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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 25 of 113 Research Studies Displayed
Flannery DD, Puopolo KM, Hansen NI
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
This retrospective review examined antimicrobial susceptibility of infants ≥22 weeks' gestation who were cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptibility was defined as intermediate or resistant on treatment results. The authors identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data was available for 79.1% of isolates. All 81 Gram-positive isolates with ampicillin and gentamicin were susceptible in vitro. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 76.6% isolates were nonsusceptible to ampicillin, 8.5% nonsusceptible to gentamicin, and 7.3% isolates were nonsusceptible to both. The authors estimated that overall 8% of EOS cases were caused by isolates nonsceptible to ampicillin and gentamicin and were most likely to occur among preterm, very-low birth weight infants.
Citation: Flannery DD, Puopolo KM, Hansen NI . Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens. Pediatr Infect Dis J 2022 Mar;41(3):263-71. doi: 10.1097/inf.0000000000003380..
Keywords: Newborns/Infants, Sepsis, Antibiotics, Medication
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
Citation: Flannery DD, Mukhopadhyay S, Morales KH . Delivery characteristics and the risk of early-onset neonatal sepsis. Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Menon K, Schlapbach LJ, Akech S
Criteria for pediatric sepsis-a systematic review and meta-analysis by the Pediatric Sepsis Definition Taskforce.
This meta-analysis conducted by the Pediatric Sepsis Definition Taskforce determined the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with sepsis, severe sepsis, or septic shock in children with infection; and multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock. Criteria for included studies were case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms "sepsis," "septicemia," or "septic shock" in the title or abstract. One hundred and six studies met eligibility criteria of which 81 were included. Sixteen studies provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies for the mortality outcome. Significant and consistent associations with mortality were demonstrated in children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score.
Citation: Menon K, Schlapbach LJ, Akech S . Criteria for pediatric sepsis-a systematic review and meta-analysis by the Pediatric Sepsis Definition Taskforce. Crit Care Med 2022 Jan;50(1):21-36. doi: 10.1097/ccm.0000000000005294..
Keywords: Children/Adolescents, Sepsis, Evidence-Based Practice
Alrawashdeh M, Klompas M, Kimmel S
Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals.
This study examined the epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals from January 2009 to September 2015. This retrospective cohort study looked at about 373 hospitals with a total of 6,715,286 hospitalizations. Using ICD-9 CM codes, 5.6% had sepsis, 1.9% had opioid-related hospitalizations, and 0.1% had both. Patients hospitalized with both diagnoses were younger and healthier, had more bloodstream infections from Gram-positive and fungal pathogens, and had lower in-hospital mortality rates. Of 1,803 patients with opioid-related hospitalizations who died in-hospital, 51.5% had sepsis. From 2009 to 2015, the proportion of sepsis hospitalizations that were opioid-related increased by 77%.
Citation: Alrawashdeh M, Klompas M, Kimmel S . Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals. Crit Care Med 2021 Dec;49(12):2102-11. doi: 10.1097/ccm.0000000000005141..
Keywords: Sepsis, Opioids, Hospitalization
Greenwald E, Olds E, Leonard J
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
The authors sought to describe the rate of guideline-concordant care, and hypothesized that guideline-concordant care in community pediatric emergency care settings would be associated with decreased hospital length of stay (LOS). They found that guideline-concordant care was not associated with hospital LOS. The elements that drove overall concordance were timely recognition, vascular access, and timely antibiotics. Emergency care for pediatric sepsis in the community settings studied was concordant with guidelines in only 24% of the cases. They recommended future study to evaluate additional drivers of outcomes and ways to improve sepsis care in community emergency care settings.
Citation: Greenwald E, Olds E, Leonard J . Pediatric sepsis in community emergency care settings: guideline concordance and outcomes. Pediatr Emerg Care 2021 Dec;37(12):e1571-e77. doi: 10.1097/pec.0000000000002120..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Guidelines, Evidence-Based Practice
Krutsinger DC, Yadav KN, Harhay MO
A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals.
This systematic review and meta-analysis looked at enrollment rates for randomized controlled trials (RCTs) conducted in the ICU, with the focus on patients with acute respiratory distress syndrome (ARDS), acute lung injury (ALI), or sepsis, and which factors influenced enrollment rates. The authors conducted a systematic review using PubMed for ARD/ALI and sepsis to identify individually published RCTs among the seven highest impact general medicine and seven highest impact critical care journals between 2009 and 2019. A total of 457 articles were identified, with 94 trials meeting inclusion criteria. Trials most commonly evaluated were pharmaceutical interventions (53%), were non-industry funded (78%), and required prospective informed consent (81%). The overall enrollment rate was less than 1 participant per site per month, with single-center trials having a significantly higher enrollment rate than multicenter trials. Enrollment for sepsis trials was almost twice the rate as ARDS/ALI.
