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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 8 of 8 Research Studies Displayed
Haessler S, Guo N, Deshpande A
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
This study compared the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP. The definition for sCAP includes a principal diagnosis of pneumonia or a secondary pneumonia diagnosis paired with a principal diagnosis of sepsis or respiratory failure. One-hundred seventy-seven US hospitals within the Premier Healthcare Database were used to identify 154,799 patients with pneumonia, with 14.1% meeting criteria for sCAP. The sCAP patients had higher organ failure scores and inpatient mortality, longer lengths of stay, and higher costs than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures and respiratory cultures and more often had isolates resistant to first-line community-acquired pneumonia antibiotics. The most common pathogen acquired from blood cultures was Streptococcus pneumoniae and from the respiratory tract Staphylococcus aureus and Pseudomonas species. The most common antibiotics prescribed were vancomycin (65%) and piperacillin-tazobactam (42.8%), regardless of cultures positive for a resistant organism.
Citation: Haessler S, Guo N, Deshpande A . Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample. Crit Care Med 2022 Jul;50(7):1063-71. doi: 10.1097/ccm.0000000000005498..
Keywords: Community-Acquired Infections, Pneumonia, Respiratory Conditions, Outcomes
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States.
The purpose of this AHRQ-authored cross-sectional study was to assess whether patients with pneumonia who were admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. The researchers linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS) to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. The MPSMS data included 46,047 patients with pneumonia across 2,590 hospitals discharged from July 1, 2010, through December 31, 2019. For data from 2010 to 2017, analysis was completed from October 2019 through July 2020, and for data from 2018 to 2019 analysis was completed from March through April 2022. The study concluded that readmission rates are associated with the quality of hospital care for pneumonia; patients with pneumonia admitted to hospitals with high all-cause readmission rates had a higher likelihood of developing adverse events during the initial hospitalization.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML . Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States. JAMA Netw Open 2022 May 2;5(5):e2214586. doi: 10.1001/jamanetworkopen.2022.14586..
Keywords: Hospital Readmissions, Hospitals, Adverse Events, Pneumonia, Respiratory Conditions
Bartley PS, Deshpande A, Yu PC
Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes.
Among patients hospitalized for influenza pneumonia, the researchers reported the rate of coinfection and distribution of pathogens and also compared outcomes of patients with and without bacterial coinfection. They found that, in a large US inpatient sample hospitalized with influenza and community-acquired pneumonia, Staphylococcus aureus was the most frequent cause of bacterial coinfection. Coinfection was associated with worse outcomes and higher costs.
Citation: Bartley PS, Deshpande A, Yu PC . Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes. Infect Control Hosp Epidemiol 2022 Feb;43(2):212-17. doi: 10.1017/ice.2021.96..
Keywords: Influenza, Pneumonia, Infectious Diseases, Community-Acquired Infections
Rastogi R, Yu PC, Deshpande A
Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia.
This retrospective cohort study’s objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. Findings showed that patients aged 85 and over have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.
Citation: Rastogi R, Yu PC, Deshpande A . Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia. J Investig Med 2022 Feb;70(2):376-82. doi: 10.1136/jim-2021-002078..
Keywords: Elderly, Community-Acquired Infections, Pneumonia, Outcomes, Hospitalization
Tandan M, Zimmerman S, Sloane PD
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
Pneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ. The investigators concluded that respiratory rate was associated with hospitalization but was not documented for more than a quarter of residents.
Citation: Tandan M, Zimmerman S, Sloane PD . Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes. J Am Med Dir Assoc 2020 Dec;21(12):1862-68.e3. doi: 10.1016/j.jamda.2020.07.028..
Keywords: Elderly, Nursing Homes, Pneumonia, Respiratory Conditions, Hospitalization
Klompas M, Imrey PB, Yu PC
Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia.
Researchers studied the frequency of respiratory viral testing and its associations with antimicrobial utilization in adult patients hospitalized with community-acquired pneumonia. They found that, of patients with pneumonia on admission, 24.5% were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. They concluded that a minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.
AHRQ-funded; HS025008; HS024277.
Citation: Klompas M, Imrey PB, Yu PC . Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia. Infect Control Hosp Epidemiol 2021 Jul;42(7):817-25. doi: 10.1017/ice.2020.1312..
Keywords: Pneumonia, Respiratory Conditions, Antibiotics, Medication
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S . De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes. Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Sabbagh SE, Neely J, Chow A
Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America.
Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. The investigators concluded that having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease.
Citation: Sabbagh SE, Neely J, Chow A . Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America. Rheumatology 2021 Feb;60(2):829-36. doi: 10.1093/rheumatology/keaa436..
Keywords: Children/Adolescents, Pneumonia, Respiratory Conditions, Risk