Algorithms using electronic health record data to identify children with community-acquired pneumonia (CAP) and to evaluate the appropriateness of antibiotic use may facilitate antibiotic stewardship efforts, but validated measures of antibiotic choice and duration are unavailable.

We performed a cross-sectional study within a single hospital system, including hospitalized children ages 6 months to 17 years who were admitted between 1/1/2019 and 10/31/2022. CAP was defined electronically as an ICD-10 code for pneumonia, a chest x-ray or chest CT within 48 hours of admission, and at least two days of antibiotics starting within 48 hours of admission. Hospital transfers and those who died within 48 hours or had chronic conditions, intensive care unit stays ≥48 hours, or concurrent infections were excluded. We validated electronic measures of appropriate antibiotic choice and duration using a reference standard of manual chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each metric.

The electronic algorithm identified 1058 CAP encounters, and 100 were randomly selected for validation. Inappropriate antibiotic choice and duration occurred in one and 75 encounters of the 100 encounters, respectively, based on manual chart review. The electronic algorithm had a sensitivity of 100%, specificity of 93%, PPV of 14%, and NPV of 100% for inappropriate antibiotic choice and a sensitivity of 97%, specificity of 88%, PPV of 96%, and NPV of 92% for inappropriate antibiotic duration.

Metrics of inappropriate antibiotic choice and duration had acceptable performance characteristics and may facilitate syndrome-based stewardship efforts.

Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals.

Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UC rates decreased from 2017 (129.2) to 2020 (120.0). The proportion of UCs that had a positive UA increased from 60.5% in 2017 to 68.1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%). A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA.

UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices at the national level although further progress is needed.

Evaluate the prevalence and risk factors for inappropriately ordered urine cultures in primary care.

Cross-sectional study using chart reviews.

Two primary care, safety-net clinics in Houston, Texas.

Non-pregnant adults without a urinary catheter who had a urine culture and a primary care visit between 11/2018 and 3/2020.

We classified patients lacking physician documentation of the following symptoms as having an inappropriately ordered urine culture: dysuria, frequency, urgency, hematuria, fever, chills, costovertebral angle tenderness, nephrolithiasis, and pain (suprapubic, pelvic, or flank). We extracted patient demographics, visit-related diagnostic codes, past medical history, and urine culture results. Diagnostic codes were grouped based on body system, visit type (e.g. routine visit), or sign or symptom clusters. We evaluated the relationship between these factors and inappropriately ordered cultures using generalized estimating equations logistic regression.

We included 807 patients who had 870 visits. Most patients were Hispanic (66.3%) or African American/Black (24.8%) females (76.1%) with a median age of 50 years. Among 870 cultures, 210 (24%) were ordered inappropriately. We found having an abnormal urinalysis or urine characteristic (adjusted odds ratio (aOR): 13.66), acute low back pain (aOR: 4.88), a cardiovascular-related (aOR: 1.68) or gynecological/family planning visit (aOR: 10.84), being evaluated at the non-teaching clinic (aOR: 6.03), or having a routine health visit (aOR: 1.81) within the non-teaching clinic (interaction aOR: 4.27) were significantly associated with inappropriate urine cultures.

Our study revealed factors associated with inappropriately ordered urine cultures that may be unique to ambulatory settings and can help design outpatient diagnostic stewardship interventions.

We aimed to decrease the difference in first-line therapy (ΔFLT) for common acute respiratory infections (ARI) in pediatric urgent care clinics (PUCs) in relation to race, ethnicity, language, and insurance using quality improvement (QI) methodology.

Retrospective cohort study of 13-month pre-intervention (April 2022–April 2023) and 17-month (May 2023–September 2024) intervention data collection.

92 PUC sites from 9 organizations spanning 22 states.

Encounters of patients 6 months to 18 years of age with ARI diagnoses.

Sites created local multidisciplinary QI teams, cause-and-effect analyses, driver diagrams, and used Plan-Do-Study-Act (PDSA) cycles. We defined FLT per national guidelines. We measured ΔFLT between socioeconomic groups as our primary outcome. Balancing measure was overall rate of FLT. Logistic regression models evaluated the impact education-only PDSAs had on ΔFLT compared to PDSAs that used education plus another intervention modality (eg clinical decision support).

We included 895,604 encounters. Despite our QI efforts, we saw no change in ΔFLT between Spanish and English-speaking patients (3.1%), Hispanic and non-Hispanic patients (1.6%), or commercial and government-insured patients (1.6%). We saw an increase in ΔFLT between Black and White patients from 3.6% to 5.8%. We observed fluctuations in overall rates of FLT over time. The impact of PDSA cycle types was variable.

