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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 257 Research Studies DisplayedGrigoryan L, Trautner BW
Antibiotic stewardship interventions for urinary tract infections in outpatient settings: a narrative review.
Antibiotic misuse in treating urinary tract infections (UTIs) in outpatients is widespread, contributing significantly to antibiotic overuse. While multifaceted interventions involving pre- or post-design strategies have shown promise in improving antibiotic use for UTIs, the long-term sustainability of audit and feedback, a common approach, remains uncertain. Future investigations into outpatient antibiotic stewardship for UTIs should focus on assessing both the effectiveness of interventions and the feasibility of their implementation.
AHRQ-funded; HS029489.
Citation: Grigoryan L, Trautner BW .
Antibiotic stewardship interventions for urinary tract infections in outpatient settings: a narrative review.
Infect Dis Clin North Am 2024 Jun; 38(2):277-94. doi: 10.1016/j.idc.2024.03.006..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Ambulatory Care and Surgery
Bardia A, Michel G, Farela A
Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections.
This retrospective observation study examined the association between the 4 components of the Society of Thoracic Surgeons antibiotic guidelines and postoperative complications in a cohort of patients undergoing valve or coronary artery bypass grafting requiring cardiopulmonary bypass. The incidence of nonadherence to the 4 individual components was 7.9% for timing of first dose, 22.6% for antibiotic choice, 5.8% for weight-based dose adjustment, and 6.8% for intraoperative redosing. Failure to adhere to first dose timing guidelines was directly associated with Society of Thoracic Surgeons-adjudicated postoperative infection (odds ratio, 1.9). Failure of weight-adjusted dosing was associated with both postoperative sepsis and 30-day mortality. There were no significant associations among the 4 Society of Thoracic Surgeons metrics individually or as a combination that were observed with postoperative infection, sepsis, or 30-day mortality.
AHRQ-funded; HS029172.
Citation: Bardia A, Michel G, Farela A .
Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections.
J Thorac Cardiovasc Surg 2024 Jun; 167(6):2170-76.e5. doi: 10.1016/j.jtcvs.2023.03.031..
Keywords: Cardiovascular Conditions, Surgery, Antibiotics, Guidelines, Medication
Hechtman RK, Kipnis P, Cano J
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
The objectives of this observational cohort study were to identify patient characteristics associated with greater benefit from shorter time-to-antibiotics. Subjects were patients hospitalized with community-onset sepsis and treated with antimicrobials within 12 hours. The findings indicated that metastatic cancer and shock were associated with the greatest benefit. The researchers concluded that shorter time-to-antibiotics for sepsis is particularly important among patients with these conditions.
AHRQ-funded; HS026725.
Citation: Hechtman RK, Kipnis P, Cano J .
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
Am J Respir Crit Care Med 2024 Apr 1; 209(7):852-60. doi: 10.1164/rccm.202310-1800OC..
Keywords: Antibiotics, Sepsis, Medication
Hasegawa S, Harris CM, Gupta V
Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: a survey and contingent valuation study of hospitalists.
The authors surveyed hospitalists at seven U.S. healthcare systems on their reported practices related to antibiograms and their hypothetical prescribing for four clinical scenarios. The responses showed that only half of the respondents used antibiograms more than monthly. There was no evidence across the four clinical scenarios that antibiogram susceptibility levels influenced antibiotic prescribing practices. The authors concluded that antibiograms may have a limited role in hospitalist care delivery for common gram-negative rod infections.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Harris CM, Gupta V .
Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: a survey and contingent valuation study of hospitalists.
J Hosp Med 2024 Apr; 19(4):297-301. doi: 10.1002/jhm.13303..
Keywords: Antibiotics
Carrel M, Shi Q, Clore GS
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
This study looked at the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial anagrams. A total of 338,681 S. aureus isolates were obtained in Veterans Health Administration (VHA) outpatient settings from 2010 to 2019, and 6,817 isolates were obtained in University of Iowa Hospitals and Clinics outpatient settings from 2014 to 2019. Standard, seasonal, and spatial antibiograms were created for five commonly used antibiotic classes: cephalosporins, clindamycin, macrolides, tetracycline, trimethoprim/sulfamethoxazole. All models were found to have low predictive capacity, with areas under the curve of <0.7.