Citation: Krutsinger DC, Yadav KN, Harhay MO . A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals. Crit Care 2021 Nov 15;25(1):392. doi: 10.1186/s13054-021-03804-1..
Keywords: Sepsis, Respiratory Conditions
Flannery DD, Edwards EM, Puopolo KM
Early-onset sepsis among very preterm infants.
The purpose of this study was to determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants. Findings showed that, in a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Further, three-quarters of all infected infants either died or survived with a major medical morbidity. Recommendations included the need for novel preventive strategies.
Citation: Flannery DD, Edwards EM, Puopolo KM . Early-onset sepsis among very preterm infants. Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2021-052456..
Keywords: Newborns/Infants, Sepsis
Han X, Spicer A, Carey KA
Identifying high-risk subphenotypes and associated harms from delayed antibiotic orders and delivery.
Delayed antibiotic use can cause harms including mortality in certain novel patient subphenotypes. This study’s objective was to characterize and compare patients who experienced order or delivery delays and identify those novel subphenotypes with elevated risk of harm from delays. Two tertiary care medical centers and four community-based hospitals were analyzed retrospectively from 2008 to 2017. Patient demographics, vitals, laboratory values, medical order and administration times, and in-hospital survival data were obtained from their electronic health records. Order and delivery delays for each admission was calculated. Causal forests, a machine learning method, was used to identify the high-risk subgroup. Out of 60,817 admissions included, delays occurred in 58% of patients. Each additional hour of order delay and delivery delay was associated with increased mortality. A patient subgroup was identified with higher comorbidity burden, greater organ dysfunction, and abnormal initial lactate measures that had a higher risk of death associated with delays.
AHRQ-funded; HS027910; HS026151.
Citation: Han X, Spicer A, Carey KA . Identifying high-risk subphenotypes and associated harms from delayed antibiotic orders and delivery. Crit Care Med 2021 Oct;49(10):1694-705. doi: 10.1097/ccm.0000000000005054..
Keywords: Antibiotics, Medication, Sepsis
Page B, Klompas M, Chan C
Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.
US hospitals are required by the Centers for Medicare and Medicaid Services to publicly report central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioidesdiffficile, methicillin-resistant Staphylococcus aureus bacteremia, and selected surgical site infections for benchmarking and pay-for-performance programs. In this study the investigators retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015-June 2018 in 3 hospitals.
Citation: Page B, Klompas M, Chan C . Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions. Clin Infect Dis 2021 Sep 15;73(6):1013-19. doi: 10.1093/cid/ciab217..
Keywords: Sepsis, Healthcare-Associated Infections (HAIs), Hospitals, Clostridium difficile Infections, Catheter-Associated Urinary Tract Infection (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA), Central Line-Associated Bloodstream Infections (CLABSI)
Gigli KH, Rak KJ, Hershey TB
A roadmap for successful state sepsis regulations-lessons from New York.
This study looked at the reasons why New York State’s 2013 sepsis regulations were successful in improving mortality compared to less successful sepsis policies at the federal level. The authors recruited thirteen key stakeholders from three groups including four New Year State policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York State sepsis regulations, as well as two members of patient advocacy groups. The group identified themes related to participant perceptions of the sepsis policy, factors that influenced the policy’s perceived successes, and opportunities for improvement. A major factor that created early buy-in was engaging a diverse array of stakeholders in the development of the policy. Policymakers also worked to provide a balance between the desire for comprehensive reporting and the burden of data collection. The regulations also touched on all three major domains of sepsis quality: structure, process, and outcomes.
Citation: Gigli KH, Rak KJ, Hershey TB . A roadmap for successful state sepsis regulations-lessons from New York. Crit Care Explor 2021 Sep;3(9):e0521. doi: 10.1097/cce.0000000000000521..
Keywords: Sepsis, Policy
Garcia MA, Rucci JM, Thai KK
Association between troponin I levels during sepsis and postsepsis cardiovascular complications.
This study examined whether there is an association between elevated serum troponin levels and increased risk for postsepsis cardiovascular complications in patients who had been admitted for sepsis without preexisting cardiovascular disease within 5 years in adults 40 years and older. The patients were admitted with sepsis across 21 hospitals from 2011 to 2017. Peak serum troponin I levels during sepsis were grouped as normal, or tertiles of abnormal from a low of 0.04 to 0.43 ng/ml. Among 14,046 eligible adults, 10.9% had normal troponin levels, as compared to 17.3% at tertile 1, 17.6% at tertile 2, and 20.3% at tertile 3. Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events.
Citation: Garcia MA, Rucci JM, Thai KK . Association between troponin I levels during sepsis and postsepsis cardiovascular complications. Am J Respir Crit Care Med 2021 Sep 1;204(5):557-65. doi: 10.1164/rccm.202103-0613OC..
