To describe the implementation of an outpatient UTI intervention and its impact on UTI management.

Quasi-experimental retrospective controlled study.

Outpatient clinicians practicing in emergency and primary care settings within 8 Veterans Affairs Medical Centers.

An intervention conducted utilizing the CDC Core Elements Antibiotic Stewardship framework between September 2022 and July 2023. Actions included academic detailing, audit feedback, and updated reflex culture procedures. Logistic regression adjusted for covariates (risk ratio [RR], 95% confidence interval [CI]), and a difference-in-differences (DID) analysis compared multiple UTI management metrics between intervention and control facilities.

There were 278,419 and 157,067 genitourinary (GU) tract qualifying visits [mean (SD) age 71.7 (13.9), 92.6% male] within 8 intervention and 8 control sites, respectively. Antibiotic prescribing rates for a broad-based GU tract metric that included UTIs pre/post implementation were [N, (%)] 12,688 (8.0) and 4,062 (8.0) within intervention sites and 5,686 (6.3) and 1,920 (6.8) within control sites, respectively [DID aRR 0.97 (0.92, 1.02)]. Appropriate treatment selection for uncomplicated UTI (uUTI) pre/post implementation was 5,994(76.9) and 1,945(79.9), compared to 2,519(74.6) and 977(82.1) within control sites, respectively [DID aRR 0.94 (0.91, 0.98)]. uUTI appropriate treatment duration pre/post implementation was 5,709 (73.3) and 1,927 (79.2), compared to 2,469 (73.1) and 869 (73.0) within control sites, respectively [DID aRR 1.08 (1.03, 1.13)]. No evidence of diagnostic shifting or return GU visits post-implementation was observed.

Implementation of an outpatient UTI intervention in a predominantly male population was feasible but marginally effective.

Antimicrobial resistance (AMR) is a complex One Health problem that requires continuous surveillance to minimize the potential hazards. Information must be disseminated promptly in easily understandable formats to support informed decisions and actions by data end-users. One way to address this is through real-time visualizations, such as dashboards, to help key interest-holders understand and monitor AMR. A scoping review was conducted to understand the current body of evidence surrounding real-time AMR visualizations in both veterinary and human health.

Twelve sources were searched for relevant citations. 1763 citations were included in the screening process. Citations were screened for four main criteria: (i) the text had to be a primary research article in English (ii) published between 1990 and 2023, and (iii) it had to discuss the methodology of an AMR display (iv) that was updated at least quarterly.

Forty-two publications were identified as relevant. Publication information, information about the data used in the described displays, display information, and user information were charted. Publications were from 25 countries and utilized data from over 40 databases. Various bacterial genera and species were reported; the most common bacterial species were Escherichia coli and Staphylococcus aureus. Displays were most focused mainly on human data.

AMR data visualization has been implemented globally and is a critical component of continued AMR surveillance. Displays are often part of a larger surveillance system. A key challenge is designing a visualization for an intended audience and the information then being utilized by that audience.

To evaluate healthcare workers’ (HCWs) providing tuberculosis (TB) services knowledge, attitudes, and practices (KAP) regarding infection prevention and control (IPC), assess barriers and facilitators to TB IPC implementation and adherence, and evaluate existing TB IPC policies at public health facilities in Namibia’s //Karas region.

Concurrent mixed-methods design.

Public healthcare facilities in Namibia’s //Karas region.

Quantitative data were collected using an online questionnaire distributed via email and social media platforms to HCWs providing TB services. Descriptive statistics were used to summarize respondent characteristics and KAP scores, followed by bivariate analysis using the Pearson χ2 test (P < .05) to assess associations between knowledge scores and respondent characteristics. Focus group discussions (FGDs) were conducted with TB focal persons from District Coordinating Committees, transcribed, and analyzed thematically using a 6-phased approach. Data collection spanned 8 months (April 17–November 10, 2023).

HCWs demonstrated good knowledge (91.2%) and positive attitudes (85.3%) toward TB IPC, with practice scores less optimal (61.8%). Knowledge was associated with district (P = .001), department (P = .036), and education level (P = .010). Staff shortages were the most cited barrier, and training emerged as a key facilitator. FGDs confirmed the implementation of TB IPC policies at institutional level and revealed barriers, including inadequate infrastructure, limited resources, stigmatization, and lack of managerial support. Facilitators included effective communication, health education, and personal protective equipment availability.

Strengthening TB IPC requires investment in infrastructure, training, consistent monitoring, and policy enforcement. Targeted IPC interventions can address key barriers and improve adherence across public health facilities.

To evaluate the impact of a guidance document on treatment decisions and clinical outcomes for infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and Stenotrophomonas maltophilia.

This was a single-center, retrospective, quasi-experimental, pre- and post-intervention study. The primary outcome was adherence to antibiotic selection and dosing as recommended by the guidance document. Secondary outcomes included clinical efficacy, readmission within 90 days, all-cause 30-day mortality, 90-day microbiologic recurrence, and antibiotic-associated adverse effects.

The study was conducted at a large, academic medical center in the Southeastern United States.

The study included adult patients who were admitted to our institution from November 2018 to June 2024 who grew CRAB or S. maltophilia from any culture and were definitively treated.

This study included an institution specific treatment algorithm for the treatment of infections caused by resistant gram-negative organisms published on June 1st, 2022, on our institution’s antimicrobial stewardship website.

