Evidence map›Paper›PMID 27655061›Full record

Trial reportJournal of the American Geriatrics Society2016

Constitutional Symptoms Trigger Diagnostic Testing Before Antibiotic Prescribing in High-Risk Nursing Home Residents.

Angela C Eke-Usim, Mary A M Rogers, Kristen E Gibson, Christopher Crnich, Lona Mody, Targeted Infection Prevention Study Team

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Geriatrics Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Guideline
  2. Review
  3. Observational
  4. Review
  5. Article
  6. Article
  7. Review
  8. The Winter Respiratory Viral Season During the COVID-19 Pandemic.Journal of the American Medical Directors Association · 2020
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Angela C Eke-UsimSchool of Public Health, University of Michigan, Ann Arbor, Michigan.
Mary A M RogersDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Kristen E GibsonDivision of Geriatric and Palliative Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.
Christopher CrnichSchool of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Lona ModyDivision of Geriatric and Palliative Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan. lonamody@umich.edu.
Targeted Infection Prevention Study Team
University of Michigan–Ann Arbor · USMichigan United · USUniversity of Wisconsin–Madison · US

Funding

Research Education CoreP30AG024824 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Neil Alexander · 2004 to 2026
$29.2M
Pathway from Functional Disability to Antimicrobial Resistance in Nursing HomesR01AG041780 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MODY, LONA · 2013 to 2017
$1.8M
Targeted Infection Prevention (TIP) Program in Nursing HomesR01AG032298 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MODY, LONA · 2009 to 2013
$1.7M
Preventing Infections and Antimicrobial Resistance in the Aging Population: Translational Research and Training ProgramK24AG050685 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Lona Mody · 2015 to 2026
$1.4M
NIA NIH HHS K24 AG050685NIA NIH HHS P30 AG024824NIA NIH HHS R01 AG032298NIA NIH HHS R01 AG041780
6 · The paper itself

Abstract

objectivesTo evaluate the use of diagnostic testing before treating an infection in nursing home (NH) residents suspected of having a urinary tract infection (UTI) or pneumonia.

designProspective longitudinal study nested within a randomized trial, using data from control sites.

settingSix NHs in southeast Michigan.

participantsNH residents with an indwelling urinary catheter, enteral feeding tube, or both (N = 162) with 695 follow-up visits (189 (28%) visits with an infection). MEASUREMENTS: Clinical and demographic data-including information on incident infections, antibiotic use, and results of diagnostic tests-were obtained at study enrollment, after 14 days, and monthly thereafter for up to 1 year.

resultsOne hundred (62%) NH residents had an incident infection requiring antibiotics, with substantial variations between NHs. In addition to presence of infection-specific symptoms, change in function was a significant predictor of ordering a chest X-ray to detect pneumonia (odds ratio (OR) = 1.7, P = .01). Similarly, change in mentation was a significant predictor of ordering a urinalysis (OR = 1.9, P = .02), chest X-ray (OR = 3.3, P < .001), and blood culture (OR = 2.3, P = .02). Antibiotics were used empirically, before laboratory results were available, in 50 of 233 suspected cases of UTI (21.5%) and 16 of 53 (30.2%) suspected cases of pneumonia. Antibiotics were used in 17% of visits without documented clinical or laboratory evidence of infection.

conclusionConstitutional symptoms such as change in function and mentation commonly lead to diagnostic testing and subsequent antibiotic prescribing. Antibiotic use often continues despite negative test results and should be a target for future interventions.

Indexed as

Drug PrescriptionsPneumoniaRadiographyUrinalysisUrinary Tract InfectionsAgedAnti-Bacterial AgentsFemaleHomes for the AgedHumansLungMaleMedication Therapy ManagementMichiganNursing HomesSymptom AssessmentAnti-Bacterial Agentsantibiotic stewardshipfunctional declinenursing homes

Identifiers

PMID27655061
PMCPMC5119646
OpenAlexW2522311400

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.