To characterize the incidence of contact precautions (CPs) on a palliative care unit (PCU) at a tertiary hospital in Canada.

Descriptive retrospective chart review.

Palliative care unit.

Adults admitted to the PCU who were placed on CPs during admission.

A retrospective chart review was conducted on all PCU admissions for 25 months from September 24, 2022, to October 29, 2024. Patient orders, clinical notes, medication records, microbiology results, and transport documentation were reviewed. A descriptive and basic comparative statistical analysis was performed.

CPs were used in 13 of 549 patient encounters (2.37%), with an incidence of 2.02 per 1,000 PCU patient-days. Indications included known MRSA (5/13), suspected CPO (4/13), new MRSA (3/13), and known vancomycin-resistant Enterococcus (1/13). The mean duration of CPs was 15.4 ± 14.1 (range 0.2–47.8) days. Mean hospital and PCU lengths of stay in the CP group were 24.8 ± 14.7 and 14.6 ± 14.8 days, respectively, compared to 23.8 ± 31.3 and 11.7 ± 11.7 days in the non-CP group (P = .816 for hospital stay; P = .491 for PCU stay). No significant differences were observed between groups in age, sex, or length of stay. Antibiotics were used in 9/13 patients, and 5/13 patients remained on CPs until death on the PCU.

This study is the first known retrospective review of CP use in palliative care. Further research is needed to explore its impact on infection outcomes, mortality, and patient-centered measures.

This study aimed to evaluate the impact of a pharmacist-led support system on the administration rate of vancomycin (VCM) loading dose, 0–24-hour area under the concentration–time curve (AUC0–24), incidence of acute kidney injury (AKI), and all-cause mortality in hospitalized patients.

This retrospective study with interrupted time series analysis was conducted from January 2021 to May 2024.

A public tertiary referral center providing acute and specialized inpatient care in Japan.

Among the 587 hospitalized patients who received VCM during the study period, 326 were evaluated.

The intervention comprised implementation of a pharmacist-led support system involving prospective prescription review and direct intervention when a VCM loading dose (25–30 mg/kg) was not prescribed.

The loading dose administration rate increased significantly by 43.2% immediately introducing the support system (95% confidence interval: 8.40–77.90; P = 0.0156), without significant trend change thereafter. AUC0–24 also increased significantly (241.0 vs 307.0; P < 0.001); there were no significant differences in AKI incidence or 90-day mortality.

The support system improved the loading dose administration rate and AUC0–24 without significantly increasing AKI or mortality. The improvement was immediate and sustained over 122 weeks, supporting its use in institutions aiming to optimize VCM loading doses where evidence remains limited.

Healthcare has deleterious impacts on the environment through production of massive amounts of waste leading to generation of greenhouse gas (GHG) emissions. Single-use materials used for preparation and administration of intravenous (IV) medications are a large component of hospital waste. Transitioning medications from the IV-to-oral (PO) route, called switch therapy, may be a means of decreasing unnecessary waste and associated emissions arising from hospital care.

This was a retrospective cohort study involving adult patients receiving IV antimicrobials with a highly bioavailable PO equivalent at a large academic medical center. For a randomly selected subset of patients, the mean number of IV days of therapy (DOT) for which PO therapy could have been administered based on our institution’s policy was determined for each antimicrobial. This proportion was applied to the full cohort to estimate the total unnecessary IV DOT. A GHG emissions estimation tool was used to estimate the emissions generated from the excess antimicrobials.

During the study period, 15,037 IV DOT were administered, of which 9,694 DOT (64%) were estimated to be unnecessary. This was estimated to have generated 2,049 kilograms of total waste and 0.353 metric tons of carbon dioxide equivalents, equivalent to 904 miles driven.

Optimizing IV-to-PO antimicrobial switch policies may be an effective way to decrease hospital environmental impact through reduction of single-use supply waste and associated emissions. Future work should prioritize evaluating other potential antimicrobial stewardship interventions as a means to reduce GHG emissions.

This study evaluated the impact of a multimodal antimicrobial stewardship intervention on fluoroquinolone (FQ) use for prophylaxis in outpatient urologic procedures.

This single-center retrospective cohort study included patients from the South Texas Veterans Affairs (VA) outpatient urology clinic who underwent procedures between December 1, 2020, and February 29, 2024. Interventions included academic detailing, provider-specific FQ use reports, and prospective urine culture reviews with feedback. One pre-intervention cohort (PRE) and three post-intervention cohorts (POST2021, POST2022, POST2023) were analyzed. The primary outcome was FQ days of therapy (DOT); secondary outcomes included inappropriate prescriptions, post-operative complications, emergence of FQ resistance within 1 year, and Clostridioides difficile infection within 30 days of prophylaxis.

