Respiratory syncytial virus (RSV), although frequently reported in pediatric populations, is also associated with significant morbidity and mortality in vulnerable adults. From an Infection Control perspective, it is therefore of particular concern in hospital and long-term care settings.

We report an RSV outbreak that occurred in the memory care unit of a Veterans Affairs-affiliated long-term care facility where the characteristics of the resident population posed unique challenges to halting transmission.

The outbreak occurred in a 30-bed unit within a 230-bed Veterans Affairs-affiliated long-term care facility in Florida.

An investigation was performed in coordination with the local Department of Health. All residents on the affected unit had dementia with resulting difficulty participating in infection prevention measures, including isolation, masking, and hand hygiene. Interventions implemented included twice weekly RSV testing, enhanced cleaning protocols, staggered mealtimes/outdoor dining, and cancellation of group activities, visitations, and new admissions. A retrospective case–control study was performed to assess for potential risk factors for acquiring RSV.

Over a 21-day period in 2022, 20 out of 29 residents tested positive for RSV within the affected unit. No other units were involved. Univariate analysis did not find any statistically significant risk factors for acquiring RSV infection, although small sample size may have impacted the results.

A multifaceted approach was ultimately successful in preventing ongoing transmission of RSV within and beyond the unit. The infection control techniques utilized in this unique patient population could potentially be applicable to challenging outbreak situations at other facilities.

Routine immunization programs may reduce antibiotic use, but few studies have comprehensively examined their impact on antibiotic utilization. We aimed to explore temporal trends in vaccination and antibiotic use among young children in the United States.

Ecological study using the Merative® MarketScan Commercial Claims and Encounters database.

We analyzed claims data on pediatric vaccine uptake (pneumococcal conjugate, Haemophilus influenzae type b, diphtheria-tetanus-pertussis, and influenza) and antibiotic prescriptions and antibiotic-treated respiratory tract infections among US children <5 years during 2000–2019. Vaccination status was assessed annually, and children were categorized based on receipt of all four vaccines, 1–3 vaccines, or no vaccines. Antibiotic prescriptions were classified by spectrum and drug class. Respiratory infections included otitis media, pharyngitis, pneumonia, sinusitis, and viral infections.

Among 6.7 million children, vaccine uptake increased from 32.5% receiving all four vaccines in 2004 to 66.8% in 2019. During this period, overall antibiotic prescriptions decreased from 1.89 to 1.01 per person-year, with the greatest reductions in macrolides (73.3%) and broad-spectrum antibiotics (57.0%). Antibiotic-treated respiratory tract infections declined from 2.43 to 1.61 episodes per person-year, with the largest decreases in sinusitis (64.7%) and pharyngitis (39.8%).

The findings suggest a temporal association between routine childhood immunization uptake and reduced antibiotic utilization. Although immunization programs are primarily aimed at protecting children from vaccine-preventable diseases, their potential role in complementing antimicrobial stewardship efforts and other factors influencing antibiotic reduction warrants further investigation through more rigorous study designs.

To estimate the cost-effectiveness of methicillin-resistant Staphylococcus aureus (MRSA) nares poymerase chain reaction (PCR) use in pediatric pneumonia and tracheitis.

We built a cost-effectiveness model based on MRSA prevalence and probability of empiric treatment for MRSA pneumonia or tracheitis, with all parameters varied in sensitivity analyses. The hypothetical patient cohort was <18 years of age and hospitalized in the pediatric intensive care unit for community-acquired pneumonia (CAP) or tracheitis. Two strategies were compared: MRSA nares PCR-guided antibiotic therapy versus usual care. The primary measure was cost per incorrect treatment course avoided. Length of stay and hospital costs unrelated to antibiotic costs were assumed to be the same regardless of PCR use. Both literature data and expert estimates informed sensitivity analysis ranges.

When estimating the health care system willingness-to-pay threshold for PCR testing as $140 (varied in sensitivity analyses) per incorrect treatment course avoided, reflecting estimated additional costs of MRSA targeted antibiotics, and MRSA nares PCR true cost as $64, PCR testing was generally favored if empiric MRSA treatment likelihood was >52%. PCR was not favored in some scenarios when simultaneously varying MRSA infection prevalence and likelihood of MRSA empiric treatment. Screening becomes less favorable as MRSA PCR cost increased to the highest range value of the parameter ($88). Individual variation of MRSA colonization rates over wide ranges (0% – 30%) had lesser effects on results.

MRSA nares PCR use in hospitalized pediatric patients with CAP or tracheitis was generally favored when empiric MRSA empiric treatment rates are moderate or high.

This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.

This retrospective study compared pediatric patients’ MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.

The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.

Pediatric patients receiving care within MHN with Medicaid coverage.

MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.

MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.

Surgical site infections (SSI) result in significant patient morbidity and excess healthcare costs. Colorectal surgeries have the highest SSI risk, as they manipulate the organ with the largest endogenous bioburden. This risk can be mitigated through complex prevention bundles, shown effective at reducing SSI in multiple studies, although little is known about their “real-world” use.

