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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 18 of 18 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
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
Haessler S, Lindenauer PK, Zilberberg MD
Blood cultures versus respiratory cultures: 2 different views of pneumonia.
This study examined characteristics and outcomes of patients with positive cultures for pneumonia by site. The authors compared results from blood and respiratory cultures to see if organisms and resistance patterns differed by site. They studied adult patients discharged from July 2010 to June 2015 with principal diagnoses of pneumonia, respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia. Out of 138,651 hospitalizations of patients with pneumonia, 9.3% yielded positive cultures with 6438 from respiratory culture and 5992 blood cultures, and 45 both respiratory and blood cultures. Isolates from respiratory samples were often more resistant than were isolates from blood. Patients with positive cultures in both sites had higher case-fatality, longer lengths of stay and higher costs than patients who only had one culture site positive. Among respiratory cultures, the most common pathogens identified were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%).
Citation: Haessler S, Lindenauer PK, Zilberberg MD . Blood cultures versus respiratory cultures: 2 different views of pneumonia. Clin Infect Dis 2020 Oct 23;71(7):1604-12. doi: 10.1093/cid/ciz1049..
Keywords: Pneumonia, Community-Acquired Infections, Respiratory Conditions, Infectious Diseases
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
Citation: Joshi RP, Pejaver V, Hammarlund NE . A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results. J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, COVID-19, Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality, Clinical Decision Support (CDS)
Thomson J, Hall M, Ambroggio L
Antibiotics for aspiration pneumonia in neurologically impaired children.
The objective of the study was to compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). The investigators concluded that anaerobic therapy appeared to be important in the treatment of aspiration pneumonia in children with NI. They suggested that while Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.
Citation: Thomson J, Hall M, Ambroggio L . Antibiotics for aspiration pneumonia in neurologically impaired children. J Hosp Med 2020 Jul;15(7):395-402. doi: 10.12788/jhm.3338..
Keywords: Children/Adolescents, Pneumonia, Respiratory Conditions, Neurological Disorders, Antibiotics, Medication, Outcomes
Higgins TL, Deshpande A, Zilberberg MD
Assessment of the accuracy of using ICD-9 diagnosis codes to identify pneumonia etiology in patients hospitalized with pneumonia.
Researchers assessed the validity of ICD-9 organism-specific administrative codes for pneumonia using microbiological data as the criterion standard, using data from 178 US hospitals in the Premier Healthcare Database. They found that, in this study, ICD-9 codes did not reliably capture pneumonia etiology identified by laboratory testing; because of the high specificities of ICD-9 codes, however, administrative data may be useful in identifying risk factors for resistant organisms. The low sensitivities of the diagnosis codes may limit the validity of organism-specific pneumonia prevalence estimates derived from administrative data.
AHRQ-funded; HS024277, HS025026.
Citation: Higgins TL, Deshpande A, Zilberberg MD . Assessment of the accuracy of using ICD-9 diagnosis codes to identify pneumonia etiology in patients hospitalized with pneumonia. JAMA Netw Open 2020 Jul;3(7):e207750. doi: 10.1001/jamanetworkopen.2020.7750.
Keywords: Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality
Abreo A, Wu P, Donovan BM
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
This study looked at infant respiratory syncytial virus (RSV) bronchiolitis and its association with increased odds of pneumonia, otitis media, and antibiotic utilization in infants 7-12 months. The data suggested the potential value of future RSV vaccination programs on subsequent respiratory health.
Citation: Abreo A, Wu P, Donovan BM . Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization. Clin Infect Dis 2020 Jun 24;71(1):211-14. doi: 10.1093/cid/ciz1033..
Keywords: Newborns/Infants, Antibiotics, Medication, Respiratory Conditions, Pneumonia
Glick AF, Tomopoulos S, Fierman AH S, Tomopoulos AH
AHRQ Author: Elixhauser A
Association between outdoor air pollution levels and inpatient outcomes in pediatric pneumonia hospitalizations, 2007 to 2008.
Pneumonia is a leading cause of pediatric admissions. Although air pollutants are associated with poor outcomes, few national studies have examined associations between pollutant levels and inpatient pediatric pneumonia outcomes. In this study, the investigators examined the relationship between ozone (O3) and fine particulate matter with a diameter </=2.5 microm (PM2.5) and outcomes related to disease severity. They concluded that greater levels of O3 and PM2.5 were associated with more severe presentations of pneumonia.
