Patients discharged from emergency departments (ED) with antibiotics for common infections often receive unnecessarily prolonged durations, representing a target for transition of care (TOC) antimicrobial stewardship intervention.

This study aimed to evaluate the effectiveness of TOC pharmacists’ review on decreasing the duration of discharge oral antibiotics in patients discharged from the ED at an academic medical center. Pharmacist interventions were guided by an antibiotic duration of therapy guidance focused on respiratory, urinary, and skin infections developed and implemented by the antimicrobial stewardship program. Pharmacist interventions from January 27, 2023, to December 29, 2023, were analyzed to quantify the total number of antibiotic days saved and the percentage of provider acceptance.

The ED TOC pharmacists reviewed a total of 157 oral antibiotic prescriptions. 86.6% percent of the reviews required pharmacist interventions. The most common indications for the discharge antibiotics were urinary tract infections (50.0%) and skin infections (23.4%). The total number of antibiotic days saved was 155 days with the provider acceptance rate of 76.5%. In 21% of cases, providers did not count the antibiotic doses administered in the ED, contributing to unnecessarily prolonged duration. 10.2% of patients re-presented to the ED while 6.4% of patients were hospitalized within 30 days of index ED discharge.

The transitions of care pharmacist-led intervention was successful in optimizing the duration of discharge oral antibiotics in the ED utilizing prospective audit and feedback based on institutional guidance. The ED represents a high-yield setting for TOC-directed antimicrobial stewardship.

Medication safety is critical for pediatric cardiac care, especially in low- and middle-income countries (LMICs), where limited resources contribute to high rates of medication errors. Studies in LMICs have shown that pharmacist interventions can reduce medication errors by up to 57% and proved that clinical pharmacists are essential for ensuring accurate and optimized medication use. This study aims to evaluate the role of clinical pharmacist interventions to rectify prescription errors in a pediatric cardiac care setting in Pakistan.

This single-center retrospective study was conducted from January to August 2022 in a pediatric cardiac ward at the National Institute of Cardiovascular Diseases. Pediatric patients of all age groups and genders diagnosed with acquired, inherited, or congenital heart diseases were included. We reviewed patient files for any prescription changes made by the clinical pharmacist, based on a comprehensive review of the patient profile, treatment regimens, and laboratory results, to ensure safe and effective pharmacotherapy.

260 pharmacist interventions were observed among 2754 patients over eight months, demonstrating a significant role in mitigating medication errors. The interventions addressed wrong doses (126), incorrect frequencies (101), redundant coverage (23), and therapy duration errors (8). Antibiotics were the most frequent source of prescription errors, accounting for 81% of the interventions.

Clinical pharmacists’ involvement in pediatric cardiac care significantly reduces medication errors in LMICs, as demonstrated by this study. These findings underscore the need to integrate clinical pharmacists into multidisciplinary teams to enhance medication safety and improve patient outcomes.

Antimicrobial resistance (AMR) is a growing global health crisis, with Klebsiella pneumoniae being a key pathogen due to its multidrug resistance (MDR). This study aimed to investigate the resistance profiles, demographic correlations, and molecular characteristics of MDR K. pneumoniae at UNIOSUN Teaching Hospital, Osogbo, Nigeria.

From January to April 2022, 99 clinical isolates (K. pneumoniae) were collected from various specimen types (blood, sputum, urine, wound, stool, and oral cavity). Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method, and virulence genes were analysed using multiplex polymerase chain reaction.

All isolates exhibited resistance to ceftriaxone, cefotaxime, and colistin, with high resistance observed for cefepime and carbapenems (meropenem, imipenem, and ertapenem). Molecular characterization revealed the presence of virulence genes K1, K2, and mrkD in 15 isolates, while other tested virulence genes (fimH, ramA, traT, K3, and K5) were not detected. Significant associations were identified between resistance patterns and demographic factors, including age and sex, highlighting potential vulnerabilities in specific populations.

This study underscores the alarming prevalence of MDR K. pneumoniae and aligns with global trends of rising AMR. Addressing these challenges requires targeted antimicrobial stewardship programs, infection control measures, public education, and enhanced surveillance systems. Incorporating molecular resistance testing and novel therapeutic agents in future research is crucial to developing effective containment strategies and preserving antibiotic efficacy.