Twenty-two patients with CRAB (14 pre- and 8 post-intervention) and 150 with S. maltophilia (75 pre- and 75 post-intervention) were evaluated. For CRAB, 0 (0%) patients in the pre-intervention group and 5 (62.5%) in the post-intervention group met the primary outcome (P < .001). For S. maltophilia, 21 (28%) patients in the pre-intervention group compared to 38 (50.7%) in the post-intervention group met the primary outcome (P < .004). Secondary outcomes did not differ significantly pre- and post-intervention.

These findings demonstrate that implementing a local treatment guideline based on IDSA guidance may increase the utilization of evidence-based directed antimicrobial therapy for CRAB and S. maltophilia.

Previous antimicrobial therapy is a common risk factor for Clostridioides difficile infections (CDIs). Clinical practice guidelines (CPGs) assist clinicians in prescribing the correct antibiotics for various clinical syndromes to avoid unnecessary or overly broad-spectrum antibiotic use. Understanding adherence to CPGs can help determine the preventability of CDIs.

Quality improvement project.

Tertiary military medical hospital.

All patients with positive test for Clostridioides difficile at Brooke Army Medical between November 2022 and October 2023.

During the evaluation period, 128 positive cases were identified. In the three months prior to a positive test, 85 (67%) of patients had at least one day of antibiotic exposure. For those receiving antibiotics, the median number [Interquartile Range (IQR)] of total antibiotic days within 30, 60, and 90 days of a positive test was 6 [2 – 9], 7 [4.5 – 13.5], and 7 [5 – 14] days, respectively. In these cases, all antibiotic indications appeared on the CPG for 50 (59%) cases. However, prescribers did not adhere to the CPG in 23 (46%) of these cases. Overall, 58 cases (45%) were considered preventable due to clinicians not following the CPG or a condition not appearing on the CPG.

In this single center study, retrospective analysis of individual CDI provided direction for the antimicrobial stewardship team by identifying CPG recommendations that were not followed as well as identifying conditions not on previous CPGs. Tying patient harm from CDIs with inappropriate antimicrobial use builds the local evidence base to prevent future CDIs.

To evaluate the ability of large language models (LLMs) with targeted feedback to classify medications as antimicrobial or non-antimicrobial and their implication in antimicrobial stewardship.

Cross-sectional evaluation using a two-phase process: initial unguided classification and feedback-informed reclassification.

Medication-level analysis of health system prescribing data.

A data set of 7,239 unique medication entries from health systems in the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) project.

Four LLMs, including ChatGPT-3.5, Copilot GPT-4o, Claude Sonnet 4, and Gemini 2.5 Flash, classified all entries against a manual reference standard. Models then received feedback on 20% of misclassified cases for reclassification. Metrics included accuracy, macro F1-score (95% confidence intervals via bootstrap resampling), positive predictive value, negative predictive value, processing time, and error reduction rates (ERRs). McNemar’s test assessed accuracy between phases and model differences.

Baseline accuracy varied among LLMs. Postfeedback, all accuracies improved significantly (P < .001) to Gemini (99.6%), Claude Sonnet 4 (99.4%), ChatGPT-3.5 (81.0%), and Copilot (79.7%). Gemini achieved the highest macro-F1 (98.9%, 95% CI: 98.4–99.3) and ERR (69.2%). Processing time were fastest for Copilot (42 s), followed by ChatGPT-3.5 (47 s), Gemini (1,080 s), and Claude (3,475 s). Manual classification of this task is estimated to take 18 hours without LLM. Misclassification was most common among antiseptics, antiparasitics, and drugs with antimicrobial components for non-infectious uses (eg, sulfasalazine).

Top-performing LLMs achieved accuracy levels suitable for automating initial antimicrobial classification in stewardship workflows. Performance variability underscores the need for careful selection and continued human oversight in clinical applications.

Four LLMs were evaluated for antimicrobial classification using 7,239 medications. Claude Sonnet 4 and Gemini achieved>99% accuracy, while ChatGPT-3.5 and Copilot showed substantial limitations. Top performers could automate stewardship workflows with appropriate oversight.

Evaluating the COVID-19 pandemic restrictions and their effect on rates of new respiratory viral infections in patients undergoing hematopoietic stem cell transplantation (HSCT), and if there were changes to the morbidity and mortality rates compared to historical controls.

Retrospective chart review.

University-based tertiary care center.

All patients who underwent HSCT, including chimeric antigen receptor T-cell therapy, between 7/1/2013 and 12/19/2021 were included in the study. No eligible patients were excluded.

We found a significant difference in new respiratory infections as measured by a respiratory viral pathogen (RVP) polymerase chain reaction-based assay during transplant admissions between the pre- and early COVID-19 eras, with complete absence of new respiratory viral infections in the early COVID-19 era. The late-COVID-19 era, coincident with availability of severe acute respiratory syndrome coronavirus 2 vaccines and relaxation of some hospital-based restrictions, had a similar incidence of new RVP positivity compared to the pre-COVID-19 era. For allogeneic HSCT outcomes alone, rates of pediatric intensive care unit admission (66.7% vs 32.2%, p = .01), intubation (57.1% and 18.6%, p < .01), and oxygen requirement (66.7% vs 40.7%, p = .04) were found to be statistically different with new RVP positivity. Other outcomes examined, including death at 100/180/365 days post-transplant, length of stay, and acute graft-versus-host disease incidence, were similar, regardless of new RVP positivity.

In order to reduce morbidity, these findings argue for a continuation of the strict protective isolation practices initially employed during the pandemic for HSCT patients, particularly during viral emergence following the COVID-19 lockdown.