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Research Studies is a compilation of published research articles funded by ´óÏóAPPor authored by ´óÏóAPPresearchers.

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1 to 25 of 65 Research Studies Displayed
Pulia MS, Griffin M, Schwei R
Antibiotic treatment in patients hospitalized for nonsevere COVID-19.
This study’s objective was to examine the association of community-acquired pneumonia (CAP) antibiotic treatment started on admission with clinical outcomes among a large sample of patients hospitalized for nonsevere COVID-19. The primary outcome was a composite measure of deterioration including vasopressor, high-flow oxygen, noninvasive ventilation, invasive mechanical ventilation, intermediate care, and intensive care unit admission; and in-hospital mortality occurring on day 2 or later. The primary composite outcome was higher in the CAP group (20.8%) compared with the unexposed (no antibiotic) group (18.4%), but the difference did not meet the predefined criteria for clinical significance. Patients who received CAP antibiotics had higher odds of poor clinical outcomes.
AHRQ-funded; HS028669.
Citation: Pulia MS, Griffin M, Schwei R . Antibiotic treatment in patients hospitalized for nonsevere COVID-19. JAMA Netw Open 2025 May 1; 8(5):e2511499. doi: 10.1001/jamanetworkopen.2025.11499..
Keywords: Antibiotics, Medication, COVID-19, Antimicrobial Stewardship, Community-Acquired Infections
Antoon JW, Nian H, Todd J
Guideline-concordant antibiotic use in children with community-acquired pneumonia.
Although national guidelines recommend narrow-spectrum antibiotics for pediatric pneumonia, adherence remains inconsistent. This retrospective study of children treated at two emergency departments found that just 57% of those receiving antibiotics were treated in accordance with guidelines. Factors associated with better adherence included chest indrawing, while interstitial findings and lack of viral testing were linked to guideline-discordant prescribing. The findings suggest that more targeted antimicrobial stewardship interventions are needed in pediatric emergency settings to promote evidence-based prescribing and reduce unnecessary broad-spectrum antibiotic use.
AHRQ-funded; HS029331.
Citation: Antoon JW, Nian H, Todd J . Guideline-concordant antibiotic use in children with community-acquired pneumonia. Hosp Pediatr 2025 Apr; 15(4):300-08. doi: 10.1542/hpeds.2024-007994..
Keywords: Children/Adolescents, Antibiotics, Pneumonia, Respiratory Conditions, Community-Acquired Infections, Antimicrobial Stewardship, Guidelines, Practice Patterns
Geanacopoulos AT, Amirault JP, Michelson KA
Community-acquired pneumonia diagnosis following emergency department visits for respiratory illness.
A decade-long study examined the frequency of community-acquired pneumonia diagnoses following emergency department visits for respiratory symptoms. The research analyzed data from 10,329 pediatric patients aged 3 months to 18 years who received care at four hospital-affiliated clinics between 2011 and 2021. The investigation tracked pneumonia diagnoses made within a week after emergency department discharge. The findings showed that post-discharge pneumonia diagnoses were uncommon, occurring in less than 1% of cases, though elevated body temperature during the initial visit increased the likelihood of subsequent diagnosis.
AHRQ-funded; HS000063, HS02650.
Citation: Geanacopoulos AT, Amirault JP, Michelson KA . Community-acquired pneumonia diagnosis following emergency department visits for respiratory illness. Clin Pediatr 2025 Jan; 64(1):83-90. doi: 10.1177/00099228241254153.
Keywords: Community-Acquired Infections, Pneumonia, Emergency Department, Pneumonia, Children/Adolescents, Respiratory Conditions
Gasoyan H, Deshpande A, Imrey PB
Potential implications of using locally validated risk factors for drug-resistant pathogens in patients with community-acquired pneumonia in US hospitals: a cross-sectional study.
An analysis of community-acquired pneumonia treatment examined data from 50 U.S. hospitals between 2010 and 2015, evaluating antibiotic prescription practices in patients with community-acquired pneumonia. The study investigated how following current guidelines for treating drug-resistant infections would affect antibiotic usage patterns. The research compared outcomes between using hospital-specific risk factors versus general risk criteria when deciding on extended-spectrum antibiotic treatment. Hospital practices showed wide variation, with 19-75% of patients receiving broad-spectrum antibiotics. The investigation revealed that implementing either risk-based approach would substantially reduce extended-spectrum antibiotic use, though effects varied among facilities.
AHRQ-funded; HS024277.
Citation: Gasoyan H, Deshpande A, Imrey PB . Potential implications of using locally validated risk factors for drug-resistant pathogens in patients with community-acquired pneumonia in US hospitals: a cross-sectional study. Clin Infect Dis 2024 Nov 22; 79(5):1277-82. doi: 10.1093/cid/ciae448.
