To describe the use of non-beta-lactam agents (NBL) to treat ampicillin-susceptible Enterococcus bacteremia (ASEB), and to identify factors associated with their use.

A single-center retrospective study at a rural tertiary referral center was conducted to identify ASEB episodes between January 1, 2016, and 31 December, 2021. Patient, microbiological, infection, clinical management characteristics, and outcomes were compared between those who received NBL versus BL agents for definitive therapy. Multivariable logistic regression analysis was used to determine factors associated with NBL use.

158 episodes of ASEB in 153 patients were included. 43 episodes (27%) were treated with NBL for definitive therapy. Factors associated with NBL therapy were younger age, history of penicillin allergy, history of cancer, end-stage renal disease (ESRD), polymicrobial bacteremia, lack of metastatic foci, and lack of endocarditis. Combination therapy was used in 23% of those treated with BL therapy versus zero patients receiving NBL therapy. All-cause 30-day and 90-day mortality and 30-day relapse rate were not statistically different. In the regression model, NBL therapy was more likely in those with: younger age (AOR 0.95, p < .01), any penicillin allergy (AOR 5.87, p < .01), history of cancer (AOR 5.25, p < .01), ESRD (AOR 12.48, p < .001), and polymicrobial bacteremia (AOR 4.20, p < .01).

NBL was used as definitive treatment in 27% of ASEB with good clinical outcomes. This real-life experience suggests NBL can be successfully used to treat ASEB based on clinical discretion.

Investigate the factors associated with symptomatic respiratory infection and uptake of seasonal SARS-CoV-2 and influenza vaccine amongst healthcare workers (HCWs).

Longitudinal prospective multi-center study.

Two tertiary healthcare centers in Ireland.

N = 893 self-selected HCWs across all disciplines.

Monthly self-reported questionnaires from September 2024 to February 2025 completed by all participants, providing infection symptoms, self-testing for COVID-19 and receipt of vaccination against SARS-CoV-2 or influenza in the preceding 30 days. Additional data collected included comorbidities, known diagnosis of Long COVID, demographic data, prior infection and vaccination status, and healthcare role. Multivariable logistic regression models assessed the factors associated with symptom development, self-testing, and vaccine uptake.

Symptomatic respiratory illness was reported by n = 321 (36%) of participants during the study period, with a preexisting diagnosis of Long COVID associated with developing symptoms. Testing for COVID-19 was performed by 63% (n = 202) of symptomatic individuals, with a shorter duration since prior infection the only significant predictor of self-testing. Vaccine uptake was variable, with 37% receiving influenza and 22% receiving SARS-CoV-2 vaccination for that period. Older age and shorter interval since previous vaccine were associated with increased uptake of both vaccines, while men were more likely to be vaccinated against COVID-19.

In the postpandemic period, self-reported symptomatic respiratory infections remain common amongst HCWs. The legacy of the pandemic influences this, with a preexisting diagnosis of Long COVID associated with increased symptom burden, while low vaccination rates and understanding the factors associated with this present a challenge to ongoing risk mitigation.

Escherichia coli, frequently abbreviated as E. coli, is a common gastrointestinal tract inhabitant in both people and animals. It may also be found in soil, aquatic settings, and plants.

The purpose of the study was to identify the frequency and three susceptibilities of E. coli in various clinical samples taken from patients in the Jazan area.

Using a multi-center approach, this retrospective cross-sectional study analyzed the results of culture and antimicrobial susceptibility of isolates from urine, wound swabs, and sputum samples. The study covered the period from January 2023 to December 2023 and included all public and private hospitals in the Jazan region.

The majority of isolates were derived from urine samples in 1161 patients (85.49%), followed by pus in 123 patients (9.06%) and sputum in 74 patients (5.45%). There were high sensitivity rates to Amikacin, Tigecycline, and Imipenem by (97.49%), (90.87%), and (90.35%), respectively, while there were high resistance rates to Norfloxacin, Ampicillin, and Cefotaxime by (93.67%), (79.60%), and (71.65%), respectively.

