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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 37 Research Studies DisplayedRamanathan S, Evans CT, Hershow RC
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
The objective of this retrospective study was to compare prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-VA settings. Subjects were veteran and non-veteran dental patients with cardiac conditions or prosthetic joints; most were males aged 55 years older. The results showed that VA settings had a higher prevalence of guideline concordant prescribing among those with prosthetic joints, and when assessing dosing errors. The authors recommended that future studies focus on the extent to which integrated electronic health records may be responsible for increased guideline concordant prescribing in the VA setting.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
BMC Infect Dis 2023 Jun 23; 23(1):427. doi: 10.1186/s12879-023-08400-y..
Keywords: Dental and Oral Health, Antibiotics, Medication, Prevention, Cardiovascular Conditions, Practice Patterns
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 and Ethnic Minorities, Practice Patterns, Medication
Guzman A, Brown T, Lee JY
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Researchers assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Classifying all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis, they concluded that ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. They further indicated that programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.
AHRQ-funded; HS024930.
Citation: Guzman A, Brown T, Lee JY .
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Antibiotics 2022 Nov 4;11(11). doi: 10.3390/antibiotics11111554..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Practice Patterns
Warren DK, Peacock KM, Nickel KB
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
The authors investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). They found that anti-methicillin-sensitive Staphylococcus aureus antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. They concluded that the high numbers needed to treat suggest that potential benefits of post-discharge antibiotics should be weighed against potential harms associated with antibiotic overuse.
AHRQ-funded; HS019455.
Citation: Warren DK, Peacock KM, Nickel KB .
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
Infect Control Hosp Epidemiol 2022 Oct;43(10):1382-88. doi: 10.1017/ice.2021.400..
Keywords: Antibiotics, Cancer: Breast Cancer, Cancer, Medication, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Women, Practice Patterns
Cuellar A, Pomeroy JML, Burla S
Quality of antibiotic prescribing in a large direct-to-patient telehealth program: an observational study.
This study looked at the quality of antibiotic prescribing in direct-to-patient (DTP) telehealth visits compared to primary care visits, retail clinics, urgent care, or emergency department (ED). Claims were examined for 2,400,198 visits who were continually enrolled with a large national health insurer during 2016-2017 and treated for acute respiratory infection (ARI), or for women uncomplicated UTI. For streptococcal pharyngitis, the authors further measured whether a culture or rapid Group A Streptococcus test was done. Antibiotic prescription management for ARIs and UTIs was guideline-concordant comparable between televisits and several other settings. Patients with pharyngitis who received antibiotics were less likely to receive rapid Strep testing for televisits compared with primary care, retail clinics, urgent care, and EDs.
AHRQ-funded; HS025163.
Citation: Cuellar A, Pomeroy JML, Burla S .
Quality of antibiotic prescribing in a large direct-to-patient telehealth program: an observational study.
J Gen Intern Med 2022 Sep;37(12):3202-04. doi: 10.1007/s11606-021-07354-8..
Keywords: Antibiotics, Medication, Telehealth, Health Information Technology (HIT), Practice Patterns
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
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.
AHRQ-funded; HS019455.
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
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
Hubbard CC, Evans CT, Calip GS
Characteristics associated with opioid and antibiotic prescribing by dentists.
The objective of this study was to identify county-level characteristics that may be high-impact targets for opioid and antibiotic interventions to improve dental prescribing. The investigators concluded that dental prescribing of opioids was decreasing, whereas dental antibiotic prescribing was increasing. High prescribing of antibiotics was associated with high prescribing of opioids. The investigators suggested that strategies focused on optimizing dental antibiotics and opioids are needed given their impact on population health.
AHRQ-funded; HS025177.
Citation: Hubbard CC, Evans CT, Calip GS .
Characteristics associated with opioid and antibiotic prescribing by dentists.
Am J Prev Med 2021 May;60(5):648-57. doi: 10.1016/j.amepre.2020.11.017..
Keywords: Antibiotics, Opioids, Medication, Practice Patterns
Szymczak JE, Keller SC, Linder JA
"I never get better without an antibiotic": antibiotic appeals and how to respond.
