%) received CAP. There was no difference found in UTI incidence among those treated with CAP and those who were not.
AHRQ-funded; HS000063.
Citation: Varda BK, Finkelstein JB, Wang HH .
The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis.
J Pediatr Urol 2018 Dec;14(6):539.e1-39.e6. doi: 10.1016/j.jpurol.2018.04.022..
Keywords: Antibiotics, Antimicrobial Stewardship, Urinary Tract Infection (UTI), Newborns/Infants, Imaging, Medication, Prevention
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)