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.

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.

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.

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.

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.

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.

Acinetobacter baumannii is known to cause global outbreaks and routine surveillance to prevent nosocomial transmission has historically been limited. A longitudinal surveillance study of Acinetobacter isolates using whole genome sequencing (WGS) and whole genome multilocus sequence typing (wgMLST) was performed to map the distribution of sequence types (STs) and intrahospital transmission.

All Acinetobacter clinical isolates were collected in two hospitals (H1, H2) from fifteen units between 2017 and 2021 in Southeast Michigan and analyzed. The isolates were subjected to WGS using the NextSeq instrument (Illumina). The contigs were de novo assembled using SPAdes (v3.7.1) and wgMLST analysis was performed using BioNumerics software v7.6. Minimum spanning tree (MST) and dendrograms were created to map distribution of STs and putative transmissions.

ST2Pas was the most prevalent in both hospitals (H1:47.2% and H2:59.7%), followed by ST406Pas (H1:11.1%, H2:8%). ST15Pas (H1:9.7%) was only found in H1. Transmission was mapped for ST2Pas, ST406Pas (H1, H2), and ST15Pas for H1 and mainly located in the ICU settings.

Presence of several STs (ST2Pas, ST406Pas, and ST15Pas) prevalent from both hospitals suggest that these are common circulating strains in the area. Sporadic transmission events mainly in the ICU settings in both hospitals (H1 and H2) were noted indicating attention to enhanced infection prevention and control measures. Given that Acinetobacter infections are predominantly hospital acquired, an effective surveillance plan incorporating WGS and wgMLST may improve the ability to identify and track trends rapidly, implement effective infection control intervention, and reduce healthcare-associated infections (HAIs).

Days of antibiotic spectrum coverage (DASC) is a novel metric that incorporates the antibiotic spectrum into consumption metrics, addressing the limitations of traditional metrics such as days of therapy (DOT). This study aimed to evaluate the feasibility of integrating DASC into the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system.

Retrospective observational study.

Hospitals voluntarily participating in J-SIPHE.

Inpatients from 1,833 hospitals between January 2019 and December 2022.

Antibiotic use was assessed using DOT, DASC, and DASC/DOT. Antibiotic spectrum coverage scores were assigned based on published data or expert consensus. Annual trends were assessed using median values, and hospital-level variation was explored by hospital size. Proportional use of antibiotic classes by DOT and DASC was compared using 2022 data.

As the number of hospitals participating in J-SIPHE increased over time—particularly small and medium-sized hospitals—median DOT and DASC per 1,000 patient-days declined by 21.2% and 19.1%, respectively, from 2019 to 2022, while DASC/DOT remained stable. In 2022, proportional use of antibiotic classes varied by hospital size, and rankings differed when comparing DOT- and DASC-based measures. Broad-spectrum agents such as carbapenems and fluoroquinolones ranked higher by DASC than DOT. Hospital-level distributions of DOT and DASC/DOT showed substantial variation across hospital sizes.

Integration of DASC metrics into national surveillance is feasible. DASC and DASC/DOT complement DOT by incorporating spectrum breadth, providing more comprehensive insight into antimicrobial use patterns and supporting stewardship benchmarking and intervention planning.

Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) of the perineum. Recent retrospective studies from quaternary centers suggest improved outcomes and a potentially less aggressive clinical course for FG than non-perineal NSTIs. However, comprehensive nationwide data remain limited.

This retrospective cohort study analyzed the National Inpatient Sample (2016–2020) to compare outcomes between FG and non-perineal NSTIs. Adult patients undergoing surgical debridement with a diagnosis of FG or NSTI were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), hospital costs, and home discharge rates. Multivariable regression analyses adjusted for patient demographics, comorbidities, and hospital characteristics.

A total of 5,007 FG and 24,782 non-perineal NSTI patients were identified. Crude in-hospital mortality rates were 5.8% for FG and 5.4% for non-perineal NSTIs, with stable trends observed over five years. After adjustment, no significant difference in mortality was observed (adjusted odds ratio [aOR]: 1.04; 95% CI: 0.90–1.20). However, FG was associated with longer LOS (adjusted mean difference: 1.99 days; 95% CI: 1.53–2.46) and higher hospital costs ($37,809 higher; 95% CI: $29,540–$46,077). Home discharge rates were similar between groups (aOR: 0.97; 95% CI: 0.89–1.05).

Despite similar mortality rates, FG hospitalizations were associated with increased LOS and higher costs compared to non-perineal NSTIs. These findings may suggest potential nationwide disparities in FG care quality, particularly outside specialized referral centers. Further research is needed to understand if standardized care pathways tailored to FG may optimize management and reduce resource utilization.

To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.

Retrospective cohort study.

PINC-A1 Healthcare Database (2008–2021).

Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.

We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.

We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0–37.6%; full range: 0%–98.0%]; median odds ratio [95% CI]: 84.7 [63.3–115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%–0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04–1.31], P = .007).

Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.

Infection control measures like contact precautions may conflict with patient-centered palliative care principles, but their efficacy and harms in this context remain understudied. This review evaluates how contact precautions affect quality of life, social connectedness, and infection control efficacy in palliative care.

Systematic scoping review.

Palliative care settings (eg, palliative care units and hospices)

Adults and children receiving palliative care, with no restrictions on age or comorbidity.