Keywords: Sepsis, Cardiovascular Conditions, Risk
Mohr NM, Campbell KD, Swanson MB
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provider telemedicine and adherence with sepsis bundle components in rural community hospitals. The investigators found that telemedicine patients were more likely to receive initial blood lactate measurement, timely broad-spectrum antibiotics, and adequate fluid resuscitation.
Citation: Mohr NM, Campbell KD, Swanson MB . Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments. J Telemed Telecare 2021 Sep;27(8):518-26. doi: 10.1177/1357633x19896667..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Sepsis
Wayne MT, Seelye S, Molling D
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. The purpose of this study was to examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. The investigators concluded that this cohort study found that time-to-antibiotics for sepsis has declined over time. However, there remained significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment.
Citation: Wayne MT, Seelye S, Molling D . Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis. JAMA Netw Open 2021 Sep 4(9):e2123950. doi: 10.1001/jamanetworkopen.2021.23950..
Keywords: Sepsis, Veterans
Lasater KB, Sloane DM, McHugh MD
Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes.
Despite nurses' responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, the investigators estimated the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients' odds of in-hospital and 60-day mortality, readmission, and length of stay.
Citation: Lasater KB, Sloane DM, McHugh MD . Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. Am J Infect Control 2021 Jul;49(7):868-73. doi: 10.1016/j.ajic.2020.12.002..
Keywords: Sepsis, Nursing, Provider: Nurse, Inpatient Care, Hospitals
Barbash IJ, Davis BS, Yabes JG
Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1).
This study evaluated the effect of Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) on treatment patterns and patient outcomes. Findings showed that, two years after its implementation, SEP-1 was associated with variable changes in process measures, with the greatest effect being an increase in lactate measurement within 3 hours of sepsis onset. There were small increases in antibiotic administration and fluid administration, a small increase in ICU admissions, and no changes in mortality or discharge to home.
Citation: Barbash IJ, Davis BS, Yabes JG . Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1). Ann Intern Med 2021 Jul;174(7):927-35. doi: 10.7326/m20-5043..
Keywords: Sepsis, Medicare, Outcomes, Quality Measures, Quality of Care
Masonbrink AR, Harris M, Hall M
Safety events in children's hospitals during the COVID-19 pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. The objective of this study was to compare pediatric hospitalization safety events during the pandemic versus previous years. The investigators concluded that postoperative sepsis rates increased among children hospitalized during COVID-19. They suggest that efforts are needed to improve safety of postoperative care for hospitalized children.
AHRQ-funded; HS024554; HS024592.
Citation: Masonbrink AR, Harris M, Hall M . Safety events in children's hospitals during the COVID-19 pandemic. Hosp Pediatr 2021 Jun;11(6):e95-e100. doi: 10.1542/hpeds.2020-004937..
Keywords: Children/Adolescents, COVID-19, Patient Safety, Sepsis, Adverse Events, Hospitalization, Hospitals, Inpatient Care, Infectious Diseases, Public Health
Cifra CL, Westlund E, Ten Eyck P
An estimate of missed pediatric sepsis in the emergency department.
Citation: Cifra CL, Westlund E, Ten Eyck P . An estimate of missed pediatric sepsis in the emergency department. Diagnosis 2021;8(2):193-98. doi: 10.1515/dx-2020-0023..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Risk
Michelson KA, Williams DN, Dart AH
Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis.
This study’s objective was to create a guide for objectively grading the likelihood of delayed diagnosis of appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis. Case vignettes were constructed for each condition and then presented to expert Delphi panels for review. In each vignette, the patient had a previous emergency department visit within 7 days of the delayed diagnosis. The panels graded the likelihood of a delayed diagnosis on a five-point scale. Consensus was achieved within three Delphi rounds for all appendicitis and sepsis vignettes, and 77% of DKA vignettes. The authors created a case review guide from the consensus scores that will aid researchers and quality improvement specialists in objective case review to determine if delayed diagnosis had occurred for those three conditions.
Citation: Michelson KA, Williams DN, Dart AH . Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis. Diagnosis 2021;8(2):219-25. doi: 10.1515/dx-2020-0035..
Keywords: Diagnostic Safety and Quality, Sepsis, Medical Errors, Adverse Events, Patient Safety
Paul R, Niedner M, Brilli R
Metric development for the multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative.
A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes (IPSO), has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites. This paper describes the metric development for the multicenter IPSO Collaborative.
Citation: Paul R, Niedner M, Brilli R . Metric development for the multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative. Pediatrics 2021 May;147(5):e2020017889. doi: 10.1542/peds.2020-017889..
Keywords: Children/Adolescents, Sepsis, Quality Improvement, Quality of Care, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Milstone AM, Rosenberg C, Yenokyan G
Alcohol-impregnated caps and ambulatory central-line-associated bloodstream infections (CLABSIs): a randomized clinical trial.