Characterization and assessment of Department of Defense’s (DoD’s) Antibiotic Stewardship Programs (ASPs) to determine adherence to Centers for Disease Control and Prevention (CDC) Core Elements and compare to national adherence

Retrospective, observational with supplemental survey

Facility characteristics and CDC Core Elements (CE) adherence data for 2017–2021 were retrieved from the National Healthcare Safety Network’s (NHSN) annual hospital survey with DoD data from the Defense Health Agency and national data from the Antibiotic Resistance and Patient Safety Portal. An online supplemental survey was administered to DoD hospitals. Descriptive statistics and bivariate analyses were completed for facility characteristics and supplemental survey questions to determine correlations between variables. A framework analysis compared DoD ASPs to CEs and Priority Elements.

Supplemental surveys were completed for 85.1% of DoD’s hospitals. DoD’s hospitals were smaller on average than national hospitals. ASP leaders were assigned more often than volunteer and typically served in the role for less than four years. Staffing mix differed, with more equivalent proportions of civilian/contractor to military at larger hospitals in the U.S. Most DoD ASPs consisted of ≤ 25% pharmacists. ASP leaders were largely available on a daily basis; pharmacist leaders spent more time on ASP activities than physicians. CE adherence was high, but in 2021 DoD lagged national adherence in the structural CEs of Leadership, Accountability, and Pharmacy Expertise.

DoD hospitals lagged in national adherence to the structural CEs, presenting opportunities for ASP improvement. Refinement of CE adherence measurements, coupled with impact on health outcomes, could aid in better-identifying areas for improvement.

To explore the progress that the Veterans Health Administration has made to minimize the impact of the penicillin (PCN) allergy label, we determined the proportion of Veterans who reported a PCN-class allergy at the time of hospitalization and described antibiotic use in hospitalizations with and without a PCN-class allergy.

Cross-sectional study.

National sample of 6,541,299 acute care admissions between 2011 and 2022.

We calculated the prevalence of PCN-class allergies on admission and used Poisson regression to compare patterns of antibiotic use between hospitalizations with and without a PCN-class allergy.

The prevalence of PCN-class allergies on admission decreased from 12.99% to 11.20%. Use of cefazolin and non-pseudomonal third-generation cephalosporins increased regardless of PCN-class allergy status (“PCN-class allergy only” +11.46%, “No antibiotic allergy” +4.92%). The prevalence ratio (PR) for antibiotic use in hospitalizations with a PCN-class allergy compared to hospitalizations without antibiotic allergies, decreased for anti-Methicillin Resistant Staphylococcus aureus agents (1.26 [1.25, 1.28] to 1.15 [1.13, 1.17]), carbapenems (1.59 [1.54, 1.65] to 1.47 [1.41, 1.53]), and aztreonam (23.89 [22.45, 25.43] to 17.57 [15.90, 19.42]); and increased for fluoroquinolones (1.58 [1.56, 1.60] to 2.15 [2.09, 2.20]).

Prevalence of PCN-class allergies is declining and narrow-spectrum βL use is rising among hospitalized Veterans. Prescribing differences are decreasing between hospitalizations with and without a reported PCN-class allergy, except for aminoglycosides, clindamycin, and fluoroquinolones. These findings can serve to identify areas of focus for future analyses or interventions related to the impact of the PCN allergy label on antibiotic selection.

We sought to characterize US pediatric antimicrobial stewardship programs (ASPs), including their hospital demographics, staffing, funded full-time equivalents (FTEs) by hospital size, and relative emphasis on recommended stewardship strategies. We examined the self-reported characteristics of ASP personnel with regard to discipline, race, ethnicity, gender identity, and years of experience in antimicrobial stewardship.

Descriptive two-part survey.

Pediatric ASPs at hospitals participating in Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), a pediatric quality improvement collaborative of >70 children’s hospitals.

Survey distributed to 82 US pediatric ASPs, excluding hospitals without pediatric ASPs. Part I completed by ASP leader (physician or pharmacist). Part II distributed to ASP team members.

Part I addressed hospital demographics, ASP funding, and program choices related to the CDC’s 2019 Core Elements of Hospital Antibiotic Stewardship Programs. Part II requested that participants anonymously self-identify race, ethnicity, gender identity, training, and duration of ASP experience. Descriptive statistics performed.