Keywords: Pneumonia, Respiratory Conditions, Community-Acquired Infections, Risk, Hospitals
Ehmann MR, Klein EY, Zhao X
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
This retrospective cohort study’s objective was to describe the epidemiology of community-acquired acute kidney injury (CA-AKI) in the United States and the associated clinical outcomes. CA-AKI was identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. Outcomes for encounters resulting in hospitalization included the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. Outcomes for all encounters included occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED, with 16.6% of patients admitted to the hospital from the ED having CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to the CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation, ICU admission, and death compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease, dialysis initiation, subsequent hospitalization including ICU admission, and death during the subsequent 180 days.
AHRQ-funded; HS027793; HS026640.
Citation: Ehmann MR, Klein EY, Zhao X . Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study. Am J Kidney Dis 2024 Jun; 83(6):762-71.e1. doi: 10.1053/j.ajkd.2023.10.009..
Keywords: Community-Acquired Infections, Kidney Disease and Health, Emergency Department, Outcomes
Geanacopoulos AT, Neuman MI, Michelson KA
Cost of pediatric pneumonia episodes with or without chest radiography.
Researchers sought to assess the costs of community-acquired pneumonia (CAP) episodes with and without chest radiograph (CXR) among children discharged from the pediatric emergency department. Their retrospective cohort study used data from the Healthcare Cost and Utilization Project State ED and Inpatient Databases on children aged 3 months to 18 years with CAP in eight states from 2014 to 2019. The results indicated that use of CXR for CAP diagnosis is associated with lower costs when considering the subsequent provision of care among patients who need additional health care after initial emergency department discharge.
AHRQ-funded; HS026503; HS000063.
Citation: Geanacopoulos AT, Neuman MI, Michelson KA . Cost of pediatric pneumonia episodes with or without chest radiography. Hosp Pediatr 2024 Feb; 14(2):146-52. doi: 10.1542/hpeds.2023-007506.
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Pneumonia, Respiratory Conditions, Community-Acquired Infections
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
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
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
Deshpande A, Klompas M, Yu PC A, Klompas M, Yu PC
Influenza testing and treatment among patients hospitalized with community-acquired pneumonia.
This study looked at testing rates for influenza in hospitalized patients admitted for community-acquired pneumonia (CAP) and whether it is associated with antiviral treatment and shorter antibiotic courses. The study included patients admitted in 179 US hospitals with pneumonia from 2010 to 2015. The authors assessed influenza testing and compared antimicrobial utilization and the outcomes of test-positive, test-negative, and untested patients. Among 166,268 patients with CAP, 23.3% were tested for influenza, of whom 11.5% tested positive. Testing increased from 15.4% to 35.5% from 2010 to 2015 and was more than triple the rate during flu season (October-May) vs June to September. Patients who tested positive for influenza received antiviral agents more often and antibiotics less often and for shorter courses than patients testing negative. Patients who received early antiviral treatment with oseltamivir experienced lower 14-day in-hospital mortality, lower costs, and shorter length of stay vs patients receiving oseltamivir later or not at all.
AHRQ-funded; HS024277.
Citation: Deshpande A, Klompas M, Yu PC A, Klompas M, Yu PC . Influenza testing and treatment among patients hospitalized with community-acquired pneumonia. Chest 2022 Sep;162(3):543-55. doi: 10.1016/j.chest.2022.01.053..
Keywords: Influenza, Pneumonia, Community-Acquired Infections, Outcomes, Medication, Inpatient Care
Vaughn VM, Gandhi TN, Hofer TP
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Researchers sought to improve antibiotic duration for community-acquired pneumonia (CAP) across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). They found that, across diverse hospitals, HMS participation was associated with more appropriate use of short-course therapy and fewer adverse events in hospitalized patients with uncomplicated CAP.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Hofer TP . A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia. Clin Infect Dis 2022 Aug 31;75(3):460-67. doi: 10.1093/cid/ciab950..
Keywords: Community-Acquired Infections, Pneumonia, Antibiotics, Antimicrobial Stewardship, Medication, Respiratory Conditions
Rothberg MB, Imrey PB, Guo N MB, Imrey PB, Guo N
A risk model to identify Legionella among patients admitted with community-acquired pneumonia: a retrospective cohort study.
This study’s goal was to derive and externally validate a model to predict a positive Legionella test among adult inpatients diagnosed with pneumonia. The study used data from 177 US hospitals in the Premier Healthcare Database and 12 Cleveland Clinic Health System (CCHS) hospitals. Of 166,689 patients hospitalized for pneumonia, out of 43,070 tested for Legionella 642 (1.5%) tested positive. The strongest predictors of a positive test were a local outbreak, June-October occurrence, hyponatremia, smoking and diarrhea. A negative test was associated with prior admission within 6 months and chronic pulmonary disease.