In this paper, the investigators present various scenarios in which patients who do not meet guideline criteria for antibiotic prescribing, appeal to clinicians for antibiotics. The authors discuss the issue of antiobiotic appeals and provide examples of responses for clinicians. They suggest that clinicians should acquire a stock of responses to these appeals grounded in the latest evidence about antibiotics.
AHRQ-funded; 233201500020I; HS026506; HS025782.
Citation: Szymczak JE, Keller SC, Linder JA .
"I never get better without an antibiotic": antibiotic appeals and how to respond.
Mayo Clin Proc 2021 Mar;96(3):543-46. doi: 10.1016/j.mayocp.2020.09.031..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinician-Patient Communication, Communication, Practice Patterns
Truitt KN, Brown T, Lee JY
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
The proportion of sinusitis visits that meet antibiotic prescribing criteria is unknown. In this cross-sectional study the authors investigated the appropriateness of antibiotic prescribing for acute sinusitis in primary care. The investigators found that of 425 randomly selected sinusitis visits, 50% met antibiotic prescribing criteria.
AHRQ-funded; HS024930; 233201500020I; HS026506.
Citation: Truitt KN, Brown T, Lee JY .
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
Clin Infect Dis 2021 Jan 15;72(2):311-14. doi: 10.1093/cid/ciaa736..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Primary Care, Respiratory Conditions, Practice Patterns
Coleman DT, Stone CA, Wei WQ
Penicillin allergy labels drive perioperative prophylactic antibiotic selection in orthopedic procedures.
This retrospective chart review was conducted to study prophylactic antibiotic selection in patients with penicillin allergy labels (PALs) during and after orthopedic surgical procedures. Generally, PALs are associated with surgical site infections (SSIs). Most orthopedic surgeries use a first-generation cephalosporin such as cefazolin due to decreased costs and lower SSI rates. PAL surgical patients more often receive vancomycin and clindamycin over cefazolin for concern of penicillin and cephalosporin cross-reactivity. This study used iterative natural language processing (NLP) and manual chart review to examine Vanderbilt University Medical Center’s deidentified patient data. Perioperative antibiotic selection data were available to review for 9300 surgeries, of whom 1412 (15.2%) were patients with PALs. Surgeries in patients with PALs used cefazolin less frequently than patients without PALs, and were more frequently prescribed clindamycin. PALs patients were more frequently female and white. The first pull with NLP found a much larger number of cases where non-PAL patients used clindamycin than expected. However, after manual chart review, 550 of these cases were found to be patients with PALS who had PAL free-text inputs missed by their initial NLP protocol.
AHRQ-funded; HS026395.
Citation: Coleman DT, Stone CA, Wei WQ .
Penicillin allergy labels drive perioperative prophylactic antibiotic selection in orthopedic procedures.
J Allergy Clin Immunol Pract 2020 Nov-Dec;8(10):3634-36e1. doi: 10.1016/j.jaip.2020.07.007..
Keywords: Antibiotics, Medication, Surgery, Practice Patterns
Ramly E, Tong M, Bondar S
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, the investigators analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. They found that such strategies included structured information tools, nurse and prescriber education, and organizational improvement.
AHRQ-funded; HS022465.
Citation: Ramly E, Tong M, Bondar S .
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
J Am Geriatr Soc 2020 Oct;68(10):2222-31. doi: 10.1111/jgs.16632..
Keywords: Workflow, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Antimicrobial Stewardship, Practice Patterns
Malone SM, Seigel NS, Newland JG
Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
The objective of this study was to understand the factors that contribute to pediatric surgeons' decisions regarding the use of perioperative antibiotic prophylaxis. The investigators found that surgeons described a complex set of factors that impacted their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices.
AHRQ-funded; HS026742.
Citation: Malone SM, Seigel NS, Newland JG .
Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
Infect Control Hosp Epidemiol 2020 Jun;41(6):666-71. doi: 10.1017/ice.2020.71..