There was considerable resistance to commonly used antibiotics among Escherichia coli germs isolated from several clinical specimens. Antibiotics, including imipenem, amikacin, and nitrofurantoin, demonstrated the highest efficacy against E. coli isolates. Nalidixic acid, cefexime, and ceftriaxone showed efficacy against E. coli; nevertheless, several clinical isolates exhibited resistance.

This before–after study aimed to evaluate whether an order-set intervention would improve CABP-guideline concordance among outpatients.

This study included adult patients presenting to outpatient clinics (n = 92) and urgent care centers (n = 39) within a community-based health system without a formal outpatient antibiotic stewardship program (ASP).

The intervention consisted of an antibiotic order-set and awareness campaign. Patient encounters were identified via CABP ICD-10 codes and IDSA-relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia) were extracted from the electronic health record. Primary outcome was to describe the proportion of patients receiving concordant therapy per IDSA guideline and local antibiogram in a pre- (May 2023 – April 2024) and post-intervention period (May 2024 – December 2024).

Baseline and intervention antibiotic concordance rate was 33.3% (1,467/4,401 encounters) and 28.0% (1,388/4,954 encounters), respectively. Among patients with no comorbidity, monotherapy prescriptions (concordant and discordant) decreased post-intervention and were replaced by higher levels of combination therapy (15% increase), albeit all discordant due to lack of comorbidities. Among patients with comorbidities, combination antibiotics increased by 12% post-intervention, driven by concordant prescriptions including amoxicillin/clavulanate plus azithromycin while the most frequently prescribed discordant combination was amoxicillin plus azithromycin. Trends were similar in primary care and urgent care centers.

A stewardship intervention, including an order-set and awareness campaign improved the selection of combination therapy for appropriate patients but did not improve overall guideline concordance. For health systems without a dedicated outpatient ASP, these data will help bolster stewardship efforts towards more effective strategies.

To describe the antimicrobial management of and examine the etiology of intracranial suppurative infections (ISIs) at a single pediatric institution.

Retrospective review.

We included children hospitalized at a 367-bed freestanding pediatric institution for treatment of an ISI (epidural or subdural empyema, brain abscess) between January 1, 2015, and September 30, 2023. ISIs were identified using international classification of diseases 9/10 discharge diagnosis codes.

We collected data regarding patient characteristics, infection etiology and complications, antimicrobial choice and route (empiric, definitive, and outpatient), microbiology results, treatment duration, and treatment-related outcomes from the electronic health record.

A total of 72 patients met inclusion criteria. Most patients received a third- or fourth-generation cephalosporin, metronidazole, and vancomycin empirically (69.4%), while a third- or fourth-generation cephalosporin in combination with metronidazole was the most common definitive regimen (63.9%). Almost half of patients (44%) were transitioned to an entirely oral antibiotic regimen, after a median of 27 days of intravenous therapy. The median duration of antimicrobial therapy was 45 days (interquartile range = 33,56). Organisms in the Streptococcus anginosus group were the most common pathogens identified (62.5%). Treatment-related complications occurred in 12 (16.7%) patients.

Empiric therapy targeting resistant gram-positive organisms was not required to treat ISIs at our institution. Further data are needed on timing and requirements for oral antibiotic transition and treatment duration. In the future, there is opportunity for multi-institutional collaboration and data-sharing to determine the most appropriate management of pediatric ISIs.

To describe antimicrobial prescribing practices in 4 hospitals in Guatemala to guide the development of an ongoing antimicrobial stewardship (AS) project.

A cross-sectional mixed methodologies descriptive study design.

Practicing physicians from 4 hospitals (2 tertiary public hospitals and 2 specialty referral hospitals) within Guatemala City.

All participants responded to a survey to ascertain 3 key areas of antimicrobial prescription practices: identify key players, communication among key players, and perceptions and behaviors regarding antimicrobial prescribing. A subset of respondents participated in semi-structured interviews to further explore experiences with AS team dynamics and communication.

One hundred and ten participants completed the survey (n = 110/145, 75.8%), and 79 completed the interview (n = 79/110, 71.8%). Antimicrobial prescribing is led by physicians who are responsible for maintaining communication with infectious disease physicians. The limited role of the pharmacist and the more predominant role of the microbiologist in antimicrobial selection were notable despite similar levels of training. Efficient communication about prescribing was perceived primarily among physicians, although existing hierarchies within the healthcare system negatively influenced decision-making strategies. Participants reported difficulty in choosing an antibiotic and indicated a preference for broad-spectrum antimicrobial use.

