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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 25 of 236 Research Studies DisplayedDeshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Laytner LA, Olmeda K, Salinas J
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
The purpose of this study was to explore the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: 1) United States markets (not legal), 2) other countries, 3) leftovers from previous prescriptions, and 4) friends/relatives. The study found that of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to utilize antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to utilize non-prescription antibiotics from friends/relatives. Other predictors of intention to utilize non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic.
AHRQ-funded; HS026901.
Citation: Laytner LA, Olmeda K, Salinas J .
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
Antibiotics 2023 Sep 8; 12(9). doi: 10.3390/antibiotics12091419..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Smith MW, Carrel M, Goto M
County-level spatiotemporal distribution of fluoroquinolone-resistant Enterobacteriaceae in outpatient settings of the Veterans' Health Administration, 2000-2017.
This study’s goal was to describe the spatial distribution of fluoroquinolone resistance against Enterobacteriaceae and its chronological change between 2000 and 2017 in the nationwide Veterans' Health Administration system. Primary outcome was the county-level fluoroquinolone resistance rate, calculated as the proportion of number of unique patients with at least 1 positive fluoroquinolone-resistant Enterobacteriaceae clinical culture divided by the total number of unique patients with at least one positive Enterobacteriaceae culture in the county for each calendar year. The authors found spatially concentrated increasing prevalence in the 2000s, followed by spatial dispersion in the 2010s. Of the 107 million patient years of care in the VHA from 2000 to 2017, 1,621,762 patient years included at least 1 positive culture for Enterobacteriaceae, with 2,545,430 unique culture specimens. The resistance rate among all Enterobacteriaceae was 8% in the year 2000, with resistance peaking at 22% in 2011. This rate plateaued during 2011 to 2017. Initial resistance rates were higher in portions of the South region and southern California, with higher rates becoming widespread nationally during 2012 to 2017.
AHRQ-funded; HS027472.
Citation: Smith MW, Carrel M, Goto M .
County-level spatiotemporal distribution of fluoroquinolone-resistant Enterobacteriaceae in outpatient settings of the Veterans' Health Administration, 2000-2017.
Infect Control Hosp Epidemiol 2023 Sep; 44(9):1497-99. doi: 10.1017/ice.2022.291..
Keywords: Medication, Antibiotics
Grigoryan L, Paasche-Orlow MK, Alquicira O
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
The purpose of this study was to assess the impact of factors of patient, health system, and clinical encounters on intention to utilize antibiotics without a prescription. Use cases included antibiotics that were 1) bought in the United States, 2) provided by relatives or friends, 3) purchased in another country, or 4) from any of these sources. Between January 2020 through June 2021, a survey was administered in 6 publicly funded primary care clinics and 2 private emergency departments in Texas, United States. Study participants included adult patients visiting 1 of the clinical settings. The study found that of the 564 survey respondents 43.6% reported previous use of antibiotics without a prescription, and 31.4% reported intent to take antibiotics without a prescription. Survey respondents reported they would take antibiotics obtained from relatives or friends (22.3%), bought in the United States without a prescription (19.1%), or purchased in another country without a prescription (17.9%). Perceived high cost of doctor visits, lack of health insurance, and younger age were all predictors of intended use of nonprescription antibiotics from any of the sources. Hispanic or Latino ethnicity, being interviewed in Spanish, language barrier to medical care, and lack of transportation for medical appointments.
AHRQ-funded; HS026901.
Citation: Grigoryan L, Paasche-Orlow MK, Alquicira O .
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
Clin Infect Dis 2023 Aug 22; 77(4):510-17. doi: 10.1093/cid/ciad241..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Deshpande A, Klompas M, Guo N
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
The purpose of this retrospective cohort study was to examine clinical practice guidelines which recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. The researchers conducted a study of adults admitted with CAP from 2010 through 2015 and initially treated with IV antibiotics at 642 US hospitals. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. The study found that of 78,041 CAP patients, 6% were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a greater mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, less than 15% of very low-risk patients were switched early.
AHRQ-funded; HS029477; HS025026.
Citation: Deshpande A, Klompas M, Guo N .
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
Clin Infect Dis 2023 Jul 26; 77(2):174-85. doi: 10.1093/cid/ciad196..
