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重要原因，但大多数临床医生和 决策者倾向于与细菌感染相等败血症。结果，当前的准则强调 即使抗生素不会立即为所有可疑败血症患者施用抗生素 使纯病毒败血症患者受益，并可能在个人和人口水平上造成伤害。 但是，病毒对败血症总体燃烧的贡献却很差，而且很重要 关于抗生素利用模式和潜在抗生素相关的危害仍然存在问题 人口。拟议的项目旨在对社区发作的比例进行严格的估计 由呼吸道病毒引起的败血症，描述病毒败血症中当前的抗生素利用率，量化潜力 抗生素相关的危害，并确定可以安全限制抗生素的患者亚组。这 该提案的最终目标是促进败血症患者更安全，更细微的治疗 AHRQ提高了改善患者安全和避免伤害的优先事项。拟议的研究将完成 通过将大型数据集使用具有200多种潜水员的电子健康记录（EHR）的丰富临床数据，该目标 医院，一种基于EHR的验证方法，用于识别败血症和复杂的因果推理统计数据 解决混杂的技术以购买三个目标：（1）确定社区的比例 - 败血症归因于呼吸道病毒，并表征了抗生素的使用和延长的预测指标 该人群中的抗生素； （2）评估病毒患者的抗生素处方的医院水平变化 败血症和评估高利用医院患者的风险调整后果； （3） 评估阳性病毒评估和低降钙蛋白水平的组合作为指标的潜在效用 该抗生素可以安全地扣留或迅速停止。 候选人克莱尔·沙佩尔（Claire Shappell）博士是一名高级研究员，肺和重症监护医师 在Brigham and妇女医院（BWH），具有使用EHR数据的经验，以获得可行的见解 重症监护中的问题。 Shappell博士在K08期间的目标是通过 大型医疗保健数据集的获取，准备和处理；学习因果关系的统计方法 推理分析包括倾向分数方法和多级数据的方法；获得专业知识 使用R统计计算软件；并增强科学交流的能力。实现 这些目标，她组建了一个由DRS领导的多学科心态团队。迈克尔·克洛马斯（Michael Klompas）和Chanu Rhee，用于使用EHR数据进行败血症监测和结果研究的专家。通过完成 K08奖奖，Shappell博士将有很好的位置，以实现她成为一个长期目标 独立的身体科学家，具有使用大型临床数据集的专业知识，以改善重病的护理 患者特别关注败血症和抗生素利用率。