AHRQ-funded; HS027472.
Citation: Carrel M, Shi Q, Clore GS .
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
Antimicrob Resist Infect Control 2024 Mar 22; 13(1):34. doi: 10.1186/s13756-024-01388-3..
Keywords: Antibiotics, Medication
Szymczak JE, Petty LA, Gandhi TN
Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial.
The purpose of this two-arm parallel cluster-randomized trial study will be to assess the effectiveness of the Reducing Overuse of Antibiotics at Discharge Home multicomponent implementation strategy ("ROAD Home") on antibiotic overuse at discharge for community-acquired pneumonia and urinary tract infection. ROAD Home includes 1) a baseline needs assessment to develop a tailored group of potential stewardship interventions, 2) supported decision-making in selecting interventions for implementation, and 3) external facilitation subsequent to an implementation blueprint. The primary outcome of the study is baseline-adjusted days of antibiotic overuse at discharge. Secondary outcomes include 30-day patient outcomes and antibiotic-associated adverse events. A mixed-methods assessment will evaluate implementation outcomes including acceptability, feasibility, fidelity, and sustainment.
AHRQ-funded; HS029482.
Citation: Szymczak JE, Petty LA, Gandhi TN .
Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial.
Implement Sci 2024 Mar 4; 19(1):23. doi: 10.1186/s13012-024-01348-w..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Tucker KJ, Ham Y, Holmer HK
Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis.
The purpose of this study was to retrospectively evaluate patients receiving vancomycin for possible eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. The researchers evaluated adult patients between August 2017 to July 2018. Of the 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Of the patients receiving vancomycin as first-line therapy, 96.4 % were potentially eligible for beta-lactam prophylaxis.
AHRQ-funded; HS026819.
Citation: Tucker KJ, Ham Y, Holmer HK .
Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis.
Surg Pract Sci 2024 Mar; 16:100232. doi: 10.1016/j.sipas.2023.100232..
Keywords: Surgery, Antibiotics, Medication
De Castro GC, Slatnick LR, Shannon M
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
Researchers abstracted episodes of febrile neutropenia (FN) in pediatric patients with cancer occurring at Vanderbilt Children's Hospital and Colorado Children's Hospital to capture time-to-antibiotic (TTA) metrics and clinical outcomes including major complications. Results showed that only 0.6% of episodes required immediate ICU management, with a median TTA of 28 minutes; for the remaining patients, the median TTA was 56 minutes. TTA was not associated with major nor any other complications in adjusted analysis. The researchers concluded that there was no clear evidence that a reduced TTA improves clinical outcomes in pediatric oncology FN and it should not be used as a primary quality measure.
AHRQ-funded; HS025696.
Citation: De Castro GC, Slatnick LR, Shannon M .
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
JCO Oncol Pract 2024 Feb; 20(2):228-38. doi: 10.1200/op.23.00583..
Keywords: Children/Adolescents, Cancer, Antibiotics, Medication
Ramanathan S, Evans CT, Hershow RC
Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study.
The study aimed to evaluate antibiotic prophylaxis adherence and associated adverse drug events (ADEs) in dental settings. A retrospective cohort study of adults with cardiac conditions or prosthetic joints from 2015 to 2017 was conducted. Of 61,124 patients receiving antibiotic prophylaxis, 62 (0.1%) experienced ADEs. Guideline concordance was not linked to ADEs (adjusted OR: 0.78, 95% CI: 0.25-2.46), and this was consistent across different dental settings.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study.
Front Pharmacol 2024 Jan 16; 15:1249531. doi: 10.3389/fphar.2024.1249531.
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Guidelines, Dental and Oral Health, Practice Patterns
Qureshi N, Kroger J, Zangwill KM
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
The purpose of this study was to assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). The researchers conducted a mixed-methods study of AS perceptions utilizing surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). The study found that pre-OASCN, 24% of respondents believed there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or hesitation to change existing practices. Clinicians reported statistically significant increases in AS importance, perceived AS activity, and more openness to change after OASCN.
AHRQ-funded; HS026168.
Citation: Qureshi N, Kroger J, Zangwill KM .