The existing structure between physicians in hospitals facilitates antimicrobial prescribing practices. However, optimization of antimicrobial use may occur if multidisciplinary teams participate in antimicrobial selection activities. The results of this study provide valuable insight and can be used as a starting point toward the implementation of effective AS strategies within Guatemala and other similar countries in Central America and the Caribbean.

To evaluate the effectiveness and acceptability of ventilation interventions in naturally ventilated hospitals in Liberia.

Difference-in-differences analysis of pre- and post-air changes per hour of intervention and control spaces.

Hospitals in Bong and Montserrado Counties, Liberia.

Seventy patient care spaces were evaluated at baseline. Six spaces underwent physical intervention modifications, while 2 spaces were assessed for indirect effects and 2 others used as controls. Healthcare workers were interviewed to assess ventilation knowledge and acceptability.

Ventilation interventions included the installation of window screens, louvered doors and windows, and wind turbines.

We measured carbon dioxide levels with portable meters and documented persons per room to estimate per-person ventilation rates in both L/s/person for the initial assessment and air changes per hour (ACH) in the intervention. Measurements were taken in patient care spaces in 7 hospitals in Liberia. Healthcare worker acceptability was evaluated via structured interviews.

Two-thirds (46/70) of patient care spaces were below the WHO-recommended ventilation threshold of 60 L/s/person. Six spaces underwent ventilation interventions, including placement of window screens (3), wind turbines (2), and louvered doors and windows (1), with 2 additional spaces being indirectly affected by these interventions and 2 more spaces serving as controls. Ventilation improved by an average of 2 ACH in the spaces with wind turbines and louvered doors and windows. Overall acceptability of the interventions was high.

Implementing interventions to improve ventilation in naturally ventilated healthcare facilities is efficacious, feasible, and acceptable, though longer-term evaluations should assess sustainability.

Currently, the Infectious Diseases Society of America (IDSA) Guidelines for Uncomplicated Urinary Tract Infections (UTIs) recommend a 3 to 7-day antibiotic course of oral beta-lactam agents when other recommended agents are not feasible. In recent years, studies have demonstrated efficacy in shorter courses of antimicrobial therapy for acute uncomplicated cystitis compared with longer courses, but there is limited data regarding intravenous beta-lactams for acute uncomplicated cystitis.

This single-center, retrospective, non-inferiority cohort study included adult patients admitted to University of Kentucky Albert B. Chandler Medical Center or Good Samaritan Hospital with acute uncomplicated cystitis. The primary outcome assessed was treatment failure, defined as the need for retreatment with additional antibiotic therapy within 30 days of antibiotic completion. Secondary outcomes include incidence of C. difficile infection within 30 days of antibiotic therapy, hospital readmission, and outpatient telephone encounters within 30 days of discharge. Patients were divided into the short course (those receiving three days or less of beta-lactam antibiotics and at least 1 day was IV) or the long course (those receiving four or more days of beta lactam antibiotics).

Overall, 52 patients met the criteria to be included in the final study, with 33 in the short course beta-lactam group and 19 in the long-course beta-lactam group. Failure rates between short and long course were 15.2% and 15.8% respectively (p=1.000). Ceftriaxone was the most commonly utilized antibiotic in both groups. The median total antibiotic duration between the long and short groups was 3 and 6 days respectively (p<0.001).

In hospitalized patients warranting initial IV therapy for acute uncomplicated cystitis, a 3-day total of beta-lactam therapy, with transition to oral, should be considered.

Effective antimicrobial stewardship (AMS) programs must address the needs of culturally and linguistically diverse (CALD) patients who often experience language barriers and varying cultural beliefs regarding antibiotics. They are at greater risk of receiving suboptimal or inappropriate care, yet guidance to support AMS practices for this population remains limited.

To investigate antibiotic knowledge, perspectives, and experiences of CALD patients.