Keywords: Antibiotics, Community-Acquired Infections, Pneumonia, Respiratory Conditions, Medication
Ramanathan S, Evans CT, Hershow RC
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
The objective of this retrospective study was to compare prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-VA settings. Subjects were veteran and non-veteran dental patients with cardiac conditions or prosthetic joints; most were males aged 55 years older. The results showed that VA settings had a higher prevalence of guideline concordant prescribing among those with prosthetic joints, and when assessing dosing errors. The authors recommended that future studies focus on the extent to which integrated electronic health records may be responsible for increased guideline concordant prescribing in the VA setting.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
BMC Infect Dis 2023 Jun 23; 23(1):427. doi: 10.1186/s12879-023-08400-y..
Keywords: Dental and Oral Health, Antibiotics, Medication, Prevention, Cardiovascular Conditions, Practice Patterns
Cabral SM, Harris AD, Cosgrove SE
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
This retrospective cohort study assessed adherence to surgical antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals from 2019 to 2020. The authors looked at adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. They evaluated adherence of prophylaxis regimes, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. They found that across 825 hospitals and 521,091 inpatient elective surgeries, 59% were adherent to prophylaxis guidelines. The most common reason found for nonadherence was unnecessary vancomycin use. Patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone.
AHRQ-funded; HS028363.
Citation: Cabral SM, Harris AD, Cosgrove SE .
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
Clin Infect Dis 2023 Jun 16; 76(12):2106-15. doi: 10.1093/cid/ciad077..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Guidelines, Evidence-Based Practice, Surgery
Kakiuchi S, Perencevich EN, Livorsi DJ
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Monitoring antibiotic use is essential for encouraging the appropriate use of antibiotics. However, defining appropriate metrics presents multiple challenges. The purpose of this study was to compare 2 metrics for antibiotic outpatient consumption at the Veterans Health Administration (VHA) pharmacies: the number of prescriptions in EMRs and the number of dispensed days, or days supplied. During the study period, 13,373,460 clinic visits (5.0%) of the 265,613,607 total clinic visits had an antibiotic prescription, and the total of days supplied was 182,793,572. The study found that the mean days supplied per prescription continued mainly unchanged during the study period. Comparing the number of prescriptions and days supplied normalized by the number of clinic visits, these 2 metrics changed in parallel, with only minor differences from 2010 to 2019. When the researchers focused on short-term prescriptions usually utilized for acute illnesses (14 days or less), prescription number and days supplied reflected an increasing discrepancy. The number of prescriptions underestimated the decline compared to days supplied. Alternatively, long-term prescriptions (15 days or more) reflected the opposite discrepancy. For comparisons between facilities, the researchers found considerable differences in rankings of healthcare systems based on the 2 metrics.
AHRQ-funded; HS027472.
Citation: Kakiuchi S, Perencevich EN, Livorsi DJ .
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):941-44. doi: 10.1017/ice.2022.189..
Keywords: Medication, Ambulatory Care and Surgery, Antibiotics, Antimicrobial Stewardship
Suzuki H, Heintz BH, Livorsi DJ
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Researchers evaluated the measurement performance by days of antibiotic spectrum coverage (DASC) versus days of therapy (DOT), the preferred metric for measuring inpatient antimicrobial consumption within the U.S. Their retrospective study analyzed inpatient antimicrobial use at the Iowa City Veterans’ Affairs Healthcare System acute-care hospital. Antimicrobial DOT did not decrease significantly during a period of robust stewardship activities, but a significant downward trend in the antimicrobial spectrum, as measured by DASC was detected. The researchers concluded that the DASC metric may help to monitor the effect of stewardship activities more broadly.
AHRQ-funded; HS027472.
Citation: Suzuki H, Heintz BH, Livorsi DJ .
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):934-37. doi: 10.1017/ice.2022.312..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Laytner L, Chen P, Nash S
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
This study examined non-prescription use of antibiotics among Hispanic adults in the Houston area. The study included Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews were conducted in English or Spanish with 35 participants primarily female (68.6%) and aged 27 to 66. Participants reported obtaining antibiotics through under-the-counter US markets, trusted persons, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare, and communication difficulties. However, participants expressed confidence in medical recommendations from pharmacists and trusted community members.
AHRQ-funded; HS026901.