Keywords: Children/Adolescents, Antibiotics, Surgery, Antimicrobial Stewardship, Medication, Practice Patterns
Fischer MA, Mahesri M, Lii J
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
This study examined antibiotic prescribing by clinicians when there was no visit or without clear indications for use. The authors discuss the fact that current ambulatory antibiotic stewardship policies do not capture prescribing outside of clinician visits or clear indications for use. They measured the frequency for all filled antibiotic prescriptions in Medicaid patients in the period 2004-2013. They found that out of 298 million antibiotic fills for 53 million patients (62% for children), 55% were for clinician visits with an infection-related diagnosis, 17% were for visits without an infection-related diagnosis, and 28% were not associated with a visit.
AHRQ-funded; HS024930; HS023236; HS024651; HS026506; 2332015000201.
Citation: Fischer MA, Mahesri M, Lii J .
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
Health Aff 2020 Feb;39(2):280-88. doi: 10.1377/hlthaff.2019.00545..
Keywords: Antimicrobial Stewardship, Medicaid, Antibiotics, Medication, Practice Patterns, Children/Adolescents
Chiotos K, Rock C, Schweizer ML
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
This survey compares results with a similar 2013 survey that characterizes contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities. There was decreased frequency of active surveillance for MRSA, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
AHRQ-funded; HS026393.
Citation: Chiotos K, Rock C, Schweizer ML .
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
Infect Control Hosp Epidemiol 2019 Sep;40(9):1046-49. doi: 10.1017/ice.2019.172.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Practice Patterns
Yarrington ME, Anderson DJ, Dodds Ashley E
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
This study’s objective was the quantify the effect of the 2016 FDA “black box” update on the use of fluoroquinolone antibiotics among a cohort of southeastern US hospitals. Fluoroquinolone was given a black box warning after many serious adverse events were reported. Antibiotic use data from 29 southeastern US hospitals over a 5-year period was analyzed. Fluoroquinolone use declined both and before after the FDA advisory update in 2016.
AHRQ-funded; HS023866.
Citation: Yarrington ME, Anderson DJ, Dodds Ashley E .
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1297-300. doi: 10.1017/ice.2019.247..
Keywords: Antibiotics, Medication, Practice Patterns, Healthcare Utilization, Hospitals, Adverse Drug Events (ADE), Adverse Events
Gong CL, Zangwill KM, Hay JW
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
Researchers sought to determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). Provider education on guidelines for the appropriate ARI treatment is compared with suggested alternatives, which use computerized clinical decision support to suggest non-antibiotic treatment choices; accountable justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and peer comparison. The authors concluded that behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
AHRQ-funded; HS019913.
Citation: Gong CL, Zangwill KM, Hay JW .
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
J Gen Intern Med 2019 Jun;34(6):846-54. doi: 10.1007/s11606-018-4467-x..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Practice Patterns, Healthcare Costs, Respiratory Conditions
Sick-Samuels AC, Woods-Hill CZ, Fackler JC
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
The goal of this study was to evaluate whether the use of antibiotics at the Johns Hopkins pediatric intensive care unit (PICU) changed in relation to a reduction in utilization of blood culture. Antibiotic usage is used as a balancing measure, because a reduction in blood cultures could lead to an increase in antibiotic treatment if clinicians continued treatment in scenarios when blood culture results were not available. The authors examined the administration of antibiotics over 12 months while a locally developed blood-culture guideline was being implemented. The distribution of antibiotics remained similar over the pre- and post-implementation periods.
AHRQ-funded; HS025642.
Citation: Sick-Samuels AC, Woods-Hill CZ, Fackler JC .
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
Infect Control Hosp Epidemiol 2019 Apr;40(4):482-84. doi: 10.1017/ice.2019.10..
Keywords: Antibiotics, Children/Adolescents, Intensive Care Unit (ICU), Medication, Practice Patterns
Morgan JR, Carey KM, Barlam TF
Inappropriate antibiotic prescribing for acute bronchitis in children and impact on subsequent episodes of care and treatment.