A cross-sectional survey was conducted between May to November 2023 at a Western Sydney tertiary hospital. Adult patients of CALD background on systemic antibiotics for more than 72 hours under surgical, respiratory, and geriatric specialties were surveyed on their understanding of their antibiotic treatment.

Of the 177 patients, median age was 70 years old (21–99 years), and 95/177 (53.7%) were males. Of the 177 patients, 171/177 (96.6%) reported speaking a language other than English at home. While 160/177 (90.4%) patients were told that they were treated with antibiotics, only 67/177 (37.9%) were told about duration, 35/177 (19.8%) were told about the side effects, and 27/177 (15.3%) were given written information. Information was provided by doctors to 125/177 (70.6%) patients, 72/177 (40.7%) by nurses, and 3/177 (1.7%) by pharmacists. Patients preferred to have received information from their doctor 79/177 (44.6%) or any healthcare professional 91/177 (51.4%).

Improving antibiotic education for CALD patients is essential to address communication gaps. Enhancing knowledge will support appropriate use, improved adherence and outcomes, and promote shared decision-making. Strengthening health literacy in CALD populations should be a priority for AMS programs.

To evaluate clinical outcomes in patients with uncomplicated β-hemolytic Streptococcus spp. bloodstream infections (BSI) transitioned to oral antimicrobial therapy (OAT) compared with those that remain on intravenous antimicrobial therapy.

Retrospective cohort study.

Tertiary academic hospital.

This retrospective cohort study included adult patients hospitalized between 1/1/2013 and 12/31/2019 diagnosed with uBSI due to β-hemolytic streptococci. Patients were excluded if BSI was due to endovascular, central nervous system, or bone/joint infection or patient was immunosuppressed or died within 72 hours of identification of BSI. We compared outcomes including: 30-day mortality, antimicrobial therapy, BSI relapse, 30-day rehospitalization, adverse drug events, and reversion to IV therapy. Fisher’s exact test was used for categorical variables; Mann – Whitney test and Independent T-test for continuous variables.

232 BSIs were included. OAT was used in 152 (65%). Cohort demographics were similar. Mortality was also similar between cohorts (2% vs 6% P = .13). Hospital length of stay was shorter in the OAT cohort with a median of 5 days (interquartile range 4.00, 8.00) versus 8 (5.00, 16.00) in the IV group (P < .0001). Patients transitioned to OAT were more likely to finish antibiotics outpatient (93% vs 62% P < .001).

For β-hemolytic Streptococcus uBSI, OAT was associated with decreased length of stay without adverse clinical outcomes. Opportunities exist to modify clinical management of uBSI.

To identify barriers and facilitators of infection prevention and control (IPC) practices at King Faisal Hospital (KFH) in Kigali, Rwanda, using the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Qualitative study involving semi-structured interviews.

King Faisal Hospital, a tertiary healthcare facility in Kigali, Rwanda.

A purposive sample of 25 hospital staff members from various roles involved in infection control practices.

Semi-structured interviews were conducted, guided by the SEIPS framework which includes domains of person, environment, tasks, organization, tools, and process. Interviews were transcribed, coded, and analyzed to identify recurring themes related to IPC barriers and facilitators.

Key barriers included overcrowding, lack of isolation rooms, and significant staff-related factors, such as new staff attitudes, infrequent training, and inconsistent monitoring. Facilitators of IPC practices included adequate availability of hand sanitizer, soap, water, and personal protective equipment, as well as strong IPC policies from hospital administration. A systemic barrier identified was consumer access to antibiotics without a prescription, raising concerns about inappropriate use and antibiotic resistance.

To enhance IPC practices, interventions such as increased IPC training and monitoring are recommended. Long-term solutions may include hospital expansion and isolation room creation for each unit. Additionally, legislative action limiting consumer access to antibiotics without a physician’s prescription could mitigate antibiotic resistance at the community and hospital levels.

Clostridioides difficile infections (CDI) increased at a large, regional hospital in New South Wales, Australia, in 2021, coinciding with an increase at hospitals Australia wide. We aimed to investigate the association between antibiotic prescribing practices and hospital-acquired CDI at the hospital to inform antimicrobial stewardship (AMS) programs.

