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Search All Research Studies
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- Ambulatory Care and Surgery (1)
- Antibiotics (12)
- (-) Antimicrobial Stewardship (16)
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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 16 of 16 Research Studies DisplayedVaughn VM, Gandhi T, Petty LA
Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with COVID-19: a multi-hospital cohort study.
A randomly sampled cohort of 1705 patients hospitalized with COVID-19 was used. Data was collected on early empiric antibacterial therapy within 2 days of hospitalization, empiric antibacterial therapy and community-onset bacterial co-infections. Of the 1705 patients, 56.6% were prescribed early empiric antibacterial therapy, with 3.5% having a confirmed community-onset bacterial infection. Use varied across hospitals, ranging from 27% to 84%. Patients were more likely to receive the therapy if they were older, had more severe illness, had a lobar infiltrate, or were admitted to a for-profit hospital. Over the one-month period empiric antibacterial use decreased.
AHRQ-funded; HS026530; HS026725.
Citation: Vaughn VM, Gandhi T, Petty LA .
Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with COVID-19: a multi-hospital cohort study.
Clin Infect Dis 2021 May 18;72(10):e533-e41. doi: 10.1093/cid/ciaa1239..
Keywords: COVID-19, Infectious Diseases, Community-Acquired Infections, Antimicrobial Stewardship, Antibiotics, Medication, Hospitalization
Schimmel JJ, Haessler S, Imrey P
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
The Infectious Disease Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown. The authors conducted this retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010-2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes.
AHRQ-funded; HS024277.
Citation: Schimmel JJ, Haessler S, Imrey P .
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
Clin Infect Dis 2020 Sep 12;71(6):1427-34. doi: 10.1093/cid/ciz983..
Keywords: Antimicrobial Stewardship, Community-Acquired Infections, Infectious Diseases, Pneumonia
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
Anderson DJ, Watson S, Moehring RW
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Watson S, Moehring RW .
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Hospitals, Infectious Diseases, Medication, Patient Safety
Smith TC, Davis MF, Heaney CD
Pig movement and antimicrobial use drive transmission of livestock-associated staphylococcus aureus CC398.
Staphylococcus aureus was originally considered a hospital-associated organism, but new classes of methicillin-resistant strains have emerged outside of the hospital setting, including among livestock. This article discusses a recent study which examined the transportation of pigs on over 200 farms; the authors of this article contend that the results of the study demonstrate the importance of cooperation between occupational health services, genomics, veterinary medicine, and farmers in understanding the epidemiology of MRSAs as related to livestock.
AHRQ-funded; HS019966.
Citation: Smith TC, Davis MF, Heaney CD .
Pig movement and antimicrobial use drive transmission of livestock-associated staphylococcus aureus CC398.
MBio 2018 Dec 11;9(6). doi: 10.1128/mBio.02459-18..
Keywords: Antimicrobial Stewardship, Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety, Prevention
Kline SE, Sanstead EC, Johnson JR
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
In this study, the investigators developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. The investigators predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, they concluded that because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
AHRQ-funded; HS022912.
Citation: Kline SE, Sanstead EC, Johnson JR .
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1340-46. doi: 10.1017/ice.2018.228..
Keywords: Surgery, Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Healthcare Costs
Kadri SS, Adjemian J, Lai YL
Difficult-to-treat resistance in gram-negative bacteremia at 173 US hospitals: retrospective cohort analysis of prevalence, predictors, and outcome of resistance to all first-line agents.
Resistance to all first-line antibiotics necessitates the use of less effective or more toxic "reserve" agents. In this study, the Premier Database was analyzed for inpatients with select Gram-negative bloodstream infections (GNBSIs). Prevalence and aminoglycoside resistance of difficult-to-treat resistance (DTR) episodes were compared with carbapenem-resistant, extended-spectrum cephalosporin-resistant, and fluoroquinolone-resistant episodes using CDC definitions. The investigators concluded that nonsusceptibility to first-line antibiotics was associated with decreased survival in GNBSIs. They suggest that DSR is a simple bedside prognostic measure of treatment-limiting coresistance.
AHRQ-funded; HS025008.
Citation: Kadri SS, Adjemian J, Lai YL .
Difficult-to-treat resistance in gram-negative bacteremia at 173 US hospitals: retrospective cohort analysis of prevalence, predictors, and outcome of resistance to all first-line agents.
Clin Infect Dis 2018 Nov 28;67(12):1803-14. doi: 10.1093/cid/ciy378..
Keywords: Antibiotics, Antimicrobial Stewardship, Infectious Diseases
Michener A, Heath B, Crnich CJ
Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship.
This article describes the results of a series of 1-hour case-based discussions on recognition, diagnosis, and infections common in older adults, including those living in long-term care settings, and antibiotic stewardship that were developed by the authors. This series of five discussions was held at 15 Veterans Affairs medical centers in their skilled nursing centers. There were participants from an array of disciplines who completed an evaluation as well as pre- and post-course knowledge assessment. Total participants numbered from 68 to 108 per center. There were positive assessments, with many participants saying they were likely to make changes to help combat health associated infections.
AHRQ-funded; HS023866.
Citation: Michener A, Heath B, Crnich CJ .
Infections in older adults: a case-based discussion series emphasizing antibiotic stewardship.