To obtain further insight into the implementation of SSI prevention bundles consisting of guideline-recommended infection control elements in colorectal surgery, we distributed a multiple-choice survey to the hospitals within the Society for Healthcare Epidemiology of America Research Network from November 2022 to December 2023.

A total of 42 (45%) hospitals completed the survey. The bundle elements most used were intravenous pre-operative antibiotic prophylaxis (88%) and skin prep with an alcohol-chlorhexidine solution (86%). Infection control elements of surgical closure such as glove change and separate instrument tray were reported by 67% and 64%, respectively. Combined oral antibiotics with mechanical bowel prep were reported by 52%. Less than 50% of hospitals reported consistent bundle audit and feedback to frontline surgical staff. The most persistent barriers to implementation were a general culture resistant to change (40%) and clinicians’ lack of compliance with the institutional bundle (38%).

Our study found significant variability in the implementation of bundles consisting of multiple infection control elements to prevent SSI in clinical practice. Further research is needed to determine the strategies most effective in optimizing high-fidelity adoption of complex prevention bundles and to study their effect on SSI in colorectal surgery.

Increased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines.

We evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018–February 2020) and pandemic periods (March 2020–February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis.

Significant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%–63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%–161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40–1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time.

We observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.

To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.

Prospective observational study.

611-bed, quaternary care academic medical center in the United States.

126 critically ill adults (mean age 68.1 ± 15.6 yr, 51.6% male, median APACHE II score 20.5 [IQR 15–25]); 71.4% met sepsis criteria.

Secondary infection was defined as ≥3 consecutive antibiotic days within a year after the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, BMI, and glucocorticosteroid dose. Time-to-event analysis employed Cox proportional hazards modeling; cumulative infection burden was assessed via nonparametric tests using normalized antibiotic exposure (AD as a proportion of days alive).

Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days (P < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, P = 0.739) or readmission (OR 1.01, P = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes (P = 0.0033), with higher exposure among patients experiencing two or more secondary infections (P = 0.026 and P = 0.036, respectively). Cox regression showed a significant association between AD and time to first secondary infection (HR 1.10, 95% CI: 1.04–1.15, P = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.

Extended AD, in critically ill patients, prolongs hospitalization without reducing mortality or readmission rates. These findings highlight the importance of robust antibiotic stewardship practices, where shorter, targeted regimens may minimize unintended complications.

To quantify the impact of a changing cohort strategy on COVID-19 transmission in an acute inpatient behavioral health facility.

Cohort study.

Behavioral health inpatients exposed to COVID-19.

This cohort project compared COVID-19 conversion rates during two periods. In the first period (July 2020–April 2022), exposed patients (regardless of vaccination status) were cohorted separately from unexposed individuals. In the second period (May 2022–September 2022), exposed vaccinated patients remained with unexposed patients. COVID-19 conversion was identified through post-exposure asymptomatic testing or test-confirmed symptom development, with rates quantified per all admissions, per 10,000 patient days at risk, and per patient-specific exposure.

The 27-month project included 11,761 admissions and 164,762 patient days of care. The proportion of patients up-to-date on COVID-19 vaccination at admission and discharge ranged from 11%–19%. The second period showed an increased risk of SARS-CoV-2 conversion per admission (1.87% vs 0.36%, P < 0.001) and per 1,000 patient-days at risk (1.44 vs 0.27 conversions per 1,000 patient days, P < 0.001), but not per exposure (3.44% vs 3.13%, P = 0.68).

Reducing the population of patients cohorted after a SARS-COV-2 exposure is associated with increased risk of SARS-COV-2 transmission in inpatient psychiatric settings.

Antibiotic stewardship programs (ASPs) are crucial to prevent the emergence of antibiotic resistance and to improve outcomes for patients. A validated instrument rooted in a theoretically derived implementation science framework will increase our understanding of ASP implementation and enable comparisons across implementation sites.

Antibiotic stewards (infectious disease pharmacists and physicians) were recruited from Veterans Affairs (VA) hospitals to complete a survey on stewardship implementation. We used the Consolidated Framework for Implementation Research (CFIR) to guide development of an ASP implementation survey assessing 22 potential determinants of implementation across five domains of CFIR. We conducted confirmatory factor analyses (CFA) to assess construct validity of 8 construct measures and evaluated internal consistency.

A total of 150 stewards completed the survey from 110 VA hospitals. CFA for most CFIR constructs exhibited good fit. Internal consistency for CFIR construct subscales (Cronbach’s alpha) ranged from 0.54–0.96, indicating modest to strong internal consistency. Determinants that were rated highly present at the sites (across site means ≥ 4.0 or above) included Self-Efficacy, Engaging, Evidence Strength and Quality and Relative Advantage, indicating stewards found ASP evidence compelling and felt their personal involvement was effective in engendering positive results for the ASP.

Psychometric properties indicate validity of the first CFIR-based survey of determinants for ASP implementation outcomes. Clinical, quality improvement, and research teams can use this survey to identify contextual determinants of ASP implementation and use this information to guide selection of strategies and compare results across multiple sites.