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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 196 Research Studies Displayed
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C . Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections. JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Keller SC, Caballero TM, Tamma PD
AHRQ Author: Miller MA
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD . Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic. JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW . Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative. JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
Citation: Giesler DL, Krein S, Brancaccio A . Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study. Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Vaughn VM, Hersh AL, Spivak ES
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
In this review, the authors discussed what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge. They introduced an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
Citation: Vaughn VM, Hersh AL, Spivak ES . Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework. Clin Infect Dis 2022 May 3;74(9):1696-702. doi: 10.1093/cid/ciab842..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Hospitals
Butler AM, Durkin MJ, Keller MR
Association of adverse events with antibiotic treatment for urinary tract infection.
The purpose of this study was to compare the risk of relative harms associated with different antibiotics prescribed for the treatment of uncomplicated urinary tract infection (UTI). The researchers identified 1,169,033 healthy, nonpregnant women between the ages of 18 to 44 who had an uncomplicated UTI and who initiated an oral antibiotic regimen for the treatment of common uropathogens between July 2006 and September 2015. The study found that of the two first-line treatments, the drug trimethoprim-sulfamethoxazole (versus nitrofurantoin) was associated with a higher risk of adverse drug-related events including: hypersensitivity, acute renal failure, skin rash, urticaria, abdominal pain, and nausea/ vomiting, but a similar risk of adverse possible microbiome-related events. When researchers compared non-first line drugs with nitrofurantoin, the non-first line drugs were associated with a greater risk of adverse drug events and possible microbiome-related adverse events including non-Clostridium difficile diarrhea, C. difficile infection, vaginitis/vulvovaginal candidiasis, and pneumonia. The duration of the treatment influenced the risk of possible microbiome-related adverse events. The study concluded that the risk of adverse events differs widely by both antibiotic drug and duration of regimen.
Citation: Butler AM, Durkin MJ, Keller MR . Association of adverse events with antibiotic treatment for urinary tract infection. Clin Infect Dis 2022 Apr 28;74(8):1408-18. doi: 10.1093/cid/ciab637..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Adverse Drug Events (ADE), Adverse Events, Clostridium difficile Infections
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
Citation: Chiotos K, Fitzgerald JC, Hayes M . Improving vancomycin stewardship in critically ill children. Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
Citation: Sharara SL, Arbaje AI, Cosgrove SE . The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition. J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Sun DS, Kissler SM, Kanjilal S
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
The purpose of this study was to evaluate the relationship between the seasonal use of 5 classes of antibiotics (penicillins, macrolides, quinolones, tetracyclines, and nitrofurans) and antibiotic resistance across 3 species of bacteria: Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The study found seasonal peaks in use which varied by class, with resistance in all 9 species-antibiotic combinations peaking in the spring and winter. Resistance to all antibiotic classes had the highest correlation with the use of the macrolides and penicillins which were the winter peaking classes. The researchers concluded that antibiotic use strategies will not be equally effective across all species and all antibiotics, but instead selection for resistance across antibiotic classes may be governed by penicillins and macrolides, the most commonly prescribed classes of antibiotics.
Citation: Sun DS, Kissler SM, Kanjilal S . Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance. PLoS Biol 2022 Mar;20(3):e3001579. doi: 10.1371/journal.pbio.3001579..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication
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
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation: Olsen MA, Greenberg JK, Peacock K . Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion. J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords: Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
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
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
Citation: Katz MJ, Tamma PD, Cosgrove SE . Implementation of an antibiotic stewardship program in long-term care facilities across the US. JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Sarfani S, Stone CA, Murphy GA
Understanding penicillin allergy, cross-reactivity, and antibiotic selection in the preoperative setting.
This study provided a review of the prevalence of penicillin allergy label (PAL), the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool were proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.
Citation: Sarfani S, Stone CA, Murphy GA . Understanding penicillin allergy, cross-reactivity, and antibiotic selection in the preoperative setting. J Am Acad Orthop Surg 2022 Jan;30(1):e1-e5. doi: 10.5435/jaaos-d-21-00422..
Keywords: Antibiotics, Medication, Medication: Safety
Li LX, Szymczak JE, Keller SC
Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm.
This article discusses using the core elements for outpatient antibiotic stewardship as a framework for direct-to-consumer (DTC) telemedicine. There is limited scholarship regarding adapting and implementing antibiotic stewardship principles in this setting. The authors discussed utilizing the core elements for outpatient antibiotic stewardship as a framework for efforts moving forward.
Citation: Li LX, Szymczak JE, Keller SC . Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm. J Antimicrob Chemother 2021 Dec 24;77(1):13-15. doi: 10.1093/jac/dkab371..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Telehealth, Health Information Technology (HIT)
Vaughn VM, Gandhi TN, Chopra V
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Antibiotics are commonly prescribed to patients as they leave the hospital. In this study, the investigators aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions. The investigators concluded that antibiotic overuse after discharge was common and varied widely between hospitals.