MedEdPORTAL 2018 Sep 21;14:10754. doi: 10.15766/mep_2374-8265.10754..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Elderly, Infectious Diseases
Morgan JR, Barlam TF, Drainoni ML
A qualitative study of the real-world experiences of infectious diseases fellows regarding antibiotic stewardship.
A qualitative study was performed to explore infectious disease (ID) fellows' experiences and perspectives regarding their antibiotic stewardship training and their role as future antibiotic stewards. The investigators concluded that ID fellowship training was not successfully conveying the public health importance of antibiotic stewardship or the role of ID physicians as leaders of antibiotic stewardship programs. They noted that fellows were more focused on concrete tasks related to stewardship.
AHRQ-funded; HS022242.
Citation: Morgan JR, Barlam TF, Drainoni ML .
A qualitative study of the real-world experiences of infectious diseases fellows regarding antibiotic stewardship.
Open Forum Infect Dis 2018 Sep;5(9):ofy102. doi: 10.1093/ofid/ofy102..
Keywords: Antibiotics, Antimicrobial Stewardship, Education: Continuing Medical Education, Infectious Diseases
Kline SE, Neaton JD, Lynfield R
Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.
The objective of this study was to determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home. The investigators concluded that an outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).
AHRQ-funded; HS022912.
Citation: Kline SE, Neaton JD, Lynfield R .
Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.
Infect Control Hosp Epidemiol 2018 Sep;39(9):1049-57. doi: 10.1017/ice.2018.151..
Keywords: Antimicrobial Stewardship, Infectious Diseases, Patient Self-Management, Prevention, Surgery, Patient Safety
Johnson SP, Zhong L, Chung KC
Perioperative antibiotics for clean hand surgery: a national study.
This research is a national study on the use of prophylactic antibiotics in soft tissue hand surgery when antimicrobials are not indicated. Insurance claims from the Truven MarketScan Databases were used to identify patients who had 1 of 5 outpatient surgery procedures including: open or endoscopic carpal tunnel release; trigger finger release; de Ouervain release, and wrist ganglion excision between 2009 and 2015. An increase of 72.5% in prophylactic intravenous antibiotics was shown from 2009 to 2015. Patients with a younger age, male sex, lower income, or obesity had higher odds of receiving antibiotics. Total charge for these antibiotics equaled $1.6 million.
AHRQ-funded; HS023313.
Citation: Johnson SP, Zhong L, Chung KC .
Perioperative antibiotics for clean hand surgery: a national study.
J Hand Surg Am 2018 May;43(5):407-16.e1. doi: 10.1016/j.jhsa.2017.11.018..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Medication, Patient Safety, Surgery
Jump RLP, Crnich CJ, Mody L
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review.
AHRQ-funded; HS022465.
Citation: Jump RLP, Crnich CJ, Mody L .
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
J Am Geriatr Soc 2018 Apr;66(4):789-803. doi: 10.1111/jgs.15248.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Long-Term Care, Antimicrobial Stewardship, Antibiotics, Medication, Evidence-Based Practice, Guidelines
Burnham CA, Hogan PG, Wallace MA
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
The authors compared microbial communities and levels of richness and diversity in community-dwelling subjects and in intensive care unit patients before and after the use of topical decolonization protocols. They found a reduction in S. aureus without eradicating endogenous microbiota.
AHRQ-funded; HS021736; HS024269.
Citation: Burnham CA, Hogan PG, Wallace MA .
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
Antimicrob Agents Chemother 2016 Dec;60(12):7303-12. doi: 10.1128/aac.01289-16.
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Keywords: Antimicrobial Stewardship, Antibiotics, Infectious Diseases, Prevention, Patient Safety
Bartsch SM, Huang SS, Wong KF
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
The authors used their Regional Healthcare Ecosystem Analyst (RHEA) simulation model and found that the 32-month delay in changing carbapenem-resistant Enterobacteriaceae (CRE) breakpoints might have resulted in 1,821 additional carriers in Orange County, CA. They recommend that policymakers aim to minimize the delay in the adoption of new breakpoints for antimicrobials against emerging pathogens when containment of spread is paramount, ideally less than 1.5 years.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Huang SS, Wong KF .
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
J Clin Microbiol 2016 Nov;54(11):2757-62. doi: 10.1128/jcm.00635-16.
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Keywords: Infectious Diseases, Antibiotics, Antimicrobial Stewardship
Wares JR, Lawson B, Shemin D
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
The researchers hypothesized that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of multidrug-resistant organisms (MDRO) and further that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. They found that reducing antimicrobial treatment markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. They suggested that improving the environmental decontamination efficacy between patient dialysis treatments as an effective method for reducing colonization and contamination rates.
AHRQ-funded; HS021666.
Citation: Wares JR, Lawson B, Shemin D .
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
PLoS One 2016 May 19;11(5):e0153820. doi: 10.1371/journal.pone.0153820.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Prevention, Ambulatory Care and Surgery, Infectious Diseases
Hamilton KW, Gerber JS, Moehring R
Point-of-prescription interventions to improve antimicrobial stewardship.
The purpose of this review was to discuss interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship.
AHRQ-funded; HS023866.
Citation: Hamilton KW, Gerber JS, Moehring R .
Point-of-prescription interventions to improve antimicrobial stewardship.
Clin Infect Dis 2015 Apr 15;60(8):1252-8. doi: 10.1093/cid/civ018.
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Keywords: Antimicrobial Stewardship, Infectious Diseases, Medication, Patient Safety, Prevention