Burn injuries result in loss of skin barrier and altered immune responses that in turn make patients especially vulnerable to healthcare-associated infections. Despite prolonged exposures of these patients to hospital environments, burn-specific infection prevention strategies are understudied. We present a research agenda identifying key research gaps and organizing them into priority areas to guide future investigations in this high-risk population.

Members of the Society for Healthcare Epidemiology of America (SHEA) Burn Infection Prevention and Control Special Interest Group and the American Burn Association (ABA) collaborated to develop this research agenda, combining expertise in infection prevention, antimicrobial stewardship, and burn care.

We identified five priority areas: (1) improving surveillance and epidemiologic data on burn infections; (2) better understanding of microbiology, including biofilms and the microbiome; (3) evaluating wound healing strategies; (4) refining infection prevention and control practices unique to burn units; and (5) building burn patient specific risk assessment and predictive models. The agenda highlights the need for standardized definitions and shared data platforms. It calls for evaluation of practical strategies for infection prevention, stewardship, and environmental control.

This research agenda intends to help guide future studies aimed at furthering knowledge and improving outcomes in burn care.

To determine the local applicability of 2021 American Academy for the Study of Liver Diseases spontaneous bacterial peritonitis (SBP) treatment guidelines by evaluating the microbiology and clinical outcomes of SBP cases in an academic health system.

Retrospective cohort study.

Five-hospital academic health system.

Hospitalized adult patients with SBP.

This study involved 2 components. First, patients meeting inclusion criteria with peritoneal fluid cultures positive for a pathogen were included in the culture-positive group. Antibiotic susceptibilities were analyzed for these patients. Second, remaining culture-negative patients were randomly selected and sequentially evaluated until the culture-negative and culture-positive groups were approximately the same size. Clinical data for all patients were evaluated based on empiric antibiotics received.

Forty-nine patients with culture-positive SBP and 48 patients with culture-negative SBP were included. Eight (16%) positive cultures contained TGC-nonsusceptible organisms. Patients receiving empiric third-generation cephalosporin (TGC) monotherapy had similar clinical outcomes as patients receiving empiric broad-spectrum therapy, including similar 30-day mortality (36% vs 38%; P = 1.00), 90-day mortality (55% vs 55%; P = 1.00), and median duration of hospitalization (6.5 d vs 8 d; P = .25). ICU admission, recent hospitalization, and nosocomial infection were not associated with TGC-nonsusceptible pathogen isolation in a univariate logistic regression analysis.

Within our health system, 16% of isolates in culture-positive SBP patients were nonsusceptible to TGCs. No statistically significant difference was detected in clinical outcomes in patients receiving TGC or broader-spectrum antimicrobial therapy.

To evaluate the efficacy of the Abbott ID NOW system in detecting COVID-19 using different specimen collection methods, emphasizing diagnostic accuracy and patient comfort.

Three cohorts were analyzed, including two using the nasopharyngeal (NP) swab technique and one utilizing the swish-and-gargle (SG) method. Positive percent agreement (PPA), negative percent agreement (NPA), and cycle threshold (Ct) values were assessed to determine the system’s performance.

The PPA for the NP swab cohorts averaged around 70%, while the SG cohort exhibited a higher PPA of 80%. All cohorts maintained high NPAs, close to 100%. The SG method significantly reduced false negatives, especially at lower Ct values, indicative of elevated levels of viral RNA. Additionally, the NP swab method, often uncomfortable, posed challenges in repeated testing scenarios, particularly among healthcare workers.

While the Abbott ID NOW system demonstrates reliable COVID-19 detection, the SG method emerges as a superior collection technique to NP swabs, offering enhanced diagnostic accuracy and improved comfort for test takers. This study underscores the importance of selecting appropriate collection methods to ensure accurate and efficient COVID-19 testing.

Despite concerns regarding toxicity and antimicrobial resistance, clindamycin prescriptions have remained significant at a large military healthcare system. This study evaluates patient and prescriber factors associated with outpatient clindamycin prescriptions.

This study evaluated clindamycin prescriptions filled between January and December 2023 at outpatient pharmacies in a large military healthcare system.

During the study period there were 1046 outpatients prescriptions for clindamycin among 972 adult and pediatric patients.

The cohort was predominately female (576, 55.1%) with a median age 48 [IQR 27.5–66]. The clinics with the most prescriptions were the emergency department (45.4%), primary care (23.6%), and surgical clinics (14.9%). While there were 533 prescribers, the ten highest writers of clindamycin accounted for 18.1% of all prescriptions. Beta-lactam allergy (38.5% vs. 16.0%, p ≤ 0.00001) was more common in patients with a dental indication and less common in those with a skin and soft tissue infection (51.3% vs. 23.3%, p ≤ 0.00001).