This analysis included data from 548 patients (150 PRE, 139 POST2021, 168 POST2022, 91 POST2023). Median age was similar across groups (p = 0.20), with over 90% male in each cohort (p = 0.07). Over one-third in each cohort received pre-operative oral antibiotics, 25% of which were FQs. More than 90% received pre-operative IV antibiotics, and over 50% received post-operative oral antibiotics. A significant reduction in FQ DOT/100 procedures was noted from pre- to post-intervention groups (98.6 PRE, 49.6 POST2021, 53.5 POST2022, 45.1 POST2023). No significant differences were observed in the secondary clinical outcomes.

A multimodal stewardship initiative reduced FQ use before urologic procedures, mainly due to decreased IV use. Further efforts are needed to optimize pre-operative FQ use and address drivers of post-operative antibiotic prescribing.

Antimicrobial resistance (AMR) poses an escalating global threat, transforming once-treatable infections into major health challenges. Although antibiotic misuse is a well-known driver of AMR, particularly in low- and middle-income settings, the silent epidemic may be fueled by socioeconomic disparities even in high-income countries. This systematic review investigates the relationship between socioeconomic status (SES) and AMR prevalence across high-income nations based on the World Bank classification.

The studies included in this review span multiple observational designs (cross-sectional, cohort, and case-control) across various high-income nations, assessing the association between SES indicators (eg, income, education, and household crowding) and AMR strains, primarily methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Escherichia coli.

Findings consistently indicate that lower SES correlates with higher AMR prevalence, particularly in MRSA infections (r = 0.76, Blakiston et al). The review highlights that indices of SES (often derived from government census data) are consistently associated with lower income, lower educational attainment, and increased household density with elevated AMR prevalence.

The variability among studies in SES metrics, including income measures and deprivation indices, limits generalizability. Exceptions to this trend, noted in select studies focusing on distinct AMR strains like ceftriaxone-resistant E. coli, underscore the complexity of SES-related AMR mechanisms. This review supports public health initiatives aimed at targeting low-SES communities with AMR mitigation strategies, advocating for continued monitoring and intervention to curb AMR spread in vulnerable populations.

The treatment of asymptomatic bacteriuria (AB) has been associated with increased in antibiotic resistance and Clostridioides difficile infection, without clinical benefit. One strategy to improve management is to incorporate a recommendation in the microbiological report. The aim of the study was to assess the impact of this intervention on antibiotic prescribing for AB.

Potential cases of AB were identified, and the following comment was included in the microbiology report: “Assess according to clinical findings. In AB, no treatment is recommended”. Patient demographics, sample characteristics, reason for request, isolated microorganism, resistance profile, time to clinician’s review of the report, initiation of treatment and its causes, and repeat urine culture were collected. Factors associated with adherence to the recommendations were evaluated.

A total of 391 possible AB cases were identified. The majority of samples originated, from primary care (96%) and in women over 65 years of age (98%). Antibiotic treatment was initiated in 60% of cases, while the microbiological recommendation was followed in 40%. Factors associated with nonadherence to the recommendation included urine culture request prompted by foul-smelling or cloudy urine, and repeat culture. In contrast, urine cultures requested during routine health checks were more likely to be associate with adherence to the recommendation.

The inclusion of a commentary in the microbiology report contributed to a reduction in antimicrobial prescription in AB. This intervention may be effective in optimising antibiotic prescribing practices and improving urine culture request management policies.

Clostridioides difficile infection (CDI) is common among patients undergoing hematopoietic stem cell transplantation (HSCT). Oral vancomycin prophylaxis may effectively prevent CDI in certain populations. We investigated the effectiveness of oral vancomycin primary prophylaxis in preventing CDI in HSCT patients.

We searched six databases from inception to March 21, 2025, for studies comparing the incidence of CDI in HSCT patients who received oral vancomycin primary prophylaxis versus those who did not. We built a Bayesian random-effects model for meta-analysis. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of positive vancomycin-resistant Enterococcus cultures, blood stream infections, graft-vs-host disease, and length of hospital stay. We also assessed for heterogeneity and publication bias using Robust Bayesian Meta-Analyses.

Six studies met inclusion criteria with a total of 1,236 patients. Four of the studies were of fair to good quality. Oral vancomycin primary prophylaxis reduced the incidence of CDI during hospitalization (OR 0.31; 95%CrI 0.16–0.59). Studies were weakly heterogeneous but had strong publication bias. Oral vancomycin primary prophylaxis reduced the odds of CDI by 12% after accounting for publication bias (OR 0.88; 95%CrI 0.32–1.16), although this reduction was not statistically significant. Secondary outcomes were similar in both groups.