Despite local interventions to reduce differences in prescribing, we noted a widening of the ΔFLT by race. More work is needed to understand causes of these disparities and develop effective interventions that improve equitable antibiotic prescribing.

The clinical impact of carbapenem-resistant Acinetobacter baumannii (CRAB) remains controversial, with uncertainty about whether it directly contributes to mortality or merely reflects underlying patient’s morbidity. This study aimed to evaluate the impact of CRAB colonization and infection on patient outcomes.

A retrospective cohort study was conducted in an Israeli tertiary hospital between January 2023 and December 2024. Patients were categorized into CRAB-negative (A group), CRAB-present on admission (POA, B group), and hospital-acquired CRAB (C group). Time-varying Cox proportional hazards models were used to estimate 30- and 90-day mortality risks while adjusting for immortal time bias. Kaplan–Meier and cumulative hazard curves were generated, and univariable Firth logistic regressions were performed as exploratory analyses.

Of 3,080 patients, 149 had CRAB-POA and 108 acquired CRAB. Risk factors for CRAB-POA included long-term care facility residence (odds ratio (OR) = 4.1) and mechanical ventilation (OR = 2.3). Hospital-acquired CRAB was associated with longer length of stay and ventilation. Time-varying Cox models adjusting for immortal time bias showed that both CRAB colonization and infection were associated with increased 30-day mortality (hazard ratio (HR) range: 1.95–2.88) and 90-day mortality (HR range: 2.11–2.93), compared with CRAB-negative patients. Implementation of enhanced screening and cohorting in the late study period was associated with reduced CRAB acquisition (OR = 0.13, 95% confidence interval (CI): 0.07–0.24) and mortality (OR = 0.62, 95% CI: 0.41–0.94).

Both CRAB colonization and infection are associated with twofold increase in mortality after adjusting for disease severity. Enhanced infection control measures reduced acquisition and mortality.

Platelet-rich plasma (PRP) injections are increasingly performed in outpatient settings to treat select musculoskeletal injuries, arthritis, hair loss, and wounds. There is a need for procedure-specific guidance and standardization of PRP practices to mitigate associated infection prevention (IP) risks such as bloodborne pathogen exposure and unsafe injection use.

Develop a standardized approach for PRP administration which incorporates existing IP regulatory and professional society guidance.

Observation and descriptive review of PRP injection protocols across subspecialties at a tertiary medical center, focused on ambulatory IP and regulatory standards compliance. Development of a standardized operating procedure (SOP) to mitigate IP risks and align with regulatory guidance.

Observations were completed in orthopedic, wound care, and oral maxillofacial surgery clinics. Variability in practice was noted for product labeling, centrifugation, and injection modalities. A multidisciplinary workgroup convened to develop and operationalize an SOP. Classification of PRP as a blood product introduced nuances to protocols for product preparation, handling, administration, labeling, and documentation to comply with regulatory standards.

Development and implementation of an SOP for PRP treatment requires an awareness of the scope of practice in a healthcare system and identification of pertinent regulatory standards for integration into workflows. Partnerships between IP teams, subspecialty clinical providers, blood safety experts, quality and safety teams, and healthcare technology are essential to minimize variability in practice, ensure safety of patients and healthcare personnel, and align with regulatory standards.

Microbial contamination of textiles in healthcare settings is common and hypothesized to contribute to pathogen transfer. This systematic literature review aims to summarize the current evidence on microorganism transfer to and from textiles in healthcare and on factors that influence transfer.

Systematic literature review.

Cochrane, Medline/Ovid, EMBASE, and Web of Science were searched. Studies were included if the transfer experiment involved textiles as origin material or destination material, the transfer mechanism was described accurately, and transfer events were quantifiable. Results on transfer and factors associated with transfer were extracted.

We included 21 studies with 490 transfer experiments. Considerable heterogeneity in all relevant study variables resulted in a very broad range of reported transfer proportions, from less than 1% to up to 100%. Cotton was the most frequently studied textile (13 studies) while Staphylococcus aureus was the most frequent pathogen of interest (13 studies). Highest transfer proportions (85–100%) were reported in transfer experiments from solid surfaces to textiles by wiping. Very low transfer proportions (0.01–2.5%) were reported in transfer experiments from textiles to textiles by pressure. Moisture and friction were associated with higher transfer.

This study highlights the wide range of microbial transfer quantity from and to textiles in healthcare, depending on transfer mechanism, moisture, and other factors. The findings can inform the design of infection prevention and control (IPC) practices in healthcare.