Despite local guidelines, clindamycin was still frequently used for a variety of indications in a large military healthcare system with high clindamycin resistance rates. Additionally, a small number of providers were found to be responsible for a disproportionate number of clindamycin prescriptions, highlighting potential targets for intervention for future antimicrobial stewardship interventions.

Limited data regarding predictors of antibiotic prescription for acute upper respiratory infections (URI) are available for ambulatory patients with cancer.

Adult cancer patients with URI who presented to the Urgent Care Center or Symptom Care Clinic (SCC) and had a respiratory pathogen panel (RPP) between September 1, 2019 and March 11, 2020, were evaluated. Patients were dichotomized by receipt of antibiotic prescription (yes vs no). Demographics, cancer treatment, URI characteristics, and URI management were compared by Student’s t test or Mann–Whitney U test and χ2 or Fisher’s exact test as appropriate. Logistic regression was performed to evaluate predictors of antibiotic prescription.

Of 552 patients, 384 (69.6%) received cancer treatment within 30 days of the URI, and 377 (68.3%) had a positive RPP result. Antibiotics were prescribed in 156 (28.3%) patients, and 26/156 (16.7%) were appropriate. Multivariate logistic regression showed that predictors of antibiotic prescribing included SCC visit location (odds ratio (OR) 2.09, 95% confidence interval (CI) 1.30–3.38), symptom duration >7 days (OR 2.29, 95% CI 1.26 – 4.17), earache (OR 9.30, 95% CI 3.47 – 24.93), sinus symptoms (OR 2.64, 95% CI 1.53 – 4.56), negative RPP result (OR 1.88, 95% CI 1.18 – 2.98), and negative RPP result for influenza (OR 3.31, 95% CI 1.53 – 7.16).

Almost one-third of outpatients at a single cancer center were prescribed antibiotics for URI with only 16.7% being appropriate. Getting real-time RPP results can be helpful to optimize antibiotic prescribing. Understanding risk factors for antibiotic prescribing in ambulatory cancer patients with URI may better direct antimicrobial stewardship efforts.

We recently added C. diff toxin assay to polymerase chain reaction (PCR) as a two-tier algorithm to investigate whether this approach improves patient outcomes and antibiotic stewardship.

Retrospective chart review.

305-bed acute care urban teaching hospital.

All inpatients admitted who tested positive for C. diff by PCR. Testing was performed by provider order on clinical suspicion of infection. Exclusion criteria were patients with chronic diarrhea, history of IBD, and recent gastric bypass surgery.

On April 1, 2023, the two-tier testing algorithm was implemented for patients who tested positive by PCR. The EMR was reviewed through May 1, 2024, to determine whether toxin-positive patients differed from toxin-negative patients with respect to their demographics, clinical characteristics, outcomes, and initiation of antibiotic treatment.

Of 147 consecutive C. diff PCR-positive patients, 32% tested toxin-positive (n = 57) and 51% toxin-negative (n = 90). Demographics were similar across groups. Toxin-positive patients showed more symptoms of colitis, more bloating, a higher average white blood cell count, and had a higher fatality rate. Antibiotics were more commonly prescribed to toxin-positive patients (98%) than toxin-negative patients (56%) (p < 0.01). Of the 90 patients who were toxin-negative, 44% of those were not treated with antibiotics.

Our study supports previous findings that a two-tier testing strategy effectively identifies active C. diff infection rather than colonization, effectively improving antibiotic stewardship efforts. Some toxin-negative patients also had colitis symptoms and responded to antibiotics, indicating that clinical judgment is still needed in cases with discrepant results.

Chronic kidney disease (CKD) is prevalent among US Veterans. Identifying patients undergoing dialysis in real-time is crucial for implementing patient safety measures, including stewardship interventions, such as medication dosing adjustments. Limited feasible and accurate tools exist for near-real-time identification. This study aimed to develop a renal replacement therapy (RRT) flag using structured data in the Veterans Health Administration (VHA) electronic health record (EHR).

Data from Veterans who underwent cardiovascular implantable electronic device (CIED) procedures (9/2015–12/2019) were linked to US Renal Data Systems (USRDS) data. Potential identifiers included outpatient hemodialysis procedure records, community care hemodialysis consults, ICD-10 diagnoses, and serum creatinine (SCr) >4 mg/dL. USRDS served as the comparison standard, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Logistic regression determined the area under the curve (AUC).

Among 37,706 CIED procedures on 34,994 Veterans, 967 patients (2.6%) were identified by USRDS as ever receiving RRT (hemodialysis and peritoneal dialysis or transplant), with 520 (1.4%) actively receiving RRT at the time of CIED. The RRT flag, combining ≥4 outpatient procedures in the prior 30 days, ≥1 consult in the prior year, and/or SCr >4 mg/dL, achieved an AUC of 0.976 (95% CI: 0.97–0.98), with high sensitivity (0.96; 95% CI: 0.94–0.97) and specificity (0.99; 95% CI: 0.99–1.00). The PPV was 0.70 (95% CI: 0.67–0.74). Performance was slightly lower when consults were replaced with ICD codes.

We developed an accurate electronic flag using structured data to identify active RRT within VHA among Veterans undergoing invasive procedures, supporting patient safety and care adjustments. This flag addresses a crucial patient safety gap and supports expansion of stewardship efforts.

Assess clinical outcomes, knowledge, and attitudes about shortage mitigation interventions during a nationwide blood culture bottle shortage. We hypothesized that efforts to target ordering of blood cultures would not change patient-oriented outcomes.

Retrospective, noninferiority, multicenter study

Tertiary, rural healthcare system

Eligible patients had any culture ordered before and after mitigation strategies.

Mitigation strategies were rapidly implemented to preserve the availability of blood culture bottles for high-risk patients. Interventions included best practice advisories, algorithms, cascade questions, hard stops, education, and communication.

The primary composite outcome (death during hospitalization, death within 14 d after discharge, return to the emergency department (ED) or readmission within 14 d after discharge) occurred in 603 of 3,174 patients (19.0%) in the pregroup and 1,496 of 8,232 patients (18.2%) in the postgroup (P = 0.321), meeting noninferiority in inverse probability treatment weight (IPTW) analysis. The groups were similar in secondary outcomes and in the subgroup with severe sepsis or septic shock. 69% of 41 survey respondents answered the case questions correctly. Regulatory pressure and patient status were the strongest drivers of blood culture ordering. Clinicians favored in-person communication, algorithms, and cascade over emails, daily huddles, and hard stops/second signatures.

Implementation of mitigation strategies during the shortage was not associated with differences in outcomes including mortality, return to the ED, readmission, or length of stay. Preliminary evidence suggests that outcomes may not be affected by the absence of blood cultures in high-risk sepsis patients. If proven in future studies, sepsis recommendations could be rewritten to accommodate pretest probability for bacteremia.

To determine the frequency of antimicrobial management changes in response to positive gastrointestinal pathogen multiplex panel (GIP) results in patients with suspected infectious diarrhea, identify predictors of those changes, and assess their guideline adherence.

Single-center, retrospective cohort study

Tertiary referral center, including ambulatory and acute care settings.

Adult and pediatric patients with diarrhea and positive GIP evaluated in emergency department, inpatient, or outpatient settings between January 1 and December 31, 2018, were included. Patients considered immunocompromised due to underlying conditions and/or current/recent immunosuppressive therapies were excluded.

The primary outcome of interest was any change in antimicrobial treatment in response to a positive GIP. The secondary outcome was adherence to pathogen-specific guideline-recommended management. Marginal standardization with logistic regression models was also used to assess predictors of antimicrobial management change.

The analysis included 193 patients with diarrhea and a positive GIP. The most frequently detected pathogens were norovirus, Salmonella, and Campylobacter. The median time from test collection to result was 31 hours [Q1, Q3: 24, 52]. Of the 193 patients, 71 (37%) experienced an antimicrobial management change, 61 of whom (86%) were considered guideline-adherent. In adjusted models, empiric antimicrobial treatment and testing in outpatient settings were significantly associated with experiencing an antimicrobial change.

Around one-third of patients with a positive GIP test experienced a change in antimicrobials, and most of these changes were guideline-adherent. Most GIP tests ordered during the study period were negative, and most positive tests did not require antimicrobial therapy.

Antimicrobial resistance (AMR) is a major global health threat, driven in part by inappropriate antibiotic use. This study assessed the prevalence, patterns, and determinants of antibiotic prescription among inpatients at Tanga Regional Referral Hospital (RRH), Tanzania, using the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology.

A cross-sectional PPS was conducted using the WHO tool. Descriptive statistics summarized prescribing patterns, and logistic regression identified factors associated with antibiotic use.

Tanga RRH in Tanzania among hospitalized patients in April 2023.

Among 205 inpatients (60.5% female), 77.6% (n = 159) received ≥1 antibiotic, with a mean of 2.1 agents per patient. Metronidazole (27.7%) and ceftriaxone (17.6%) were the most frequently prescribed antibiotics. Only 2.4% of prescriptions were supported by antimicrobial susceptibility testing. In multivariate analysis, the absence of a peripheral vascular catheter was independently associated with reduced odds of antibiotic use (aOR 0.16, 95% CI: 0.06–0.43). Although 89% of prescriptions followed the Tanzanian Standard Treatment Guidelines, prescribing patterns diverged from WHO stewardship targets: only 53.8% of antibiotics were from the Access group (below the ≥60% recommended threshold). In comparison, 44.4% belonged to the broader-spectrum Watch group.

