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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Antibiotics (11)
- (-) Antimicrobial Stewardship (14)
- Case Study (1)
- Critical Care (1)
- Digestive Disease and Health (1)
- (-) Elderly (14)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (2)
- Implementation (1)
- Infectious Diseases (2)
- Long-Term Care (10)
- Medication (11)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Nursing Homes (10)
- Patient Safety (3)
- Practice Patterns (1)
- Provider (1)
- Provider: Nurse (1)
- Quality Improvement (1)
- Quality of Care (1)
- Risk (1)
- Workflow (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 14 of 14 Research Studies DisplayedUribe-Cano D, Bahranian M, Jolles SA
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Researchers studied the extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes. Using a cross-sectional chart review in 5 Wisconsin nursing homes, they found that levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections, fair for skin and soft-tissue infections, and slight for respiratory tract infections. They concluded that agreement between the revised McGeer and Loeb criteria is limited, and that nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes.
AHRQ-funded; HS022465.
Citation: Uribe-Cano D, Bahranian M, Jolles SA .
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Infect Control Hosp Epidemiol 2022 Jul;43(7):860-63. doi: 10.1017/ice.2021.221..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Antimicrobial Stewardship, Medication
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Ramly E, Tong M, Bondar S
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, the investigators analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. They found that such strategies included structured information tools, nurse and prescriber education, and organizational improvement.
AHRQ-funded; HS022465.
Citation: Ramly E, Tong M, Bondar S .
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
J Am Geriatr Soc 2020 Oct;68(10):2222-31. doi: 10.1111/jgs.16632..
Keywords: Workflow, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Antimicrobial Stewardship, Practice Patterns
Nace DA, Hanlon JT, Crnich CJ
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
This study describes the result of implementing a multifaceted antimicrobial stewardship program to reduce antibiotic use in nursing homes for urinary tract infections that are unlikely cystitis. Reduction in antibiotic use decreases incidence of Clostridioides difficile (C difficile) infections, as well as adverse drug reactions and antimicrobial drug resistance. This one-year case-control study included 12 intervention nursing homes and 13 control group nursing homes. The intervention nursing homes received a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Additionally, they received a monthly coaching call as well as a quarterly feedback report. In the intervention nursing homes, fewer unlikely cystitis cases were treated with antibiotics and C difficile infection rates were also lower. There was no increase in all-cause hospitalizations or deaths due to the intervention.
AHRQ-funded; HS023779.
Citation: Nace DA, Hanlon JT, Crnich CJ .
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
JAMA Intern Med 2020 Jul;180(7):944-51. doi: 10.1001/jamainternmed.2020.1256..
Keywords: Antimicrobial Stewardship, Antibiotics, Nursing Homes, Elderly, Quality Improvement, Quality of Care, Medication
Liao CY, Nace DA, Crnich CJ
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
The purpose of this study was to evaluate the impact of a stewardship intervention, promoting the use of antibiotic time-outs (ATOs) on the frequency and types of antibiotic change events (ACEs) in nursing homes. Data on antibiotic prescriptions in 11 nursing homes were collected over 25 months and categorized as early discontinuation, class modification, or administration modification ACEs. Findings showed that the impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. Recommendations include further research on the potential value of ATO interventions in nursing homes.
AHRQ-funded; HS022465.
Citation: Liao CY, Nace DA, Crnich CJ .
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
Infect Control Hosp Epidemiol 2020 Jun;41(6):635-40. doi: 10.1017/ice.2020.75..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly
Pulia MS, Keller SC, Crnich CJ
Antibiotic stewardship for older adults in ambulatory care settings: addressing an unmet challenge.
Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic-associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug-drug interactions, and Clostridioides difficile. In this study, to help improve the clinical care of older adults, the investigators reviewed drivers of antibiotic prescribing in this population, explored systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discussed existing stewardship interventions, and provided guidance on priority areas for future inquiry.
AHRQ-funded; HS024342.
Citation: Pulia MS, Keller SC, Crnich CJ .