AHRQ-funded; HS024277.
Citation: Rothberg MB, Imrey PB, Guo N MB, Imrey PB, Guo N . A risk model to identify Legionella among patients admitted with community-acquired pneumonia: a retrospective cohort study. J Hosp Med 2022 Aug;17(8):624-32. doi: 10.1002/jhm.12919..
Keywords: Pneumonia, Community-Acquired Infections, Infectious Diseases, Respiratory Conditions
Haessler S, Guo N, Deshpande A
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
This study compared the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP. The definition for sCAP includes a principal diagnosis of pneumonia or a secondary pneumonia diagnosis paired with a principal diagnosis of sepsis or respiratory failure. One-hundred seventy-seven US hospitals within the Premier Healthcare Database were used to identify 154,799 patients with pneumonia, with 14.1% meeting criteria for sCAP. The sCAP patients had higher organ failure scores and inpatient mortality, longer lengths of stay, and higher costs than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures and respiratory cultures and more often had isolates resistant to first-line community-acquired pneumonia antibiotics. The most common pathogen acquired from blood cultures was Streptococcus pneumoniae and from the respiratory tract Staphylococcus aureus and Pseudomonas species. The most common antibiotics prescribed were vancomycin (65%) and piperacillin-tazobactam (42.8%), regardless of cultures positive for a resistant organism.
AHRQ-funded; HS024277.
Citation: Haessler S, Guo N, Deshpande A . Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample. Crit Care Med 2022 Jul;50(7):1063-71. doi: 10.1097/ccm.0000000000005498..
Keywords: Community-Acquired Infections, Pneumonia, Respiratory Conditions, Outcomes
Gupta A, Petty L, Gandhi T
Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study.
This study’s goal was to determine if there is a correlation between overdiagnosis of urinary tract infection (UTI) and overdiagnosis of community-acquired pneumonia (CAP) in hospitals, resulting in unnecessary antibiotic use and diagnostic delays. The authors first determined the proportion of hospitalized patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then they used Pearson's correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. They included 14,085 patients treated for CAP and 10,398 patients treated for UTI. There was a moderate correlation within hospitals of the proportion of patients overdiagnosed with UTI and those overdiagnosed with CAP.
AHRQ-funded; HS026530.
Citation: Gupta A, Petty L, Gandhi T . Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study. BMJ Qual Saf 2022 May;31(5):383-86. doi: 10.1136/bmjqs-2021-013565..
Keywords: Urinary Tract Infection (UTI), Pneumonia, Community-Acquired Infections, Diagnostic Safety and Quality
D'Orazio B, Ramachandran J, Khalida C
Stakeholder engagement in a comparative effectiveness/implementation study to prevent Staphylococcus aureus infection recurrence: CA-MRSA Project (CAMP2).
The purpose of this study was to determine whether the presence and participation of a stakeholder committee would positively impact the effectiveness of the design and execution of a home-based Methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus infection prevention intervention. The trial utilized community health workers to implement infection prevention protocols in participant’s homes, including home visits, sampling household surfaces at baseline and then three months, and obtaining surveillance cultures from index patients and household members. The study assembled and convened The Clinician and Patient Stakeholder Advisory Committee (CPSAC), comprised of New York-based federally qualified health centers (FQHCs) and community health emergency departments, laboratory and clinical researchers, clinicians, and patient stakeholders. The CPSAC was tasked with trial oversight and shared decision-making and troubleshooting, and convened both in person and remotely. The researchers concluded that the inclusion and engagement of the CPSAC during the trial design and implementation was highly effective in addressing and resolving challenges in both participant recruitment and home visits.
AHRQ-funded; HS021667.
Citation: D'Orazio B, Ramachandran J, Khalida C . Stakeholder engagement in a comparative effectiveness/implementation study to prevent Staphylococcus aureus infection recurrence: CA-MRSA Project (CAMP2). Prog Community Health Partnersh 2022;16(1):45-60. doi: 10.1353/cpr.2022.0005..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Community-Acquired Infections, Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Evidence-Based Practice
Bartley PS, Deshpande A, Yu PC
Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes.
Among patients hospitalized for influenza pneumonia, the researchers reported the rate of coinfection and distribution of pathogens and also compared outcomes of patients with and without bacterial coinfection. They found that, in a large US inpatient sample hospitalized with influenza and community-acquired pneumonia, Staphylococcus aureus was the most frequent cause of bacterial coinfection. Coinfection was associated with worse outcomes and higher costs.
AHRQ-funded; HS024277.