Citation: Vaughn VM, Gandhi TN, Chopra V . Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis 2020 Dec 6;73(11):e4499-e506. doi: 10.1093/cid/ciaa1372..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Moehring RW, Ashley ESD, Davis AE
Development of an electronic definition for de-escalation of antibiotics in hospitalized patients.
The authors defined antibiotic de-escalation as reduction in either the number of antibiotics or spectrum rank and performed a retrospective study among 5 hospitals. They found that their electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. They suggested that their metric may be useful for assessing stewardship opportunities and impact.
Citation: Moehring RW, Ashley ESD, Davis AE . Development of an electronic definition for de-escalation of antibiotics in hospitalized patients. Clin Infect Dis 2021 Dec 6;73(11):e4507-e14. doi: 10.1093/cid/ciaa932..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Inpatient Care
Goodman KE, Pineles L, Magder LS
Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities.
This study’s goal was to identify comorbidities causally related to appropriate antibiotic use and to compare seven models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. Subjects included adults discharged from Premier Database hospitals in 2016-2017. Findings showed that adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals' utilization rankings.
Citation: Goodman KE, Pineles L, Magder LS . Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities. Clin Infect Dis 2021 Dec 6;73(11):e4484-e92. doi: 10.1093/cid/ciaa1127..
Keywords: Antibiotics, Antimicrobial Stewardship, Hospitals
Sankar A, Swanson KM, Zhou J
Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration.
This study examined the association of black box warnings in 2013 and 2016 with prescribing rates for fluoroquinolone. This cross-sectional study used Medicare fee-for-service beneficiaries and OneKey data on physicians and their organizations from 2011 through 2017. Sample eligibility was restricted to outpatient visits for sinusitis, bronchitis, and uncomplicated urinary tract infections. Prescription rates were compared with the prewarning period (baseline period), before and after the 2013 warning (postwarning period 1), and before and after the 2016 warning (postwarning period 2). The sample consisted of 1,238,397 unique patients with a total of 2,720,071 outpatient acute care visits. The immediate prescribing levels in postwarning period 1 increased by 3.42 percentage points and declined by -0.77 percentage points in postwarning period 2. In postwarning period 1, prescribing levels for physicians who were affiliated with hospitals with a top 10th percentile case mix index compared to those without an affiliation decreased by -1.13 percentage points, whereas the levels for primary care physicians declined by -1.34 percentage points compared with non-primary care physicians in postwarning period 2. Physicians at teaching hospitals were the only clinicians who showed a decline in postwarning period 1.
AHRQ-funded; HS025164; HS025402.
Citation: Sankar A, Swanson KM, Zhou J . Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration. JAMA Netw Open 2021 Dec;4(12):e2136662. doi: 10.1001/jamanetworkopen.2021.36662..
Keywords: Antibiotics, Medication, Practice Patterns
Clark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
Citation: Clark AW, Durkin MJ, Olsen MA . Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection. Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Moehring RW, Yarrington ME, Davis AE
Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation.
The authors investigated expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP) in hospitals. They found that network hospitals increased ASP activities and demonstrated decline in antimicrobial use over the 42-month study period. They concluded that their collaborative, consultative network proved a unique model in which hospitals can access ASP implementation expertise to support long-term program growth.
Citation: Moehring RW, Yarrington ME, Davis AE . Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation. Clin Infect Dis 2021 Nov 2;73(9):1656-63. doi: 10.1093/cid/ciab356..
Keywords: Antimicrobial Stewardship, Antibiotics, Hospitals, Implementation, Medication
Richards AR, Linder JA
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Behavioral economics recognizes that contextual, psychological, social, and emotional factors powerfully influence decision-making. Behavioral economics has the potential to provide a better understanding of, and, through subtle environmental changes, or "nudges," improve persistent quality-of-care challenges, like ambulatory antibiotic overprescribing. In this study, the investigators conducted a Medline search and performed a narrative review that examined the use of behavioral economics to understand the rationale for, and improvement of, ambulatory antibiotic prescribing.
AHRQ-funded; 2332015000201; HS026506; HS028127.
Citation: Richards AR, Linder JA . Behavioral economics and ambulatory antibiotic stewardship: a narrative review. Clin Ther 2021 Oct;43(10):1654-67. doi: 10.1016/j.clinthera.2021.08.004..
Keywords: Antimicrobial Stewardship, Antibiotics, Practice Patterns, Respiratory Conditions
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
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
Citation: Butler AM, Durkin MJ, Keller MR . Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection. Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
Fischer MA, Mahesri M, Lii J
Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018.
Ambulatory antibiotic prescriptions without a clinic visit or without documentation of infection could represent overuse and contribute to adverse outcomes. We aim to describe US ambulatory antibiotic prescribing, including those without an associated visit or infection diagnosis. The investigators conducted an observational cohort study using data of all patients receiving antibacterial, antibiotic prescriptions from 04/01/2016 to 06/30/2018 in a large US private health insurance plan. They concluded that over half of ambulatory antibiotic use was either non-visit-based or non-infection-related.
Citation: Fischer MA, Mahesri M, Lii J . Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018. Open Forum Infect Dis 2021 Sep;8(9):ofab412. doi: 10.1093/ofid/ofab412..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship