Central line-associated bloodstream infections (CLABSIs) and surgical site infections (SSIs) are major healthcare-associated infections that can be prevented by consistently applying evidence-based infection prevention practices.

To assess equity in preventing CLABSIs and SSIs in pediatric patients at a free-standing pediatric hospital, where evidence-based infection prevention practices are consistently implemented.

This observational study evaluated 2 cohorts of pediatric patients under 18 years. The CLABSI cohort included inpatients with a central line between 1/1/2016 and 12/31/2022, and the SSI cohort included patients undergoing colon, ventricular shunt, or spinal fusion surgeries between 1/1/2016 and 10/31/2022. The CLABSI rate per 1000 central line days and SSI rate per 100 surgeries were compared across different racial, ethnic, and gender groups.

In the CLABSI cohort of 8575 patients, encompassing 243,803 central line days, there were 156 CLABSIs. There was no statistical difference in CLABSI rate across race, ethnicity, and/or gender groups. The SSI cohort included 68 SSIs among 1710 patients who underwent 2230 procedures, including 714 colon, 749 ventricular shunt, and 767 spinal fusion procedures. The SSI rate was statistically higher in multiracial (9.9) and Asian (8.6) groups, compared to Caucasian (2.4) and Black (2.2) groups. A nested case-control study of the SSI cohort showed a higher SSI rate in Asians, compared to Caucasians (Odds Ratio: 3.3; 95% CI: 1.3–8.3).

Equity in preventing CLABSIs is achievable through standardized central-line care. Further study is warranted to assess if improvement opportunities exist for achieving equity in preventing SSIs.

To characterize the clinical and microbiological features of carbapenem-resistant Enterobacterales (CRE) compared to carbapenem-susceptible Enterobacterales (CSE) in the Dominican Republic (DR), and to assess risk factors associated with CRE.

Retrospective case-control study.

Hospital General Plaza de la Salud, a tertiary teaching hospital in Santo Domingo, DR, from January 2015 to June 2024.

Patients with CRE infections were identified from microbiology records. For each year, a matched group of CSE cases was selected at a 2.5:1 ratio. A total of 101 CRE cases and 280 CSE cases were included.

Data were collected on demographics, comorbidities, infection sources, hospital stay duration, antibiotic use, and microbiology results. Statistical analysis included univariate and multivariate logistic regression to identify independent risk factors for CRE.

CRE cases showed higher prevalence of Enterobacter (36.5%) and Klebsiella (38.5%), while Escherichia predominated in CSE (65.5%). CRE patients had longer hospital stays (mean 18.7 vs 4.6 days, P < 0.001), higher ICU admission rates (34.7% vs 3.6%, P < 0.001), and increased invasive procedure use (eg central venous catheters, 36.6% vs 5.4%, P < 0.001). Key risk factors included antibiotic use (OR 3.09, P < 0.001) and ICU stay (OR 3.60, P= 0.012). The peak CRE resistance rate was 3.47% in 2022, a 64% increase from pre-pandemic levels.

CRE infections in the DR increased during the COVID-19 pandemic, associated with prolonged hospitalizations and critical care. Enhanced antimicrobial stewardship is essential to curb resistance.

This study focused on exploring the relationship between antimicrobial use indicators, including the modified antibiotic heterogeneity index (mAHI), and the carbapenem susceptibility in Pseudomonas aeruginosa.

Survey-based observational study conducted across multiple facilities.

Public community hospital institutions.

This survey was conducted in 15 community hospitals in Japan. Indicators, such as the defined daily doses (DDDs), days of therapy (DOTs), antibiotic heterogeneity index (AHI), and mAHI, were analyzed for P. aeruginosa carbapenem susceptibility using Spearman’s rank correlation. The predictive accuracies of the AHI and mAHI for carbapenem susceptibility were compared using DeLong’s test for the 2 correlated receiver operating characteristic curves.

No significant correlations were observed between DDDs or DOTs and carbapenem susceptibility. However, a significant correlation was observed between carbapenem susceptibility and the mAHI (r = 0.261, P = .02), which also demonstrated a higher predictive accuracy for high susceptibility rates than that of the AHI (area under the curve: 0.75 vs 0.58, p < .01). The optimal mAHI cutoff value for predicting 90% susceptibility was 0.765, with a sensitivity of 67.7% and specificity of 76.5%.

The mAHI may be a better predictor of carbapenem susceptibility than other commonly used indicators. This study underscores the utility of the mAHI as an effective indicator of antimicrobial usage patterns for managing carbapenem susceptibility in P. aeruginosa. Incorporating the mAHI into antimicrobial stewardship programs could enhance the effectiveness of antimicrobial interventions across diverse healthcare settings.

At Saint George Hospital University Medical Center in Beirut, Lebanon, we determine (1) annual blood culture (BC) contamination (BCC) and utilization (BCU) rates vs international benchmarks, (2) identify blood culture contaminants, (3) bloodstream infections episodes in patients with and without COVID-19 after the pandemic onset, and (4) any epidemiologic trends in BCC and BCU.

Retrospective observational study.

Private tertiary referral center, from January 1, 2010, to December 31, 2022.

We define a contaminated BC as the growth of a typical contaminant/skin flora in 1-2/4 BC bottles. We calculate BCC rates as a percentage of the contaminated BC/total BC during the period and BCU rates as the number of BC/1000 patient days (PD).

The average BCU rate of 85.9/1000 PD in 2010–2019 increased to 106.6/1000 PD in 2020–2022. On average, patients with COVID-19 had a higher BCU rate of 185.9/1000 PD, corresponding to an additional 100 blood cultures/1000 PD. The average BCC rate was 7%, ranging from 6% in 2010–2019 to 8% in 2020–2022. We observed the highest BCC rate of 9% in patients with COVID-19, likely due to the higher BCU. The most frequently isolated contaminants were coagulase-negative Staphylococcus (96%), of which 65% were Staphylococcus epidermidis.

We saw a multifactorial, persistently elevated rate of BCC over 13 years as unaffected by strict infection control practices. We think that further research targeting a standardized, low BCU rather than inevitable BCC while advocating for diagnostic stewardship of low-middle-income countries is essential, especially where the lack of appropriate resource allocation and awareness are problematic.

This systematic review aims to synthesize evidence from current literature to describe how Electronic Medical Record (EMR) primary care data have been used for antimicrobial stewardship activities internationally.

Systematic literature review.

We searched Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, and Web of Science from January 1, 2013 to September 23, 2023 to retrieve studies that included concepts of “antimicrobial stewardship,” “primary care,” and “electronic medical records.” We used narrative synthesis to classify and interpret results. Data were grouped and tabulated by similar themes and concepts, including strengths, facilitators, barriers, and limitations for antimicrobial stewardship.

A total of 265 articles were identified from the initial search, of which 34 full-text articles from 10 countries met all criteria and were included in the review. Six categories of EMR data use were identified from the studies, these were for: assessing antimicrobial prescribing quality, measuring the effectiveness of an intervention, analyzing antimicrobial prescribing trends, assessing patient and provider characteristics in prescribing, evaluating novel tools or measures, and measuring specific conditions and outcomes. Facilitators of use of EMR data were generally well-described across the studies reviewed; however, barriers were not. Barriers described were centered around EMR system design and technical challenges in data extraction. Completeness of EMR data was the most consistently described limitation.

Our study highlights the range of uses of EMR data in supporting AMS in primary care internationally, and its strengths, facilitators, and barriers to use.

Discrepancies or inaccuracies between testing methods can create confusion or lead to clinical harm if antibiotics are inappropriately chosen. We report our clinical experience using the Accelerate Pheno™ followed by routine automated susceptibilities by the Vitek®2 for positive blood cultures with gram-negative rods.

This was a retrospective review of positive gram-negative blood cultures, including comparison of susceptibility testing results and impact on clinical care.

Academic teaching hospital.

All patients admitted to the hospital with gram-negative bacteremia from January 2020 to December 2022.

Microbiology was reviewed for discrepancies as defined by very major errors (VMEs), major errors (MEs), and minor errors (mEs). Clinical charts were reviewed for antibiotic therapy.

Positive blood cultures with gram-negative rods were included (n = 262). Between these two methods, overall essential agreement was 93.7% (2162/2304) and categorical agreement 93.5% (2159/2306). There were 147 discrepancies noted, including 6 VMEs, 25 MEs, and 116 mEs accounting for 96 patients. Antibiotic choice was changed in 8 patients due to perceived suboptimal empiric therapy based on the rapid susceptibility results.

The Accelerate Pheno tended to over-call resistance compared to the Vitek®2. Few patients (8) received the incorrect antibiotic based on the Pheno result. Stewardship programs may choose to optimize their rapid antibiotic susceptibility testing reporting to help minimize confusion and guide appropriate antibiotic selection.

To analyze antimicrobial prescribing practices in Australian emergency departments (ED), identifying prescribing areas requiring improvement. This aims to inform antimicrobial stewardship (AMS) strategies to enhance antimicrobial prescribing quality.

Retrospective analysis of the Hospital National Antimicrobial Prescribing Survey (NAPS) data set.

EDs in public and private Australian hospitals (n = 652).

Hospitals (n = 652) that participated in the Hospital NAPS from 2013 to 2022.

Data were collected by trained auditors from participating hospitals with the use of a standardized auditing tool, the Hospital NAPS. Data from 2013 to 2022 were analyzed descriptively. Variables assessed included guideline compliance and appropriateness by antimicrobial and indication, and reasons for inappropriateness.

There were 3,098 antimicrobial prescriptions from EDs included for analysis. Guideline compliance (63.5%) and appropriateness (70.4%) in EDs were lower compared to overall prescribing practices from all departments. The most commonly prescribed antimicrobial was ceftriaxone (16.9%, n = 523), and the most common indication was empiric prescribing for community-acquired pneumonia (16.0%, n = 497). Amoxicillin-clavulanic acid (53.2%, n = 99), and acute exacerbation of chronic obstructive pulmonary disease (54.3%, n = 57), were the antimicrobial and indication with the lowest rates of appropriateness respectively. Ceftriaxone prescribing also had a low rate of appropriateness (62.3%, n = 326). Selection of antimicrobials with too broad of a spectrum was the most common reason for inappropriateness (40.2%).

