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

> **NIH AHRQ K08** · BRIGHAM AND WOMEN'S HOSPITAL · 2024 · $152,870

## Abstract

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 beco...

## Key facts

- **NIH application ID:** 10907703
- **Project number:** 5K08HS029518-02
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Claire Shappell
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $152,870
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10907703

## Citation

> US National Institutes of Health, RePORTER application 10907703, Antibiotic Utilization Patterns and Impact on Outcomes for Patients with Respiratory Viral Sepsis (5K08HS029518-02). Retrieved via AI Analytics 2026-05-30 from https://api.ai-analytics.org/grant/nih/10907703. Licensed CC0.

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