Citation: Laytner L, Chen P, Nash S .
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
J Am Board Fam Med 2023 May 8; 36(3):390-404. doi: 10.3122/jabfm.2022.220416R1..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Patel D, Ng T, Madani LS
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
The purpose of this study was to conceptualize and implement antibiotic stewardship activities in urgent care that targets non-antibiotic-appropriate acute respiratory tract infections (ARIs) that also decreases general antibiotic prescribing and preserves patient satisfaction. The stewardship initiative commenced in fiscal year 2020 and included development of measures, comparative feedback, and education for clinicians and patients. The study measured antibiotic prescribing in fiscal years (FY) 2019, 2020, and 2021 for the stewardship goals, possible diagnosis-shifting visits, and overall prescribing. The researchers also collected patient satisfaction data for ARI visits. The study found that from FY 2019 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY 2019 to 12% in FY 2021 The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35%, and the antibiotic prescribing rate decreased overall from 30% to 10%. The patient satisfaction rate increased from 83% in FY 2019 to 89% in FY 2020 and FY 2021. There was no significant relationship between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Patel D, Ng T, Madani LS .
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
Infect Control Hosp Epidemiol 2023 May; 44(5):736-45. doi: 10.1017/ice.2022.164..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Keller S, Miller MA, Cosgrove SE
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was an antibiotic stewardship intervention implemented across the United States in 2020 in 389 primary and urgent care practices. The AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care has been created based on integration of the educational material used in the AHRQ safety program and the experiences of the participating practices. The toolkit includes presentations on developing, implementing, and maintaining antibiotic stewardship activities; a gap analysis tool; and a guide to accessing and reporting antibiotic prescription data. Practices can use these tools to build their antibiotic stewardship teams and begin working on programs. Improving antibiotic prescribing in ambulatory care is a critical need. Utilizing the AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care can assist practices in achieving their antibiotic stewardship goals.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller S, Miller MA, Cosgrove SE .
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
Am Fam Physician 2023 May; 107(5):456-57..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Tools & Toolkits
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Antoon JW, Grijalva CG, Carroll AR
Parental perceptions of penicillin allergy risk stratification and delabeling.
The purpose of this study was to explore parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting. Investigators conducted focus groups consisting of parent of children and adolescents with a PCN allergy label discharged from a large academic children’s hospital between January 1, 2019, and April 15, 2020. The focus groups answered questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). The study concluded family concerns remained even after children passed an oral challenge, and that some parents preferred testing in a hospital setting and thought it was a safer location for the procedure.
AHRQ-funded; HS026122.
Citation: Antoon JW, Grijalva CG, Carroll AR .
Parental perceptions of penicillin allergy risk stratification and delabeling.
Hosp Pediatr 2023 Apr; 13(4):300-08. doi: 10.1542/hpeds.2022-006737..
Keywords: Children/Adolescents, Antibiotics, Medication, Risk
Thurman Johnson C, Ridge LJ, Hessels AJ
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
This scoping review described how nurses are engaged in hospital-based antibiotic stewardship programs (ASPs) and to what extent this overlaps with the CDC framework. The authors concluded that, although hospitals were engaging nurses in antibiotic stewardship programs, their selected approaches did not reflect the full breadth of opportunities identified by the CDC. They noted that more detail as to how precisely nurses were engaged would be a useful addition to the literature; more research was also needed on nurse engagement in culturing or testing and penicillin allergy evaluation.
AHRQ-funded; HS026418.
Citation: Thurman Johnson C, Ridge LJ, Hessels AJ .
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
J Healthc Qual 2023 Mar-Apr;45(2):69-82. doi: 10.1097/jhq.0000000000000372.
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Provider: Nurse
Olmeda K, Trautner BW, Laytner L
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
This study assessed the prevalence of antibiotic use in children in the previous 12 months, storage of antimicrobials, and intended use of non-prescription antibiotics (professed intention for future non-prescription antibiotic use). A diverse sample of caregivers of children under 18 years were surveyed in English and Spanish at two safety net clinics in Texas from January 2021 to April 2022. There was an 82% response rate, with 17% surveyed in Spanish. Approximately 21% reported storing antibiotics in their home, specifically amoxicillin (n = 52), clindamycin (n = 10), cephalexin (n = 5), penicillin (n = 3), and trimethoprim/sulfamethoxazole (n = 3). Nearly 15% reported intention to give non-prescription antibiotics to their children, with three Spanish-speaking caregivers reporting giving non-prescription antibiotics to their child in the previous 12 months. Younger caregivers were associated with storage and intended use of non-prescription antibiotics.