Sixty-two ASPs responded: 61 (98%) with formal ASP, 40 (65%) from freestanding children’s hospitals. 40 (65%) co-led by an ASP physician and pharmacist. 60 (97%) reported dedicated inpatient physician FTE, 57 (92%) dedicated inpatient pharmacist FTE. Most programs (35 [58%]) reported inadequate staffing support. The 125 ASP professionals who completed Part II predominantly self-reported as White (89 [71%]), with fewer self-reporting as Asian (9 [15%]) or Black (4 [3%]).

US pediatric ASPs have achieved substantial progress in meeting the CDC Core Elements, but many report insufficient resources. We identified underrepresentation in the ASP workforce.

To develop and validate an automated surveillance system for healthcare-associated Clostridioides difficile infections (HA-CDI).

Multicenter cohort study.

16 acute care hospitals.

Patients admitted to participating hospitals between 2013 and 2022.

An automated surveillance system was developed with retrospective extraction from admission/discharge/transfer and laboratory databases and compared with conventional surveillance based on clinical definitions collected prospectively by infection control professionals. Comparison of HA-CDI incidence rates calculated by automated vs conventional surveillances were performed with χ2, incidence rate ratios, and linear regression. A subset of discordant cases was further investigated by reviewing medical records.

Overall, conventional surveillance reported 3,211 cases of HA-CDI for an incidence rate of 4.94 per 10,000 patient-days. Automated surveillance detected 4,708 cases, for an incidence rate of 7.24 per 10,000 patient-days (incidence rate ratio, 1.47; 95% CI, 1.40–1.53). Full concordance between both surveillance methods was observed in 62% of cases, while 34% of cases were detected only by automated surveillance, and 4% were detected by conventional surveillance only. Between 2013 and 2022, an identical declining trend in HA-CDI incidence rates of –0.54 cases per 10,000 patient-days was observed with both surveillance methods. A subset of 49 cases detected only by automated surveillance were reviewed; the main reasons for discrepancy were delayed testing (39%), colonization (24%), misclassifications (14%), and interinstitutional transfers (12%).

HA-CDI incidence rates calculated by automated surveillance were higher than those of conventional surveillance, but the overestimation was consistent over time, suggesting that a correction factor could improve precision.

To determine the impact of screening and decolonization on methicillin-resistant Staphylococcus aureus (MRSA) infection in a neonatal intensive care unit.

This is a single-center retrospective cohort study comparing patient characteristics among MRSA-colonized and MRSA-infected infants, rates of MRSA infection before and after screening with targeted decolonization, and MRSA infection among those receiving single or combined decolonization agents.

Texas Children’s Hospital Pavilion for Women is a 42-bed level three neonatal intensive care units (NICU) in Houston, TX.

Neonates admitted to the NICU from 2012 to 2022 were included in analysis of MRSA colonization and infection. The gestational age ranged from 22 weeks to 42 weeks.

The MRSA screening methodology consisted of weekly surveillance PCR or culture on admission until discharge. If positive, infants underwent decolonization consisting of topical intranasal mupirocin, and if meeting the gestational and chronological age-based criteria, topical 2% chlorhexidine wipes and topical intranasal mupirocin.

The MRSA colonization rate from 2016 to 2022 was 2.2%. Following the screening and decolonization protocol initiated in 2016, there was a sustained downtrend in the rate of MRSA infection. No MRSA-colonized neonates who received both topical mupirocin and Chlorhexidine gluconate (CHG) developed MRSA infection.

We observed a decreased rate of MRSA infection in the NICU following implementation of an MRSA screening and decolonization protocol. While our data suggests that the combination of mupirocin and CHG might prevent infection, further studies are needed due to the low prevalence of MRSA infection in our cohort.

To assess the impact of treatment guidelines on the trends of outpatient antibiotic prescription among pediatric and adult patients at a cancer center in Pakistan.

Retrospective observational study conducted between July 1st 2018 and July 31st 2023.

We determined the indication for antibiotics and the frequency of guideline-discordant prescriptions for upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), urinary tract infection (UTI), and diarrhea. The χ2 test was used to assess the impact of treatment guidelines on antibiotics prescribed for these indications.