Antibiotic stewardship for older adults in ambulatory care settings: addressing an unmet challenge.
J Am Geriatr Soc 2020 Feb;68(2):244-49. doi: 10.1111/jgs.16256..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Elderly, Patient Safety, Adverse Drug Events (ADE), Adverse Events
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
D'Agata EMC, Varu A, Geffert SF
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
This nested case-control study was conducted among 137 nursing home residents who did not receive antimicrobials, with 44 acquiring a multi-drug resistant organism. Risk factors identified included receiving gastrointestinal medication that affected the gut microbiome, the number of visits from healthcare workers, pressure ulcers, and not residing in a dementia unit.
AHRQ-funded; HS021666.
Citation: D'Agata EMC, Varu A, Geffert SF .
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
Clin Infect Dis 2018 Oct 15;67(9):1437-40. doi: 10.1093/cid/ciy358..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Digestive Disease and Health, Case Study
Michener A, Heath B, Crnich CJ
Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship.
This article describes the results of a series of 1-hour case-based discussions on recognition, diagnosis, and infections common in older adults, including those living in long-term care settings, and antibiotic stewardship that were developed by the authors. This series of five discussions was held at 15 Veterans Affairs medical centers in their skilled nursing centers. There were participants from an array of disciplines who completed an evaluation as well as pre- and post-course knowledge assessment. Total participants numbered from 68 to 108 per center. There were positive assessments, with many participants saying they were likely to make changes to help combat health associated infections.
AHRQ-funded; HS023866.
Citation: Michener A, Heath B, Crnich CJ .
Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship.
MedEdPORTAL 2018 Sep 21;14:10754. doi: 10.15766/mep_2374-8265.10754..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Elderly, Infectious Diseases
Jump RLP, Crnich CJ, Mody L
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review.
AHRQ-funded; HS022465.
Citation: Jump RLP, Crnich CJ, Mody L .
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
J Am Geriatr Soc 2018 Apr;66(4):789-803. doi: 10.1111/jgs.15248.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Long-Term Care, Antimicrobial Stewardship, Antibiotics, Medication, Evidence-Based Practice, Guidelines
Katz MJ, Gurses AP, Tamma PD
AHRQ Author: Miller MA
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
In this integrative review, the authors analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in long term care facilities. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants.
AHRQ-authored; AHRQ-funded; 2332015000201.
Citation: Katz MJ, Gurses AP, Tamma PD .
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
Clin Infect Dis 2017 Nov;65(11):1943-51. doi: 10.1093/cid/cix566.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Elderly, Long-Term Care, Nursing Homes
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
Peterson LR, Wright MO, Beaumont JL
Nonimpact of decolonization as an adjunctive measure to contact precautions for the control of methicillin-resistant Staphylococcus aureus transmission in acute care.
This was an observational study comparing methicillin-resistant Staphylococcus aureus (MRSA) transmission with no decolonization of medical patients to required decolonization of all MRSA carriers during two consecutive periods: baseline with no decolonization of medical patients and universal MRSA carrier decolonization. The study concluded that decolonization of MRSA patients does not add benefit when contact precautions are used for patients colonized with MRSA in acute (hospital) care.
AHRQ-funded; HS019968.
Citation: Peterson LR, Wright MO, Beaumont JL .
Nonimpact of decolonization as an adjunctive measure to contact precautions for the control of methicillin-resistant Staphylococcus aureus transmission in acute care.
Antimicrob Agents Chemother 2015 Oct 12;60(1):99-104. doi: 10.1128/aac.02046-15.
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Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Critical Care, Antimicrobial Stewardship, Elderly, Patient Safety
Min L, Galecki A, Mody L
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
This study used a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. It found that MDRO acquisition is common in community NHs. The need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals.
AHRQ-funded; HS019979.
Citation: Min L, Galecki A, Mody L .
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
J Am Geriatr Soc 2015 Apr;63(4):659-66. doi: 10.1111/jgs.13353..
Keywords: Nursing Homes, Antimicrobial Stewardship, Elderly, Long-Term Care, Risk