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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.

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1 to 9 of 9 Research Studies Displayed
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..
View abstract on the National Library of Medicine site.
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Strobel RJ, Harrington SD, Hill C
Evaluating the impact of pneumonia prevention recommendations after cardiac surgery.
Pneumonia is the most prevalent healthcare-associated infection after coronary artery bypass grafting (CABG), but the relative effectiveness of strategies to reduce its incidence remains unclear. In this study, the investigators evaluated the relationship between healthcare-associated infection recommendations and risk of pneumonia after CABG. These pneumonia prevention recommendations may serve as effective targets for avoiding postoperative healthcare-associated infections.
AHRQ-funded; HS022535; HS022909.
Citation: Strobel RJ, Harrington SD, Hill C . Evaluating the impact of pneumonia prevention recommendations after cardiac surgery. Ann Thorac Surg 2020 Sep;110(3):903-10. doi: 10.1016/j.athoracsur.2019.12.053..
View abstract on the National Library of Medicine site.
Keywords: Pneumonia, Cardiovascular Conditions, Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Prevention, Evidence-Based Practice, Guidelines, Risk
Asti L, Bartsch SM, Umscheid CA
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Researchers developed a decision model to determine the economic and clinical value of using sputum cultures in the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) from the hospital perspective under various conditions. They found that, overall, obtaining sputum cultures does not provide significant clinical or economic benefits for CAP or HCAP patients; however, it can reduce costs and shorten overall length of stay under some circumstances. They recommended that clinicians consider their local conditions when making decisions about sputum culture use.
AHRQ-funded; HS023317.
Citation: Asti L, Bartsch SM, Umscheid CA . The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia. Clin Microbiol Infect 2019 Aug;25(8):1038.e1-38.e9. doi: 10.1016/j.cmi.2018.11.031..
View abstract on the National Library of Medicine site.
Keywords: Pneumonia, Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Healthcare Costs, Clinical Decision Support (CDS), Decision Making
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ . Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
View abstract on the National Library of Medicine site.
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Haessler S, Lagu T, Lindenauer PK
Treatment trends and outcomes in healthcare-associated pneumonia.
This retrospective cohort study assessed changes in hospital rates of concordant antibiotic use over time and their correlation with outcomes related to management of healthcare-associated pneumonia (HCAP). The study concluded that only 1 in 5 patients with risk factors for HCAP received treatment that was fully in accordance with guidelines, and many received community-acquired pneumonia (CAP) therapy instead.
AHRQ-funded; HS018723.
Citation: Haessler S, Lagu T, Lindenauer PK . Treatment trends and outcomes in healthcare-associated pneumonia. J Hosp Med 2017 Nov;12(11):886-91. doi: 10.12788/jhm.2877..
View abstract on the National Library of Medicine site.
Keywords: Antibiotics, Elderly, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Pneumonia
Boltey E, Yakusheva O, Costa DK
5 nursing strategies to prevent ventilator-associated pneumonia.
This article reviews the top five evidence-based nursing practices for reducing ventilator-associated pneumonia (VAP) risk in critically ill adults.
AHRQ-funded; HS024552.
Citation: Boltey E, Yakusheva O, Costa DK . 5 nursing strategies to prevent ventilator-associated pneumonia. Am Nurse Today 2017 Jun;12(6):42-43..
View abstract on the National Library of Medicine site.
Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Nursing, Prevention, Pneumonia
Diehl A, Yang T, Speck K
AHRQ Author: Battles J
Evaluating the accuracy of sampling strategies for estimation of compliance rate for ventilator-associated pneumonia process measures.
The researchers evaluated the accuracy of sampling strategies to estimate monthly compliance rates with ventilator-associated pneumonia prevention measures. They concluded that sampling process measures intermittently rather than continually can yield accurate estimates of process measure performance rates.
AHRQ-authored; AHRQ-funded; 290201000027I; 29032002T.
Citation: Diehl A, Yang T, Speck K . Evaluating the accuracy of sampling strategies for estimation of compliance rate for ventilator-associated pneumonia process measures. Infect Control Hosp Epidemiol 2016 Sep;37(9):1037-43. doi: 10.1017/ice.2016.136.
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View abstract on the National Library of Medicine site.
Keywords: Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Pneumonia, Quality Improvement, Quality Measures
Ali KJ, Farley DO, Speck K
Measurement of implementation components and contextual factors in a two-state healthcare quality initiative to reduce ventilator-associated pneumonia.
The authors sought to develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention of ventilator-associated pneumonia (VAP) in a two-state collaborative. They found that a relatively small number of barriers were found to have important negative effects on implementation progress, including barriers related to workload and time issues. They modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified.
AHRQ-funded; 290201000027I.
Citation: Ali KJ, Farley DO, Speck K . Measurement of implementation components and contextual factors in a two-state healthcare quality initiative to reduce ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S116-23. doi: 10.1086/677832.
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View abstract on the National Library of Medicine site.
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Pneumonia, Prevention, Quality Improvement
Rothberg MB, Haessler S, Lagu T
Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?
The researchers sought to determine the contribution of healthcare-associated pneumonia (HCAP) criteria to case-fatality rate. They found that, after adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than community-acquired pneumonia, possibly due to HCAP organisms or to HCAP criteria themselves.
AHRQ-funded; HS018723.
Citation: Rothberg MB, Haessler S, Lagu T . Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients? Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S107-15. doi: 10.1086/677829.
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View abstract on the National Library of Medicine site.
Keywords: Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Mortality, Patient-Centered Outcomes Research, Pneumonia

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