Antibiotic Utilization Patterns and Impact on Outcomes for Patients with Respiratory Viral Sepsis

抗生素使用模式及其对呼吸道病毒性脓毒症患者预后的影响

• 批准号: 10722745
• 负责人: Claire Shappell
• 金额: $ 15.37万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722745
• 关键词: Antibiotic; Utilization; Patterns; Impact; Outcomes

Although there is increasing recognition that viruses are an important cause of sepsis, most clinicians and policymakers tend to equate sepsis with bacterial infection. As a result, current guidelines emphasize immediate administration of antibiotics for all patients with suspected sepsis, even though antibiotics will not benefit patients with pure viral sepsis and may cause harm at both the individual and population levels. However, the contribution of viruses to the overall burden of sepsis is poorly characterized, and important questions remain about antibiotic utilization patterns and potential antibiotics-associated harms in this population. The proposed project seeks to provide rigorous estimates of the proportion of community-onset sepsis caused by respiratory viruses, describe current antibiotic utilization in viral sepsis, quantify potential antibiotic-associated harms, and identify patient subgroups in whom antibiotics can safely be limited. The ultimate goal of the proposal is to promote safer, more nuanced treatment for patients with sepsis, in line with AHRQ’s stated priorities of improving patient safety and avoiding harm. The proposed research will accomplish this goal by using large datasets with rich clinical data from electronic health records (EHR) at over 200 diverse hospitals, a validated EHR-based approach to identifying sepsis, and sophisticated causal inference statistical techniques to address confounding in order to pursue three aims: (1) Determine the fraction of community- onset sepsis attributable to respiratory viruses and characterize antibiotic use and predictors of prolonged antibiotics in this population; (2) Assess hospital-level variation in antibiotic prescribing for patients with viral sepsis and evaluate risk-adjusted outcomes for patients at high- versus low- utilization hospitals; and (3) Assess the potential utility of the combination of positive viral assay and low procalcitonin level as an indicator that antibiotics can safely be withheld or rapidly discontinued. The candidate, Dr. Claire Shappell, is an advanced research fellow and Pulmonary and Critical Care physician at Brigham and Women’s Hospital (BWH) with experience using EHR data to gain actionable insights into problems in critical care. Dr. Shappell’s goals during the K08 period are to develop advanced proficiency with the acquisition, preparation, and handling of large healthcare datasets; learn statistical methods for causal inference analysis including propensity score methods and approaches to multilevel data; acquire expertise in the use of R statistical computing software; and strengthen abilities in scientific communication. To achieve these goals, she has assembled a multidisciplinary mentorship team led by Drs. Michael Klompas and Chanu Rhee, experts in the use of EHR data for sepsis surveillance and outcomes research. By the completion of the K08 award period, Dr. Shappell will be well-positioned to achieve her long-term goal of becoming an independent physician-scientist with expertise using large clinical datasets to improve care for critically ill patients, with a particular focus on sepsis and antibiotic utilization.

尽管人们越来越认识到病毒是败血症的一个重要原因，但大多数 因此，当前的指南强调，政策制定者倾向于将败血症等同于细菌感染。 立即对所有疑似脓毒症患者使用抗生素，即使抗生素不会 使纯病毒性脓毒症患者受益，但可能对个人和群体造成伤害。 然而，病毒对脓毒症总体负担的贡献尚不清楚，但重要的是 关于抗生素的使用模式和潜在的抗生素相关危害的问题仍然存在 拟议项目旨在提供对社区发病比例的严格估计。 由呼吸道病毒引起的败血症，描述当前病毒性败血症中抗生素的使用情况，量化潜力 抗生素相关的危害，并确定可以安全限制抗生素使用的患者亚组。 该提案的最终目标是促进脓毒症患者更安全、更细致的治疗，符合 AHRQ 提出的优先事项是提高患者安全和避免伤害。拟议的研究将实现。 通过使用来自 200 多个不同的电子健康记录 (EHR) 的包含丰富临床数据的大型数据集来实现这一目标 医院、基于 EHR 的经过验证的脓毒症识别方法以及复杂的因果推断统计 解决混杂问题的技术，以实现三个目标：（1）确定社区的比例 由呼吸道病毒引起的脓毒症发作，是抗生素使用的特征和长期脓毒症的预测因素 (2) 评估医院层面为病毒感染患者开具抗生素处方的差异 脓毒症并评估高利用率医院与低利用率医院患者的风险调整结果；以及 (3) 评估病毒检测阳性和降钙素原水平低联合作为指标的潜在效用 可以安全地保留或迅速停用抗生素。 候选人克莱尔·沙佩尔 (Claire Shappell) 博士是一名高级研究员、肺科和重症监护医师 在布莱根妇女医院 (BWH) 工作，拥有使用 EHR 数据获得可行见解的经验 Shappell 博士在 K08 期间的目标是提高对重症护理的熟练程度。 获取、准备和处理大型医疗数据集；学习因果统计方法 推理分析，包括倾向评分方法和多级数据方法； 使用R统计计算软件；并加强科学交流的能力。 为了实现这些目标，她组建了一个由 Michael Klompas 博士和 Chanu 博士领导的多学科指导团队。 Rhee，使用 EHR 数据进行脓毒症监测和结果研究的专家。 K08 奖期间，Shappell 博士将处于有利位置，以实现她成为一名 独立医师科学家，拥有使用大型临床数据集改善危重病护理的专业知识 患者，特别关注败血症和抗生素的使用。