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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Children/Adolescents (2)
- Clostridium difficile Infections (1)
- Community-Acquired Infections (5)
- Elderly (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- Medication (3)
- Neurological Disorders (1)
- Nursing Homes (1)
- (-) Pneumonia (8)
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- Respiratory Conditions (5)
- Risk (1)
- Surgery (1)
- Urinary Tract Infection (UTI) (1)
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 8 of 8 Research Studies DisplayedChen Z, Gleason LJ, Konetzka RT
Accuracy of infection reporting in US nursing home ratings.
The objective of this study was to assess the accuracy of publicly reported nursing home data on urinary tract infections (UTIs) and of pneumonia data, which are not publicly reported. Researchers developed a claims-based nursing home-level measure of hospitalized infections and estimated correlations between this and publicly reported ratings. Subjects were Medicare fee-for-service beneficiaries who were nursing home residents and hospitalized for UTI or pneumonia during the study period. Findings suggested that both UTI and pneumonia were substantially underreported in data used for national public reporting. The researchers concluded that alternative approaches were needed to improve surveillance of nursing home quality.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Konetzka RT .
Accuracy of infection reporting in US nursing home ratings.
Health Serv Res 2023 Oct; 58(5):1109-18. doi: 10.1111/1475-6773.14195..
Keywords: Provider Performance, Nursing Homes, Long-Term Care, Pneumonia, Urinary Tract Infection (UTI), Elderly
Deshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Metersky ML, Wang Y, Klompas M
Temporal trends in postoperative and ventilator-associated pneumonia in the United States.
The purpose of this retrospective cohort study was to assess change in rates of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the United States during 2009-2019. The study found that among 58,618 patients undergoing major surgical procedures between 2009 and 2019, the observed rate of postoperative pneumonia from 2009-2011 was 1.9% and decreased to 1.3% during 2017-2019. The adjusted annual risk each year, compared to the prior year, was 0.94. Among 4,007 patients hospitalized for any of the 4 conditions at risk for ventilator-associated pneumonia during 2009-2019, the researchers did not detect a significant change in observed or adjusted rates. Observed rates clustered around 10%, and adjusted annual risk compared to the prior year was 0.99.
AHRQ-funded; 290201800005C.
Citation: Metersky ML, Wang Y, Klompas M .
Temporal trends in postoperative and ventilator-associated pneumonia in the United States.
Infect Control Hosp Epidemiol 2023 Aug; 44(8):1247-54. doi: 10.1017/ice.2022.264..
Keywords: Pneumonia, Respiratory Conditions, Healthcare-Associated Infections (HAIs), Healthcare Cost and Utilization Project (HCUP)
Deshpande A, Klompas M, Guo N
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
The purpose of this retrospective cohort study was to examine clinical practice guidelines which recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. The researchers conducted a study of adults admitted with CAP from 2010 through 2015 and initially treated with IV antibiotics at 642 US hospitals. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. The study found that of 78,041 CAP patients, 6% were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a greater mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, less than 15% of very low-risk patients were switched early.
AHRQ-funded; HS029477; HS025026.
Citation: Deshpande A, Klompas M, Guo N .
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
Clin Infect Dis 2023 Jul 26; 77(2):174-85. doi: 10.1093/cid/ciad196..
Keywords: Antibiotics, Community-Acquired Infections, Pneumonia, Respiratory Conditions, Medication
Geanacopoulos AT, Neuman MI, Lipsett SC
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
This study’s objective was to evaluate the association of performing a chest radiograph (CXR) with 7-day hospitalization after emergency department (ED) discharge among pediatric patients with community-acquired pneumonia (CAP). This retrospective cohort study included 206,694 children aged 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. Secondary outcomes included 7-day ED revisits and a 7-day hospitalization with severe CAP. Among these children diagnosed with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs 1.7%). CXR performance varied somewhat between EDs (median 91.5%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%), ED revisits (8.5% vs 9.4%), and hospitalizations for severe CAP (0.3% vs 0.5%) as compared to EDs with the lowest quartile of CXR utilization.
AHRQ-funded; HS026503.
Citation: Geanacopoulos AT, Neuman MI, Lipsett SC .
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
Hosp Pediatr 2023 Jul; 13(7):614-23. doi: 10.1542/hpeds.2023-007142..
Keywords: Children/Adolescents, Imaging, Pneumonia, Respiratory Conditions, Community-Acquired Infections
Rothberg MB, Haessler S, Deshpande A
Derivation and validation of a risk assessment model for drug-resistant pathogens in hospitalized patients with community-acquired pneumonia.
The purpose of this study was to develop and validate a model for risk of resistance to first-line community-acquired pneumonia (CAP) therapy. The study was conducted using data for adults hospitalized for CAP from 177 Premier Healthcare database hospitals and 11 Cleveland Clinic hospitals. The study found that among 138,762 eligible patients in the Premier database, 8.8% had positive cultures and 3.8% had organisms resistant to CAP therapy. The strongest predictor of resistance was infection with a resistant organism in the previous year. Markers of acute illness such as receipt of mechanical ventilation or vasopressors, and chronic illness such as pressure ulcer or paralysis were also related with resistant infections. The study model outperformed the Drug Resistance in Pneumonia (DRIP) model in the Premier holdout sample, the Cleveland Clinic hospitals sample. Clinicians at Premier facilities utilized broad-spectrum antibiotics for 20%-30% of their patients. In discriminating between patients with and without resistant infections, physician judgment slightly outperformed the DRIP instrument but not the study model.
AHRQ-funded; HS024277.
Citation: Rothberg MB, Haessler S, Deshpande A .
Derivation and validation of a risk assessment model for drug-resistant pathogens in hospitalized patients with community-acquired pneumonia.
Infect Control Hosp Epidemiol 2023 Jul; 44(7):1143-50. doi: 10.1017/ice.2022.229..
Keywords: Community-Acquired Infections, Pneumonia, Risk
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Patel P, Deshpande A, Yu PC
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
The purpose of this study was to explore the relationships between the antibiotic regimens of empiric therapy with a respiratory fluoroquinolone or cephalosporin plus macrolide combination and the development of hospital-onset Clostridioides difficile infection (CDI). The researchers used data from 638 United States hospitals and included adults admitted with pneumonia and discharged from July 2010 through June 2015 with a pneumonia diagnosis code who received 3 or more days of either antibiotic regimen. The study sample included 58,060 patients treated with either cephalosporin plus macrolide (36,796 patients) or a fluoroquinolone alone (21,264 patients). 0.35% of patients who received cephalosporin plus macrolide and 0.31% who received a fluoroquinolone developed CDI, making CDI risks similar for fluoroquinolones versus cephalosporin plus macrolide.
AHRQ-funded; HS024277.
Citation: Patel P, Deshpande A, Yu PC .
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
Infect Control Hosp Epidemiol 2023 Jan; 44(1):47-54. doi: 10.1017/ice.2022.60..
Keywords: Pneumonia, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Medication, Infectious Diseases, Community-Acquired Infections