Citation: Glick AF, Tomopoulos S, Fierman AH S, Tomopoulos AH . Association between outdoor air pollution levels and inpatient outcomes in pediatric pneumonia hospitalizations, 2007 to 2008. Acad Pediatr 2019 May - Jun;19(4):414-20. doi: 10.1016/j.acap.2018.12.001..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Pneumonia, Respiratory Conditions, Hospitalization, Outcomes
Wiese AD, Griffin MR, Grijalva CG
Impact of pneumococcal conjugate vaccines on hospitalizations for pneumonia in the United States.
In this study, the investigators described the existing evidence for both the direct and indirect impact of Pneumococcal conjugate vaccines (PCVs) on pneumonia among children and adults in the US since PCV introduction. The introduction of PCVs into the US routine infant vaccination schedule led to important reductions in the burden of invasive pneumococcal diseases and non-invasive pneumonia among vaccinated and unvaccinated populations. The impact of direct vaccination of older adults in the US since 2014, though difficult to quantify, is currently being evaluated.
Citation: Wiese AD, Griffin MR, Grijalva CG . Impact of pneumococcal conjugate vaccines on hospitalizations for pneumonia in the United States. Expert Rev Vaccines 2019 Apr;18(4):327-41. doi: 10.1080/14760584.2019.1582337..
Keywords: Vaccination, Pneumonia, Respiratory Conditions, Hospitalization, Prevention
Eisler L, Huang G, Lee KM
Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data.
This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source. The investigators found that International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone.
Citation: Eisler L, Huang G, Lee KM . Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data. Paediatr Anaesth 2018 Mar;28(3):218-25. doi: 10.1111/pan.13319..
Keywords: Adverse Events, Children/Adolescents, Data, Pneumonia, Respiratory Conditions
Brodsky MB, Suiter DM, Gonzalez-Fernandez M
Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis.
This study evaluated screening accuracy of bedside water swallow tests used to identify patients at risk for dysphagia-associated aspiration, finding that currently-used tests offer sufficient screening.
Citation: Brodsky MB, Suiter DM, Gonzalez-Fernandez M . Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis. Chest 2016 Jul;150(1):148-63. doi: 10.1016/j.chest.2016.03.059.
Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Pneumonia
Self WH, Williams DJ, Zhu Y
Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia.
The researchers conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. They concluded that the probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus.
Citation: Self WH, Williams DJ, Zhu Y . Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia. J Infect Dis 2016 Feb 15;213(4):584-91. doi: 10.1093/infdis/jiv323.
Keywords: Children/Adolescents, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Walkey AJ, Weinberg J, Wiener RS
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
The researchers evaluated the effect of analytic approaches accounting for do-not-resuscitate (DNR) status on risk-adjusted hospital mortality rates and performance rankings. They found that after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality.
Citation: Walkey AJ, Weinberg J, Wiener RS . Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia. JAMA Intern Med 2016 Jan;176(1):97-104. doi: 10.1001/jamainternmed.2015.6324.
Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Kelly MS, Smieja M, Luinstra K
Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana.
The authors examined whether detection of respiratory viruses predicts acute lower respiratory tract infection (ALRI) outcomes in low- and middle-income countries. They found that respiratory viruses were detected from most children hospitalized with ALRI in Botswana, but only respiratory syncytial virus (RSV) and human metapneumovirus were more frequent than among children without ALRI. Further, detection of RSV from children with ALRI predicted a protracted illness course but lower mortality compared with non-RSV viruses.
Citation: Kelly MS, Smieja M, Luinstra K . Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana. PLoS One 2015 May 14;10(5):e0126593. doi: 10.1371/journal.pone.0126593.
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Pneumonia, Respiratory Conditions
Sore throat: avoid overcomplicating the uncomplicated.
In this editorial, the author described issues involving sore throat diagnosis and delineated various points concerning an article within the same journal issue, concluding that physicians should remember that the prevalence of group A streptococcus in adults with a sore throat is approximately 10%; and that they should use the Centor scoring criteria; selectively use rapid antigen-detection testing; limit antibiotic treatment to patients most likely to have group A streptococcus; and most of the time when prescribing antibiotics, use penicillin.
Citation: Linder JA . Sore throat: avoid overcomplicating the uncomplicated. Ann Intern Med 2015 Feb 17;162(4):311-2. doi: 10.7326/m14-2899.
Keywords: Antibiotics, Diagnostic Safety and Quality, Infectious Diseases, Medication, Pneumonia, Respiratory Conditions, Practice Patterns