# Understanding and Informing Early Hospital Antibiotic Prescribing for Potential Infection

> **NIH AHRQ R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2021 · $480,904

## Abstract

Background: Each year, millions of Americans are hospitalized for suspected infection and receive antibiotics.
Current guidelines strongly urge broad-spectrum antibiotics be delivered within 1 hour in the most-life-
threatening cases: severe sepsis and septic shock. However, unlike other time-sensitive medical emergencies,
there is no objective standard for the diagnosis of severe sepsis. Yet, several government initiatives incentivize
rapid antibiotic treatment for severe sepsis. There are growing concerns that this intense focus on early
antibiotics will increase overall antibiotic use, contributing to antimicrobial resistance. This R01 will measure
trade-offs associated with accelerating time-to-antibiotics to inform both individual bedside decision-making
and federal policy.
Specific Aims: (A1) Hospital antibiotic prescribing behavior: When hospitals accelerate timing of antibiotic
delivery for severe sepsis, how often is this change associated with increasing antibiotic use and broader
spectrum of coverage among all-comers with potential infection? (A2) Individual harms/benefits: For an
individual patient, we will quantify the: (a) risks of harm associated with very short courses of antibiotics
(allergic reaction, renal or liver injury, cytopenias, C. difficile infection, isolation of new resistant bacteria, and
mortality); (b) mortality benefit associated with earlier delivery of antibiotics. A3) Hospital net harms/benefits:
Based on temporal changes in antibiotic prescribing (Aim 1), patient-level harms/benefits (Aim 2), and hospital
prevalence of severe sepsis and septic shock, we will estimate the net benefits and harms associated with
temporal changes in antibiotic prescribing with simulation.
Anticipated Impact: This work will quantify the prescribing trade-offs associated with accelerating time-to-
antibiotics, the individual patient-level harms of very short courses of antibiotics, and the benefit of faster
antibiotic delivery, across subgroups of patients. Finally, we will quantify the net benefits and harms of
accelerating time-to-antibiotics across different types of hospitals with varying sepsis prevalence and
magnitude of negative externalities associated with accelerating time-to-antibiotics.
Unique Features and Innovation: Using granular, patient-level data from Kaiser Permanente Northern
California (KPNC) and nationwide Veterans Affairs (VA), and a novel measure of antimicrobial coverage
spectrum (Spectrum Score), we will evaluate the holistic benefits and harms of faster antibiotic timing, making
summary judgements about the balance of benefits straightforward and informative.
Project Methods: We will examine all KNPC and VA hospitalizations (2013-2018) admitted with potential
infection. We will assess hospital-specific temporal trends in antibiotic prescribing patterns using multilevel
models. We will assess patient-level harms/benefit using matching and regression. We will estimate the
plausible range of trade-offs that re...

## Key facts

- **NIH application ID:** 10212455
- **Project number:** 5R01HS026725-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Vincent Liu
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $480,904
- **Award type:** 5
- **Project period:** 2019-09-30 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10212455

## Citation

> US National Institutes of Health, RePORTER application 10212455, Understanding and Informing Early Hospital Antibiotic Prescribing for Potential Infection (5R01HS026725-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10212455. Licensed CC0.

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