We assessed the impact of an oral care initiative on non-ventilator-associated hospital-acquired pneumonia (NV-HAP) risk using two different measurement strategies.

We evaluated changes in NV-HAP events among all patients admitted to 17 VA Medical Centers (1) across the period 10/01/2015–12/31/2019, and (2) one-year pre- vs post- each hospital’s oral care initiative start date. We modeled and compared observed versus predicted NV-HAP events per hospitalization using (1) an electronic clinical definition and (2) diagnosis codes, adjusting for patients’ demographics, vital signs, and laboratory results at presentation.

Among 333,257 hospitalizations, 1,922 (0.58%) met NV-HAP electronic clinical criteria and 2,386 (0.72%) diagnostic coding criteria. The risk of NV-HAP defined by electronic clinical criteria was 0.62% in October 2015 and 0.54% in December 2019 (estimated difference –0.084% [95% CI: –0.17%, 0.0056%]; the risk of NV-HAP defined by diagnostic coding decreased from 1.0% to 0.48% (estimated difference –0.53% [–0.63%, –0.43%]). In the one-year pre- vs post-analysis, there was no evidence of effect of the implementation on NV-HAP using either electronic clinical criteria (adjusted risk difference –0.078% (95% CI: –0.25%, 0.091%) or diagnostic coding criteria (adjusted risk difference –0.021% (95% CI: –0.18%, 0.14%).

In a large multi-center study of hospitalized patients, we were unable to identify a clear effect of an oral care initiative on NV-HAP using electronic clinical criteria or diagnostic coding criteria.

The study aimed to summarize estimates of key epidemiological parameters to improve the effectiveness of Clostridioides difficile infection (CDI) mathematical models and quantitatively characterize high-touch surfaces (HTSs) and mutual-touch surfaces in healthcare settings.

We systematically searched four databases and applied predefined eligibility criteria to screen, select, and include peer-reviewed studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study is registered in the International Prospective Register of Systematic Reviews (CRD42023408483).

Among the 21 C. difficile infection modeling studies, 76.2% used compartmental model approaches that group patients into infection disease categories such as susceptible, infected, or recovered, while 23.8% applied agent-based model approaches that simulate individual patients, staff, or surfaces. Key epidemiological parameters varied widely: estimates of how many new cases one patient could cause—the basic reproduction number (R₀)—ranged from 0.28, suggesting limited hospital spread, to as high as 2.6, which implies sustained in-hospital transmission. Incubation periods were reported between 4 and 18 days. Recovery and recurrence rates also differed across studies. Quantitative HTSs ranking revealed that bed rails, bedside tables, and supply carts were the top three most frequently touched surfaces.

Our findings highlight that modeling studies used different assumptions and estimates, creating variations in results. Clinicians should interpret modeling outputs, such as predicted spread or effectiveness of an intervention carefully, as differences may reflect real-world variation between hospitals or methodological variation. Developing infection models that reflect real-world conditions will enable healthcare teams better simulate and prioritize interventions, optimize cleaning protocols, and improve CDI transmission models for more targeted prevention.

Surgical site infections (SSIs) are among the most common postoperative complications in colorectal surgery, and associate with increased morbidity, prolonged recovery, and higher healthcare costs. Most studies combine all SSI categories, potentially overestimating economic burden due to higher severity of organ/space infections. The specific cost impact of incisional SSIs—superficial and deep infections—remains underexplored, despite its prevention potential. This study aimed to evaluate hospital costs associated with incisional SSIs following colorectal resection.

A retrospective cohort study was conducted at a tertiary oncologic center, including patients who underwent surgical resection for primary neoplasms of the colon, rectum, or anal canal between 2018 and 2023. Patients with incisional SSIs were matched 1:1 to controls without SSI using propensity scores based on demographic and surgical variables. Total hospital costs within 60 days postoperatively were analyzed using real-world, institution-specific cost data. Multivariate regression was used to identify independent cost predictors.

Among 985 eligible patients, 176 (17.9%) developed an incisional SSI. After matching, 346 patients (173 pairs) were included in the cost analysis. Mean hospital costs were significantly higher in the SSI group (€6,065.93 vs €5,089.97; P < 0.001), primarily due to prolonged hospitalization and increased outpatient care use (medical and nursing consultations). Incisional SSI was an independent predictor of higher costs, along with open surgery, comorbidities and stoma presence.

Incisional SSIs associated with higher hospital costs after colorectal surgery. These findings support the implementation of targeted SSI prevention strategies to reduce complications and optimize healthcare resource use.

Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.

We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.

A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.

Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.

This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge.

Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire.

IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16–985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing.

The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.