English-language studies on contact precautions in palliative care were included. Ovid MEDLINE and Ovid Embase were searched from inception to December 20, 2024, using terms related to antimicrobial resistance, contact precautions, and palliative care. No publication type or status restrictions were applied. The protocol was registered on the Open Science Framework and followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Fifteen studies were included, primarily from Germany (73%) and using qualitative methods (80%). Most focused on patients in palliative care units or hospices, though geographic and methodological limitations restrict generalizability. Common challenges included fear, loneliness, disrupted intimacy, and inconsistent protocols. Contact precautions were often bundled with other infection prevention interventions, limiting the ability to assess their specific impact. Terminology varied widely. No study directly evaluated the efficacy of contact precautions in reducing antimicrobial-resistant organism (ARO) transmission, though one pediatric study reported liberal protocols and no nosocomial ARO infections.

A case-by-case approach is needed to balance infection control with patient dignity and quality of life. Consistent terminology and more robust, mixed-methods research are essential to inform evidence-based protocols in diverse settings.

To describe antimicrobial use in Tennessee from 2017 to 2023.

Retrospective analysis of antimicrobial use using data from the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option.

Acute care and critical access facilities in Tennessee.

From 2017 to 2023, 97 facilities in Tennessee submitted data to the NHSN AU Option. The number of reporting facilities increased from 25 to 95. During this time, the statewide average antimicrobial use significantly rose from 593 days of therapy (DOT)/1000 days present (DP) to 621 DOT/1000 DP (P = .0478). The All-Antibacterial Standardized Antimicrobial Administration Ratio (SAAR) values remained near 1.0, indicating overall use was as predicted. However, the All-Antibacterial SAAR values, particularly in small facilities, revealed that they utilized antibiotic agents more than predicted during the study period. Additionally, the SAAR trends varied by patient care locations, with the oncology unit (ONC) experiencing a significant increase from 0.73 to 1.12 (P-value<.0001). West Tennessee had the highest antimicrobial use rate at 736 DOT per 1000 DP, and an All-Antibacterial SAAR of 1.21. The top antimicrobial agents—vancomycin, ceftriaxone, piperacillin/tazobactam, cefepime, and cefazolin—accounted for 54% of the total antimicrobial use.

This statewide analysis of AU and SAAR trends identifies areas where additional antimicrobial stewardship efforts may be targeted to improve antimicrobial use. Facilities of different sizes and geographic locations have unique demographics that can affect antimicrobial use, requiring specialized antimicrobial stewardship techniques.

The objective of this systematic review and meta-analysis (SRMA) was to synthesize literature on the differences in risk of community-acquired third-generation cephalosporin resistant (3GC-R) uropathogens across racial and ethnic groups.

This SRMA builds on a completed scoping review of the association between race, ethnicity, and risk of colonization or community-acquired infection with ESKAPE pathogens. A literature search was conducted for the earlier scoping review in January 2022 and updated in March 2024. Following PRISMA guidelines, titles and abstracts were screened before advancing to full-text review and data extraction. A customized extraction form in Covidence captured relevant information from each study. For this SRMA, studies identified in the scoping review that reported case counts or effect measures related to colonization or community-acquired infection with 3GC-R uropathogens across distinct identities were included. Separate random effects meta-analyses assessed differences in risk of 3GC-R uropathogens between each minority racial/ethnic group and White/Caucasian persons.

Five studies comprising 13,527 subjects were included in the SRMA, among which there was generally a higher risk of 3GC-R uropathogens among Hispanic/Latinx and Asian persons compared to White persons. Only the meta-analysis of Hispanic/Latinx versus White/Caucasian persons yielded a statistically significant pooled risk ratio; specifically, Hispanic/Latinx persons had a 27% higher risk of harboring 3GC-R uropathogens (95% CI: 1.04, 1.55).

As antibiotic resistance rises in community settings, our findings support the need to understand the structural issues that underpin differential risk of 3GC-R uropathogens across race and ethnicity.

To analyze antibiotic prescribing trends and guideline concordance in outpatient settings using electronic health records (EHRs).

This quality improvement study utilized data from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, which integrates antibiotic prescribing data extracted from the EHRs of various outpatient facilities.

The study was conducted across 352 outpatient facilities in the United States.

The study included oral antibiotic prescribing data from outpatient encounters from January 2021 to June 2023, encompassing 823,938 prescriptions.

The primary outcomes were the rate of antibiotic prescribing per 1 000 prescription-related outpatient visits and identifying frequently prescribed antibiotics in adults and children. Secondary outcomes were the prescribing patterns for selected diagnoses and the concordance of these prescriptions with published guidelines.

The study estimated approximately a 20% increase in antibiotic prescribing per year, with an overall rate of 121.26 prescriptions per 1 000 prescription-related outpatient visits (95% confidence interval 121.01–121.50). Amoxicillin-clavulanate, amoxicillin, doxycycline, and cephalexin were most frequently prescribed. Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and Group A Streptococci. 51% of ciprofloxacin prescriptions were for patients aged 60 or older.

The findings stress the need for strengthened antimicrobial stewardship in outpatient settings. The increasing rate of antibiotic prescriptions and discrepancies in guideline concordance reiterate the importance of ongoing monitoring and targeted interventions.