Citation: Bartley PS, Deshpande A, Yu PC . Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes. Infect Control Hosp Epidemiol 2022 Feb;43(2):212-17. doi: 10.1017/ice.2021.96..
Keywords: Influenza, Pneumonia, Infectious Diseases, Community-Acquired Infections
Rastogi R, Yu PC, Deshpande A
Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia.
This retrospective cohort study’s objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. Findings showed that patients aged 85 and over have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.
AHRQ-funded; HS024277.
Citation: Rastogi R, Yu PC, Deshpande A . Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia. J Investig Med 2022 Feb;70(2):376-82. doi: 10.1136/jim-2021-002078..
Keywords: Elderly, Community-Acquired Infections, Pneumonia, Outcomes, Hospitalization
Adams V, Song J, Shang J
Infection prevention and control practices in the home environment: examining enablers and barriers to adherence among home health care nurses.
This study’s aim was to examine the impact of individual, home environment, and organization factors on Infection Prevention and Control (IPC) practices in home health care. A survey of 350 nurses across two large home care agencies was conducted to examine the relationship between IPC adherence and these factors. Multiple barriers to IPC practices in patients’ homes were reported including clutter (74.5%), and a dirty environment (70.3%). They also reported limited availability of some IPC supplies including personal protective equipment.
AHRQ-funded; HS024723.
Citation: Adams V, Song J, Shang J . Infection prevention and control practices in the home environment: examining enablers and barriers to adherence among home health care nurses. Am J Infect Control 2021 Jun;49(6):721-26. doi: 10.1016/j.ajic.2020.10.021..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Prevention, Provider: Nurse, Provider
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.
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
Russell D, Dowding D, Trifilio M
Individual, social, and environmental factors for infection risk among home healthcare patients: a multi-method study.
This paper is a study of nurse perceptions of individual, social, and environmental factors for infection risk among home healthcare (HHC) patients and also identifies the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 from qualitative interviews with 50 HHC nurses and structured observations of nurse visits to patients’ homes (n = 400). Perceived infection risk among patients was characterized as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Frequent environmental barriers observed during visits to patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%).
AHRQ-funded; HS024723.
Citation: Russell D, Dowding D, Trifilio M . Individual, social, and environmental factors for infection risk among home healthcare patients: a multi-method study. Health Soc Care Community 2021 May;29(3):780-88. doi: 10.1111/hsc.13321..
Keywords: Home Healthcare, Community-Acquired Infections, Risk, Provider: Nurse, Provider
O'Donoghue A, Dechen T, O'Donoghue A, Dechen T, Pavlova W W
Reopening businesses and risk of COVID-19 transmission.
In this paper, the authors used anonymized cell-phone data to quantify the potential risk of COVID-19 transmission in business establishments by building a Business Risk Index that measures transmission risk over time. They used two metrics, visits per square foot and the average duration of visits from January 2020 to June 2020. They found that an increase in a county's average Business Risk Index is associated with an increase in positive COVID-19 cases in 1 week. Their risk index provides a way for policymakers and hospital decision-makers to monitor the potential risk of COVID-19 transmission from businesses based on the frequency and density of visits to businesses.
AHRQ-funded; HS024288.
Citation: O'Donoghue A, Dechen T, O'Donoghue A, Dechen T, Pavlova W W . Reopening businesses and risk of COVID-19 transmission. NPJ Digit Med 2021 Mar 16;4(1):51. doi: 10.1038/s41746-021-00420-9..
Keywords: COVID-19, Community-Acquired Infections, Public Health, Risk
Haessler S, Lindenauer PK, Zilberberg MD
Blood cultures versus respiratory cultures: 2 different views of pneumonia.
This study examined characteristics and outcomes of patients with positive cultures for pneumonia by site. The authors compared results from blood and respiratory cultures to see if organisms and resistance patterns differed by site. They studied adult patients discharged from July 2010 to June 2015 with principal diagnoses of pneumonia, respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia. Out of 138,651 hospitalizations of patients with pneumonia, 9.3% yielded positive cultures with 6438 from respiratory culture and 5992 blood cultures, and 45 both respiratory and blood cultures. Isolates from respiratory samples were often more resistant than were isolates from blood. Patients with positive cultures in both sites had higher case-fatality, longer lengths of stay and higher costs than patients who only had one culture site positive. Among respiratory cultures, the most common pathogens identified were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%).
AHRQ-funded; HS024277.
Citation: Haessler S, Lindenauer PK, Zilberberg MD . Blood cultures versus respiratory cultures: 2 different views of pneumonia. Clin Infect Dis 2020 Oct 23;71(7):1604-12. doi: 10.1093/cid/ciz1049..
Keywords: Pneumonia, Community-Acquired Infections, Respiratory Conditions, Infectious Diseases
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

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