Antibiotic use in Tanga RRH was high, with limited microbiological guidance and heavy reliance on broad-spectrum Watch antibiotics, highlighting stewardship gaps. Strengthening antimicrobial stewardship and expanding diagnostic capacity are urgently needed to optimize antibiotic use and curb AMR in resource-limited settings.

This study aimed to compare appropriateness of restricted antimicrobial prescriptions, as assessed by antimicrobial stewardship program (ASP) prospective audit and feedback (PAF), between those ordered by medical trainees versus staff. Secondary objectives were to determine whether certain timing factors and other independent variables impacted prescription appropriateness.

Single center, retrospective cohort study.

The University of Alberta Hospital a 700-bed tertiary care hospital in Edmonton, Canada.

Prescriptions of six health-authority restricted antibiotics subject to ASP PAF between 2018 and 2023. Cases were excluded if prescriber role or prescription dates or times were unavailable.

Data from a local ASP quality improvement database was extracted. Multiple logistic regression analysis was completed with adjusted odds ratios (aOR) reported.

A total of 3,687 restricted antibiotic prescriptions subjected to PAF were included in this study, of which 1,163 (31.5%) were assessed as not appropriately prescribed. Prescriptions written by medical trainees did not have higher odds of appropriateness compared to staff (aOR 1.09 [95% CI 0.94–1.28], P = .25). Weekend prescriptions had a reduced odds of being appropriate (aOR 0.71 [0.60–0.84], P < .0001). Through the course of the Coronavirus Disease 2019 (COVID-19) pandemic, appropriateness improved from 56.2% (prepandemic), 71.5% (peri-pandemic) to 76.9% (postpandemic).

No differences were noted in restricted antibiotic prescription appropriateness between medical trainees and staff. Weekend prescriptions were less likely to be appropriate. Improved appropriateness over time may be multifactorial, including implementation of ASP preceding the pandemic. Further studies examining timing factors associated with appropriateness are needed.

Infection control practices are essential in any healthcare setting, including the prehospital setting, to protect both patients and healthcare providers. Yet, many unknowns exist about these practices in EMS settings. This review explores infection control practices in emergency medical services by exploring compliance rates and barriers documented in the published literature.

To identify relevant articles, a comprehensive search of the databases Embase, PubMed, and CINAHL was conducted. Furthermore, a hand-search of the reference lists from the included studies was performed to identifyadditional relevant research. The review followed the Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines.

A total of 184 records were initially identified—159 through database searches and 25 through hand-searching the reference lists. After removing duplicates and excluding non-English records and those published outside the specified time frame, 162 records remained. Title and abstract screening narrowed these down to 52 articles for full-text review, of which 16 met the inclusion criteria and were included in the final review.

The findings indicate that compliance rate with infection control practices among EMS providers falls short of the desired levels. However, most of the included studies utilized self-reported methods to assess compliance, which may not accurately reflect actual practices. Therefore, future research should incorporate direct observations to gain a clearer understanding of current practices. Furthermore, this review identified that the barriers faced by EMS providers are complex and multifaceted, necessitating a comprehensive strategy to effectively address these challenges.

Postdischarge antibiotics are often sub-optimal or unnecessary. This study sought to measure the risk of diarrhea in recently hospitalized patients treated with postdischarge antibiotics

Retrospective cohort study.

125 acute-care hospitals in the Veterans Health Administration (VHA).

Patients hospitalized within VHA during 2018–2021.

The primary exposure was postdischarge antibiotics. The primary outcome was time to C. difficile testing, which served as a surrogate marker for clinically significant diarrhea. Only tests that were performed during the 30 days after discharge and before all-cause hospital readmission were captured. We constructed a final Cox proportional hazards model with 27 fixed-effect predictors as well as a random intercept for each hospital.

There were 1,686,819 qualifying admissions, and 333,310 (19.8%) received postdischarge antibiotics. There were 13,387 patients (0.8%) who had a test for C. difficile done. Among those tested, the median time to testing was 6.7 days for those tested while on postdischarge antibiotics and 14.1 days for those tested while not on postdischarge antibiotics. Compared to patients not on postdischarge antibiotics, the hazard ratio for testing was 1.40 (95% CI, 1.29–1.51) among patients on low-risk postdischarge antibiotics and 1.56 (95% CI, 1.42–1.71) among those on high-risk postdischarge antibiotics.

In this national VHA hospital cohort, patients prescribed postdischarge antibiotics had a 40–56% increased risk of C. difficile testing compared to those not prescribed postdischarge antibiotics. Efforts to optimize antibiotic-prescribing at hospital discharge, particularly by reducing excessive duration and avoiding high-risk agents, may help mitigate these risks.