The purpose of this study was to evaluate the effect of 70% isopropyl alcohol-impregnated central venous catheter caps on ambulatory central-line-associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients. Findings showed that isopropyl alcohol-impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures.
Citation: Milstone AM, Rosenberg C, Yenokyan G . Alcohol-impregnated caps and ambulatory central-line-associated bloodstream infections (CLABSIs): a randomized clinical trial. Infect Control Hosp Epidemiol 2021 Apr;42(4):431-39. doi: 10.1017/ice.2020.467..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Sepsis, Children/Adolescents, Prevention
Downer B, Pritchard K, Thomas KS
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
This study looked at the association between recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. This retrospective cohort study identified 59,383 Medicare beneficiaries who were admitted to an SNF within 3 days of discharge from hospitalization that included time in an ICU for sepsis from all of 2013 to October 2015. About 58% of SNF residents showed improvement in ADL function. The higher the improvement in ADL score the less the mortality risk compared to residents who did not improve.
Citation: Downer B, Pritchard K, Thomas KS . Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis. J Am Geriatr Soc 2021 Apr;69(4):938-45. doi: 10.1111/jgs.16915..
Keywords: Elderly, Nursing Homes, Medicare, Sepsis, Mortality, Outcomes
Wayne MT, Molling D, Wang XQ
Measurement of sepsis in a national cohort using three different methods to define baseline organ function.
In 2017, the U.S. Centers for Disease Control and Prevention (CDC) developed a new surveillance definition of sepsis, the adult sepsis event (ASE), to better track sepsis epidemiology. The objective of this study was to understand how sepsis identification and outcomes differed when using the best laboratory values during hospitalization versus methods that used historical lookbacks to define baseline organ function.
Citation: Wayne MT, Molling D, Wang XQ . Measurement of sepsis in a national cohort using three different methods to define baseline organ function. Ann Am Thorac Soc 2021 Apr;18(4):648-55. doi: 10.1513/AnnalsATS.202009-1130OC..
Keywords: Sepsis, Diagnostic Safety and Quality
Kuye I, Anand V, Klompas M
Prevalence and clinical characteristics of patients with sepsis discharge diagnosis codes and short lengths of stay in U.S. hospitals.
The authors investigated the prevalence and clinical characteristics of patients diagnosed with sepsis in order to provide insight into how sepsis diagnoses are being applied as well as the breadth of illnesses encompassed by current sepsis definitions. In their study, they found that one in 10 patients who coded for sepsis were discharged alive within 3 days. Although most short-stay patients met systemic inflammatory response syndrome criteria, they met Sepsis-3 criteria less than half the time. These findings underscore the incomplete uptake of Sepsis-3 definitions, the breadth of illness severities encompassed by both traditional and new sepsis definitions, and the possibility that some patients with sepsis recover very rapidly.
Citation: Kuye I, Anand V, Klompas M . Prevalence and clinical characteristics of patients with sepsis discharge diagnosis codes and short lengths of stay in U.S. hospitals. Crit Care Explor 2021 Mar;3(3):e0373. doi: 10.1097/cce.0000000000000373..
Keywords: Sepsis, Hospitalization
Kadri SS, Lai YL, Warner S
Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals.
Researchers sought to establish the population-level burden, predictors, and mortality risk of in-vitro susceptibility-discordant empirical antibiotic therapy among patients with bloodstream infections. They found that approximately one in five patients with bloodstream infections in US hospitals received discordant empirical antibiotic therapy, receipt of which was closely associated with infection with antibiotic-resistant pathogens. Receiving discordant empirical antibiotic therapy was associated with increased odds of mortality overall, even in patients without sepsis. They concluded that early identification of bloodstream pathogens and resistance will probably improve population-level outcomes.
Citation: Kadri SS, Lai YL, Warner S . Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals. Lancet Infect Dis 2021 Feb;21(2):241-51. doi: 10.1016/s1473-3099(20)30477-1..
Keywords: Antibiotics, Medication, Sepsis, Antimicrobial Stewardship, Mortality, Risk
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
In this paper, the authors describe The Four Moments of Antibiotic Decision Making. The Four Moments were conceived as part of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use. The Four Moments provide a pragmatic approach to the core principle of antibiotic stewardship – ensuring patients who require antibiotic therapy promptly receive regimens associated with clinical success, while protecting patients from potential harm associated with unnecessary exposure to antibiotics.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE . Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help. Ann Am Thorac Soc 2021 Feb;18(2):200-03. doi: 10.1513/AnnalsATS.202005-484IP..
Keywords: Sepsis, Antibiotics, Antimicrobial Stewardship, Medication, Decision Making, Medication: Safety, Patient Safety