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
J Perinatol 2024 Jan; 44(1):62-70. doi: 10.1038/s41372-023-01823-0..
Keywords: Antibiotics, Antimicrobial Stewardship, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Donnelly JP, Seelye SM, Kipnis P
Impact of reducing time-to-antibiotics on sepsis mortality, antibiotic use, and adverse events.
Researchers estimated benefits and harms of shortened time-to-antibiotics for sepsis. Their simulation study used a cohort of over 1.5 million hospitalizations via emergency department with more than two systemic inflammatory response syndrome criteria. The results showed that impacts of faster time-to-antibiotics for sepsis varied markedly across simulated hospital types; however, even in worst-case scenarios, new antibiotic-associated adverse events were rare.
AHRQ-funded; HS026725.
Citation: Donnelly JP, Seelye SM, Kipnis P .
Impact of reducing time-to-antibiotics on sepsis mortality, antibiotic use, and adverse events.
Ann Am Thorac Soc 2024 Jan; 21(1):94-101. doi: 10.1513/AnnalsATS.202306-505OC..
Keywords: Antibiotics, Medication, Sepsis, Mortality
Liu S, Matvekas A, Naimi T
Morphomics-informed population pharmacokinetic and physiologically-based pharmacokinetic modeling to optimize cefazolin surgical prophylaxis.
This study’s objective was to use algorithms that repurpose radiologic data into body composition (morphomics) to aid in informing dosing decisions for the antibiotic cefazolin for patients undergoing colorectal surgery who have obesity. This prospective study measured cefazolin plasma, fat, and colon tissue concentrations in these patients to develop a morphomics-informed population pharmacokinetic (PopPK) model to guide dose adjustments. A physiologically-based pharmacokinetic (PBPK) model was also constructed to inform tissue partitioning in 21 morbidly obese patients (body mass index ≥35 kg/m2 with one or more co-morbid conditions). Morphomics and pharmacokinetic data were available in 58 patients with a median weight of 95.9 kg and and 55 years, respectively. The plasma-to-subcutaneous fat partition coefficient was predicted to be 0.072 for the PopPK model and 0.060 for the PBPK model. Covariates of cefazolin exposure were identified as the estimated creatinine clearance (eCL(cr) ) and body depth at the third lumbar vertebra (body depth_L3). The authors concluded that kidney function and morphomics were more informative than body weight as covariates of cefazolin target site exposure. They advised that data from more diverse populations, consensus on target cefazolin exposure, and comparative studies are needed before a change in practice can be implemented.
AHRQ-funded; HS027183.
Citation: Liu S, Matvekas A, Naimi T .
Morphomics-informed population pharmacokinetic and physiologically-based pharmacokinetic modeling to optimize cefazolin surgical prophylaxis.
Pharmacotherapy 2024 Jan; 44(1):77-86. doi: 10.1002/phar.2878..
Keywords: Surgery, Antibiotics, Medication, Prevention, Obesity, Healthcare-Associated Infections (HAIs)
Zhang 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
Flannery DD, Zevallos Barboza A, Mukhopadhyay S
Antibiotic use among infants admitted to neonatal intensive care units.
The purpose of this cross-sectional study was to examine antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the U.S. Data for almost 1.4 million infants were taken from the Premier Healthcare Database. The most common antibiotics prescribed during the study period were ampicillin, gentamicin, vancomycin, and cefotaxime. Antibiotic use declined substantially over time, primarily because of reductions in ampicillin and gentamicin. The authors noted that these findings probably reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies; shortage and subsequent discontinuation of cefotaxime may have played a role in the sharp decline in its use and the related increase in ceftazidime use.
AHRQ-funded; HS027468.
Citation: Flannery DD, Zevallos Barboza A, Mukhopadhyay S .
Antibiotic use among infants admitted to neonatal intensive care units.
JAMA Pediatr 2023 Dec; 177(12):1354-56. doi: 10.1001/jamapediatrics.2023.3664..