The top indications for antibiotic prescription were skin and skin structure infection (SSSI) (n = 5159; 21.5%), URTI (n = 2760; 11.5%) and UTI (n = 2686; 11.2%). Amoxicillin-clavulanate (n = 7964; 33.3%), was the most frequently prescribed antibiotic. A large proportion of antibiotic prescriptions for URTI, diarrhea, UTI, and LRTI were either inappropriate (n = 6695; 86.5%) or unnecessary (n = 5534; 71.5%). Results revealed a statistically significant decline in the proportion of inappropriate antibiotics for UTI (91.3% vs 84.0%; P ≤ .001) and diarrhea (92.6% vs 87.0%; P = .031) and unnecessary antibiotics for diarrhea (90.2% vs 83.2%; P = .016) with the introduction of treatment guidelines. We noted a higher proportion of unnecessary prescriptions for LRTI (41.7% vs 31.7%; P = .003) and inappropriate antibiotics for UTI (95.1% vs 87.4%; P = .011) for pediatric patients.

Misuse of outpatient antibiotics is common. Diarrhea, URTI, UTI, and LRTI are high-priority conditions for outpatient oncology-focused prescriber education and stewardship interventions.

To compare the clinical outcomes of patients with lower limb osteomyelitis (LLOM) and negative methicillin-resistant Staphylococcus aureus (MRSA) cultures treated with anti-MRSA therapy (AMT) versus those treated with no-anti-MRSA therapy (NAMT).

Retrospective cohort study.

Hospitalized adult (≥18 yr of age) patients admitted to multiple tertiary referral centers in a single healthcare system between April 1, 2017 and April 1, 2023, with LLOM and planned intravenous antibiotics for at least four weeks.

Electronic medical records were queried for demographic information, admission dates, treatment strategies, imaging and culture results, and discharge diagnoses. Descriptive statistics measured baseline characteristics, imaging, and culture results.

Out of 473 patients, 64 met the inclusion criteria and 409 were excluded. Of the 64 patients, 26 (40%) had AMT and 38 (59%) had NAMT. A larger but statistically insignificant portion of patients in the NAMT cohort failed therapy (23% AMT vs 32% NAMT, P = 0.325). However, hospital readmission for LLOM within 180 days of antibiotic completion (46.2% vs 47%, P = 0.92), hospital length of stay (median (IQR): 6 (5–9) d vs 7 (5–12.5) d, P = 0.285), incidence of new renal replacement therapy initiation (0% vs 2.6%, P = 0.594), creatinine kinase levels (0 vs 2.6%, P = 0.594), and drug-induced immune thrombocytopenia (0% vs 5.3% P = 0.349) were comparable between the two cohorts.

Treatment failure rates and adverse events did not differ significantly among patients with LLOM treated with AMT or NAMT. Further investigation of determinants of clinical failures in LLOM may help optimize overall treatment.

Emerging data surrounding the rise in antimicrobial resistance have prompted a shift towards shorter antibiotic durations. Studies show similar clinical outcomes comparing shorter antibiotic courses to longer ones for uncomplicated Gram-negative bloodstream infections (BSI). However, there is a lack of data to inform durations of therapy for Streptococcal BSI.

This was a retrospective cohort study of patients admitted to University of Utah Health with uncomplicated Streptococcal BSI. Inverse probability of treatment weighting (IPTW) was used to estimate the average treatment effects (ATE) of antibiotics administered for 10 days or fewer (short duration) versus more than 10 days (long duration). The primary outcome was a composite of recurrent BSI, all-cause mortality, and readmissions at 30 days from end of therapy.

Five hundred patients were screened and 196 were included in the final analysis. The most common sources were skin and soft tissue infections. The median duration in the short and long groups were 8 (IQR, 7–10) and 15 days (IQR, 14–17), respectively. The ATE of short versus long duration of antibiotics was not significant for the composite primary outcome (18% vs 18%; OR = 1.42 [95% CI: 0.57 to 3.53]).

We found no appreciable difference in outcomes between patients treated with short versus long antibiotic durations for uncomplicated Streptococcal BSI. Given low absolute rates of mortality and recurrent BSI, along with the lack of evidence indicating a significant difference related to treatment duration, it is reasonable to consider shorter durations. Future research is needed to confirm our findings.