Oral vancomycin primary prophylaxis prevented CDI in HSCT patients without significantly affecting secondary outcomes. However, after controlling for publication bias, these findings were no longer significant. Further studies are needed to provide stronger evidence for or against this intervention, assess long-term safety, and assess potential effects on antimicrobial resistance.

A follow-up survey of Special Pathogen Treatment Centers (SPTCs) was conducted to assess their readiness to provide critical care interventions to confirmed and suspected viral hemorrhagic fever (VHF) patients after the COVID-19 pandemic.

An electronic survey with 54 multiple-choice and free-response questions assessing VHF critical care capabilities was sent to 74 US SPTCs in April 2023.

Fourteen SPTCs (19%) completed the survey. Most respondents were prepared to provide intubation/mechanical ventilation (79%), pharmacologic cardioversion (79%), renal replacement therapy (71%), and defibrillation (71%) to suspected and confirmed VHF patients. Few were ready to provide cricothyrotomy (36%), extracorporeal membranous oxygenation (ECMO) (29%), or code status (14%). Factors impacting institutions’ ability to provide critical care to a VHF patient included staff safety (71%) and clinical futility (50%). Less than half (36%) reported that the COVID-19 pandemic positively affected their facility’s ability to care for VHF patients, while 21% indicated the pandemic prompted their facility to be better prepared to care for a VHF patient.

Most responding SPTCs reported capability for critical care interventions, although fewer had policies governing code status, ECMO, and cricothyrotomy. Institutions were less prepared to manage a VHF patient after the COVID-19 pandemic, highlighting challenges such as staff turnover and less support for training and equipment maintenance. Given that special pathogen outbreaks continue to occur globally, governments and healthcare institutions should institute measures to recruit, support, and retain staff to ensure critical care readiness for special pathogen patients.

This study aims to assess the knowledge and determine the level of compliance with human immunodeficiency virus (HIV) post exposure management (PEM) among dentists.

A descriptive cross-sectional study was done among 114 dentists.

Study was done among dentists in two Nigerian tertiary hospitals.

All dentists available, who consented to the study during the period of data collection were included in the sample. Three cadres of dentists; house officers, residents and consultants, were involved in the study.

Using self-administered questionnaires, information was sought on knowledge of managing exposures-first aid and prophylaxis as well as compliance when exposed. Data was analyzed using the SPSS statistical software.

Nearly all respondents, 111(97.4%), reported having heard about HIV PEM. Exposure incidents most frequently identified by respondents were needlestick injuries, 111(97.4%). Majority of the dentists recognized practices such as flushing exposed mucous membranes with water, 97(85.1%), and washing skin injuries with soap and water, 75(65.8%), as first aid for exposure incidents, while 20(17.5%) endorsed inappropriate measures like applying bleach to the wound. Seventy-one (62.3%) reported awareness of a HIV PEM protocol in their institution while 39(33.3%) were uncertain, with only 25(21.9%) reporting routine practice of the protocol. Fifty-six (49.1%) of the respondents had experienced an exposure of which only 30(53.6 %) reported and 32(57.1%) requested blood tests for the source patient(s).

The level of compliance with post exposure management is inadequate, therefore there is a need to update the knowledge and device methods of encouraging compliance with HIV PEM protocol among dentists.

This study aimed to evaluate the impact of an Antimicrobial Stewardship Program (ASP) on antibiotic consumption and mortality rates in the intensive care units (ICUs) of a national pediatric referral hospital in Lima, Peru.

The study population included patients under 18 years of age admitted to five ICUs during two distinct periods: prior to the implementation of the ASP (2016–2017) and following its implementation (2017–2018). Days of therapy (DOT) per 1,000 patient days were calculated to evaluate antibiotic consumption, and the results were compared between the two periods. Mortality rates and length of stay (LOS) were also assessed and compared. Differences in antibiotic consumption, mortality, and LOS were analyzed using χ2 and t tests.

Following ASP implementation, average antibiotic consumption decreased significantly from 750 DOT to 660 DOT (p = 0.01), indicating a 12% reduction. Notable declines in antibiotic use were observed specifically in the cardiology and burns ICUs, as well as in the subgroups of carbapenems, glycopeptides, and oxazolidinones. However, the analysis revealed no significant reduction in mortality rates or LOS following the implementation of the ASP.

Our findings suggest that the implementation of an ASP in pediatric ICUs is associated with a reduction in antibiotic consumption. These results underscore the critical importance of ASPs in promoting appropriate and rational use of antibiotics. Further research should explore the complex relationship between inappropriate antibiotic use and mortality in pediatric ICUs to clarify how ASP implementation may contribute to reducing mortality in this vulnerable population.