Keywords: Newborns/Infants, Antibiotics, Medication, Intensive Care Unit (ICU), Critical Care
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)
Pak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
Ramanathan S, Yan CH, Hubbard C
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Dentists are the top specialty prescriber of antibiotics in the United States, prescribing 10% of all outpatient antibiotics. The purpose of this retrospective study was to assess trends in the rates of antibiotic prescribing by dentists. The researchers also evaluated if trends varied by agent, specialty, and patient characteristics. The study found that between 2012 and 2019 dentists wrote more than 216 million antibiotic prescriptions. The annual rate of dental antibiotic prescribing remained steady over time. However, the dental prescribing rate increased in the Northeast, among oral and maxillofacial surgeons, prosthodontists, endodontists, periodontists, and for amoxicillin. The mean days' supply significantly decreased over the study period by 0.023 days per 1,000 dentists per year.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Yan CH, Hubbard C .
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1725-30. doi: 10.1017/ice.2023.151..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Dental and Oral Health
Keith A, Jenkins TC, O'Leary S
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
The objective of the planned study described in this article will be to evaluate two low-cost interventions to increase guideline-concordant antibiotic durations in children with acute otitis media (AOM). The authors will explore differences in implementation effectiveness by patient population, clinician type, clinical setting, and organization as well as by intervention type. They will also conduct formative qualitative interviews with clinicians and administrators and focus groups with the parents of patients. The results of the study will provide a framework for healthcare systems to address the problem of excessive durations of therapy for AOM and to inform national antibiotic stewardship policy development.
AHRQ-funded; HS029153.
Citation: Keith A, Jenkins TC, O'Leary S .
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
J Comp Eff Res 2023 Nov; 12(11):e230088. doi: 10.57264/cer-2023-0088..
Keywords: Children/Adolescents, Antibiotics, Medication, Ear Infections
Ojala F, Sater MRA, Miller LG
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
The authors analyzed how the persistence of methicillin-resistant Staphylococcus aureus (MRSA) colonization correlates with the genomic presence of antibiotic resistance genes. Using a Bayesian mixed effects survival model, they found that genetic determinants of high-level resistance to mupirocin was strongly associated with failure of the decolonization protocol, but they did not find a similar effect with genetic resistance to chlorhexidine or other antibiotics. They concluded that these results highlight the need to consider the properties of the colonizing MRSA strain when deciding which treatments to include in the decolonization protocol.
AHRQ-funded; HS019388.
Citation: Ojala F, Sater MRA, Miller LG .
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
PLoS Comput Biol 2023 Oct; 19(10):e1010898. doi: 10.1371/journal.pcbi.1010898..
Keywords: Antibiotics, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Medication
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).
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
Brown T, Lee JY, Guzman A
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
This retrospective cohort study examined the prevalence and appropriateness of all ambulatory antibiotic prescribing in an integrated health delivery system in the United States. The authors looked at prescribing at in-person visits and not-in-person visits (e.g. telephone, refills). Prescribing was divided into the following 5 appropriateness groups: 1) chronic antibiotic use; 2) antibiotic-appropriate; 3) potentially antibiotic-appropriate; 4) non-antibiotic-appropriate; and 5) not associated with a diagnosis. Over the 4-year study period, there were 714,057 antibiotic prescriptions ordered for 348,739 unique patients by 2,391 clinicians in 467 clinics with a patient population with a mean age of 41 years, 61% female and 78% White. Clinicians were mostly women (58%); were 78% physicians; and of those physicians were 42% primary care, 39% medical specialists, and 12% surgical specialists. The vast majority (81%) of antibiotics were prescribed at in-person visits, and 19% were not in-person visits (10% telephone, 5% orders only, and 3% refill encounters). Prescribing appropriateness was divided into 16% for chronic use, 15% antibiotic-appropriate, 39% potentially antibiotic-appropriate, 22% non-antibiotic-appropriate, and 8% not associated with a diagnosis. Prescription of antibiotics not-in-person were more likely to be chronic (20% versus 15%); less likely to be associated with appropriate or potentially appropriate diagnoses (30% versus 59%) or non-antibiotic-appropriate diagnoses (8% versus 25%); and more likely to be associated with no diagnosis (42% versus <1%).
AHRQ-funded; HS024930.
Citation: Brown T, Lee JY, Guzman A .
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
PLoS One 2023 Jul 27; 18(7):e0289303. doi: 10.1371/journal.pone.0289303..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery
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