This study examined whether inappropriate prescribing of antibiotics to treat an initial bout of acute bronchitis in childhood can increase the likelihood of further episodes and also more antibiotic prescribing. A retrospective analysis of children with at least 1 acute bronchitis episode was conducted for the period 2008 to 2015. The cohort was children born in 2008. Results showed that children who were prescribed an antibiotic as part of their initial episode were more likely to have a subsequent acute bronchitis episode and also to be prescribed an antibiotic compared with children who were not prescribed it as part of their treatment in their first episode.
AHRQ-funded; HS022242.
Citation: Morgan JR, Carey KM, Barlam TF .
Inappropriate antibiotic prescribing for acute bronchitis in children and impact on subsequent episodes of care and treatment.
Pediatr Infect Dis J 2019 Mar;38(3):271-74. doi: 10.1097/inf.0000000000002117..
Keywords: Antibiotics, Children/Adolescents, Medication, Practice Patterns
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
This editorial viewpoint discusses structured approaches that emphasize the four critical time points (‘Moments’) in the process of antibiotic prescribing, and which may improve antibiotic decisionmaking by clinicians and communication about antibiotic decisions among health care practitioners. AHRQ’s Safety Program for Improving Antibiotic Use is highlighted, since it features the training of clinicians to incorporate the ‘4 moments’ of antibiotic decisionmaking into their thought processes when prescribing antibiotics. The 4 moments are described and an example provided for each. The authors conclude that an organized approach such as the 4 moments of antibiotic decisionmaking could be helpful if it is used every time antibiotic therapy is considered.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
JAMA 2019 Jan;321(2):139-40. doi: 10.1001/jama.2018.19509..
Keywords: Antibiotics, Decision Making, Medication, Patient Safety, Practice Patterns
Mundkur ML, Franklin J, Huybrechts KF
Changes in outpatient use of antibiotics by adults in the United States, 2006-2015.
The two goals of this observational study were to describe general trends in outpatient antibiotic use among adults from 2006 to 2015, and to identify rapid shifts in use during this time period as potential indicators for key events. Patients aged 18 years and older were selected from the Optum Clinformatics Datamart, a commercial insurance claims database; linear regression was used to identify trends in use over multiple years, and change-point regression was used to identify rapid shifts in use within individual years. Outpatient use of antibiotics from 2006 to 2015 decreased substantially among adults. Rapid shifts in use occurring in 2008 and 2013 may reflect the presence of key drivers of change.
AHRQ-funded; HS024930; 233201500020I.
Citation: Mundkur ML, Franklin J, Huybrechts KF .
Changes in outpatient use of antibiotics by adults in the United States, 2006-2015.
Drug Saf 2018 Dec;41(12):1333-42. doi: 10.1007/s40264-018-0697-4..
Keywords: Antibiotics, Healthcare Utilization, Medication, Practice Patterns
Durkin MJ, Keller M, Butler AM
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). This study assessed whether the CPG had an impact on national antibiotic prescribing practices. The study found that CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs.
AHRQ-funded; HS019455.
Citation: Durkin MJ, Keller M, Butler AM .
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
Open Forum Infect Dis 2018 Sep;5(9):ofy198. doi: 10.1093/ofid/ofy198..
Keywords: Antibiotics, Decision Making, Guidelines, Practice Patterns, Urinary Tract Infection (UTI)
Hume PS, Varon J, Englert JA
Trends in "usual care" for septic shock.
The investigators examined changes in treatment patterns for septic shock in the emergency department (ED) of a large academic hospital. The investigators observed, from 2003 to 2013, significant reductions in time to antibiotics and fluids for patients with septic shock in the ED, underscoring the evolution of “usual care” over time. These findings may explain why early goal-directed therapy is not beneficial in the current era and may help inform ongoing deliberations regarding best practices for sepsis care.
AHRQ-funded; HS025008.
Citation: Hume PS, Varon J, Englert JA .
Trends in "usual care" for septic shock.
Infect Control Hosp Epidemiol 2018 Sep;39(9):1125-26. doi: 10.1017/ice.2018.154..
Keywords: Antibiotics, Emergency Department, Practice Patterns, Sepsis