AHRQ-funded; HS027869.
Citation: Olmeda K, Trautner BW, Laytner L .
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
Antibiotics 2023 Mar;12(3). doi: 10.3390/antibiotics12030491..
Keywords: Children/Adolescents, Antibiotics, Medication, Antimicrobial Stewardship
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
Jindai K, Itaya T, Ogawa Y
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Researchers examined the impact of financial incentives to providers and provider education on overall antimicrobial prescription rates. They also analyzed how nationwide outpatient antimicrobial stewardship interventions in cases where antimicrobials were deemed unnecessary for uncomplicated respiratory infections and acute diarrhea affected different age groups before and after their implementation. The results indicated that prescription rates for all age groups showed a downward trend throughout the study period. Substantial reductions in prescription rates were observed among infants under 2 years, while provider education immediately reduced prescription rates in all age groups uniformly. Interventions did not affect the long-term trend for any age group.
AHRQ-funded; HS027472.
Citation: Jindai K, Itaya T, Ogawa Y .
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):253-59. doi: 10.1017/ice.2022.49..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
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)
Smith SS, Caliendo A, Cheng BT
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
This study examined patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotics for treatment of acute rhinosinusitis (ARS). Nineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL were interviewed. Drivers of antibiotic use were: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. Deterrents included: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. A trustworthy physician’s recommendations for antibiotics were a driver, and a recommendation against antibiotics as well as a delayed antibiotic prescription also served as a deterrent.
AHRQ-funded; HS023011; 233201500020I; HS026506; HS028127.
Citation: Smith SS, Caliendo A, Cheng BT .
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
J Gen Intern Med 2023 Feb; 38(3):683-90. doi: 10.1007/s11606-022-07811-y..
Keywords: Antibiotics, Medication, Respiratory Conditions
Tan MS, Gomez-Lumbreras A, Villa-Zapata L
Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure.
The authors conducted a cohort study using electronic health records comparing encounters with colchicine plus a macrolide and colchicine with an antibiotic non-macrolide, then assessed the relationship between the two groups. They found that heart failure was more frequent in the colchicine plus a macrolide cohort and that there was also a higher mortality rate. As there is a significant increase in the risk of hepatic failure and mortality when colchicine is concomitantly administered with a macrolide, they concluded that colchicine should not be used concomitantly with these antibiotics or should be temporarily discontinued to avoid toxic levels of colchicine.
AHRQ-funded; HS025984.
Citation: Tan MS, Gomez-Lumbreras A, Villa-Zapata L .
Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure.
Rheumatol Int 2022 Dec;42(12):2253-59. doi: 10.1007/s00296-022-05201-5..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Risk, Antibiotics, Medication: Safety, Patient Safety
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C .
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial and Ethnic Minorities, Practice Patterns, Medication
Guzman A, Brown T, Lee JY
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Researchers assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Classifying all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis, they concluded that ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. They further indicated that programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.
AHRQ-funded; HS024930.
Citation: Guzman A, Brown T, Lee JY .
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Antibiotics 2022 Nov 4;11(11). doi: 10.3390/antibiotics11111554..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Practice Patterns
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
Sullivan BA, Panda A, Wallman-Stokes A
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
This study looked at a new tool called the antibiotic spectrum index (ASI) which quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). This index was tested with very low-birth-weight infants (VLBW, <1500g) in 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. The authors calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. The site with the highest DOT per patient days was found to have the lowest ASI per antibiotic days and the site with the highest mortality and infection rates were found to have the highest ASI per antibiotic days. Antibiotic utilization varied by center.
AHRQ-funded; HS026742.
Citation: Sullivan BA, Panda A, Wallman-Stokes A .
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
Infect Control Hosp Epidemiol 2022 Nov;43(11):1553-57. doi: 10.1017/ice.2021.467..
Keywords: Antibiotics, Medication, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Antimicrobial Stewardship