We conducted a retrospective case–control study for the period July 1, 2018, and June 30, 2022. Seventy hospital-acquired CDI cases were selected for the study. Cases were matched on a 1:2 basis with randomly selected controls based on date of hospitalization and age group. We conducted a multivariable analysis to explore possible risk factors for infection. We compared cases and controls who were administered antibiotics to determine if rates of inappropriate antibiotic prescriptions differed between cases and controls.

The multivariable model found that use of cephalosporins (third, fourth, or fifth generation) (adjusted odds ratio (aOR) 3.82, 95% confidence interval (CI) 1.35–10.84), use of penicillins (broad or extended broad spectrum) (aOR 5.79, 95% CI 2.15–15.58), and increased complexity of comorbidities (aOR 1.22, 95% CI 1.02–1.45) were independently associated with CDI. In patients who had antibiotics administered during their admission, inappropriate antibiotic prescribing (OR 5.68, 95% CI 1.95–16.48) and non-compliance with antibiotic prescribing guidelines (OR 5.01, 95% CI 1.07–14.76) were associated with CDI.

Our study showed that antibiotic prescribing practices were associated with hospital-acquired CDI at the hospital during the study period. The results reinforce the importance of compliance with antibiotic guidelines and provide further evidence for AMS programs to reduce CDI.

Ultraviolet-C (UV-C) radiation has emerged as a widely adopted disinfection technology in healthcare settings due to its germicidal effectiveness. However, concerns have grown regarding the potential degradation of materials, particularly polymeric surfaces, subjected to repeated UV-C exposure. Understanding the extent, mechanism, and contributing factors of UV-C-induced material degradation is essential for safe and sustainable implementation.

We conducted a scoping literature review in accordance with PRISMA guidelines to evaluate evidence on UV-C-related material degradation. Multiple databases were searched for studies published between January 1, 2000, and August 30, 2024, investigating material degradation under UV-C radiation (100–280 nm) in potentially healthcare-relevant conditions. Data abstraction captured study design, UV-C exposure characteristics, material types, degradation types, and assessment methods.

Of the 56 studies reviewed, 14 met inclusion criteria. All employed experimental designs conducted in laboratory settings. UV-C exposure resulted in both visible and structural degradation of several polymeric materials. Polycarbonate, HDPE, and PLA were the most affected, exhibiting yellowing, surface cracking, and loss of mechanical strength. Degradation was time-, dose-, and distance-dependent, with longer exposure, higher irradiance, and shorter distance correlating with more severe damage. Detection methods included visual inspection, microscopy, spectroscopy, and nanoindentation. Some studies reported UV stabilizers and antioxidant additives as potential mitigation strategies.

UV-C radiation can cause significant degradation of commonly used polymeric materials. These findings underscore the need for careful selection of materials in UV-C environments and support further research on mitigation strategies to enhance material longevity.

To determine the frequency and outcomes of early follow-up blood cultures (BCs) collected within 48 hours of patients being investigated for bacteremia in the emergency department (ED), as well as the number of new pathogens isolated.

Retrospective observational study of patients who had BCs collected in the ED between October 2019 and July 2020.

This study was conducted in a large, metropolitan ED with annual census of over 82,000 adult presentations. ED patients who had BCs collected during the study period were identified, and those who had BCs recollected within 48 hours were identified as having early follow-up BCs. The characteristics of these patients were compared to those without early follow-up BC collection. Logistic regression analyses were conducted to determine relationships between specific pathogens in EDBCs and early follow-up BC collection.

During the study period, 68,330 patients were treated in the ED, and BCs were collected from 1821 (2.7%). Of these, 449 (24.7%) had BCs recollected within 48 hours of their initial ED workup (early follow-up BCs) and were re-cultured 789 times across their collective stays. Five patients (1.1%) grew pathogens not isolated in EDBCs, all of which were susceptible to concurrent antimicrobials. No new pathogens were isolated in BCs taken >48 hours post ED workup.

Collection of early follow-up BCs was common. However, the rate of new pathogen growth was low and contributed minimally to patient management. Given associated costs and patient discomfort, the practice should be discouraged unless to clarify potential false positive results in ED BC.