Antimicrobial prescribing quality in EDs warrants improvement. Recommended targets for AMS interventions are the excessive and inappropriate use of broad-spectrum antimicrobials such as ceftriaxone and amoxicillin-clavulanic acid in common respiratory and urinary tract infections.

To compare the recovery of yeast from hospital surfaces from two different collection methods: Eswab moistened with molecular water, and premoistened stick-mounted sponge.

Comparison of collection methods for the recovery of yeast in the hospital environment.

This study took place at intensive care units of a large academic medical center.

Identify essential components of a curriculum on antimicrobial stewardship (AS) for pediatric residents.

Survey.

Academic tertiary care children’s hospital.

Pediatric residents and infectious diseases (ID)/AS content experts (CE), including pediatric ID faculty, fellows, nurse practitioners, and pharmacists.

Residents were surveyed to assess prior AS experiences and usefulness of education in different AS domains (e.g., antimicrobial resistance [AMR]). CE was surveyed to identify content to include in an AS curriculum. A specific topic (e.g., resistance in Staphylococcus aureus) achieved consensus if ≥80% of CE identified the topic as “very” or “extremely” important.

Thirty-three of 110 pediatric residents responded to the resident survey (response rate 30%). Spectrum of activity (97%), empiric therapy (94%), and duration of therapy (94%) were the domains identified by the most residents as “very” or “extremely” useful. All CE responded to the CE survey (n=26). Thirty-nine of 105 topics (37%) met the consensus threshold. The domains with most topics achieving consensus were empiric therapy (11/13 topics, 85%) and duration of therapy (5/8 topics, 63%). Only one topic was identified within the domains of antibiotic allergies, diagnostics, and AMR, reflecting 18%, 14%, and 6% of the potential topics within each domain, respectively.

A pediatric AS curriculum focused on empiric therapy and duration of therapy is likely to meet the needs of both learners and CEs.

The increase in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cases due to the omicron strain led to reduced acute care hospital beds at the Veterans Administration (VA) Hospital, North Texas; veterans with non-severe coronavirus disease 2019 (COVID-19) disease were managed at a community living center (CLC), a VA nursing home. The management of non-severe COVID-19 in VA nursing homes has not been extensively described.

We describe resident characteristics and outcomes, and infection control practices implemented during 2 COVID-19 outbreak periods (January 12–February 15, 2022, June 28–July 14, 2023). Serial testing of all CLC residents was conducted, and residents with polymerase chain reaction-confirmed SARS-CoV-2 (COVID-19) infection were included in the analysis. Resident data were ascertained from the COVID-19 facility dashboard and medical record system.

From January 12 to February 15, 2022, and June 28–July 14, 2023, 62 adults residing at the CLC were diagnosed with COVID-19. Overall, the median age was 75 years [interquartile range, 71–80], and 57 (91.9%) were men. Residents were cohorted by COVID-19 test results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning, and doffing of PPE. Thirty-seven (59.7%) residents were symptomatic. Overall, 55 (88.7%) residents were documented to have received the SARS-CoV-2 primary vaccination series. Most residents were managed at the CLC, while 12 (19.3%) were hospitalized in acute care.

It is feasible to manage high-risk residents with non-severe COVID-19 disease in a CLC utilizing a multidisciplinary approach and implementing Infection Prevention and Control strategies.

The present study aimed to describe ICU antibiotic use based on data reported from 2009 to 2018 to the Nosocomial Surveillance System (NSS) of the State Health Department in the State of Sao Paulo, Brazil.

Ecological study.

Data obtained from hospitals located in the state of São Paulo, Brazil from 2009 to 2018.

Intensive care units located at participant hospitals.

Data on healthcare-associated infections, antibiotic usage, and bacterial identification were collected and reported monthly by hospitals. Antibiotic consumption was quantified as defined daily doses (DDD) per 1000 patient-days. The relationship between antibiotic use and bacterial resistance, categorized by hospital type and ICU complexity, was analyzed using statistical methods to assess correlations and significance.

Our findings reveal an escalating trend in antibiotic consumption over the study period, with a notable increase from 588.16 DDD per 1000 patient-days in the initial year to 943.12 DDD/1000 patient-days in the final year (p < 0.01). Cephalosporins emerged as the most frequently utilized class, accounting for 33.9% of total antibiotic consumption. Public hospitals exhibited significantly higher antibiotic use compared to private and philanthropic institutions, with a mean of 889.11 DDD/1000 patient-days in public hospitals compared to 849.07 DDD/1000 patient-days in private hospitals and 785.12 DDD/1000 patient-days in philanthropic hospitals (p < 0.05).

The study provides critical insights into antibiotic use and resistance in different hospital settings, emphasizing the importance of tailored antimicrobial stewardship strategies.