Non-ventilator hospital-acquired pneumonia (NV-HAP) is common and deadly. Guidelines recommend improving oral care and mobility performance to prevent NV-HAP but data on their impact are limited. We therefore evaluated associations between oral care and mobility performance with NV-HAP and mortality rates in a large hospital network.

Retrospective cohort study

144 acute care hospitals

Adults hospitalized for ≥4 days between May 2021 and July 2023

We extracted daily data on oral care performance (yes, no) and patient mobility (bed-bound, upright, walking) and used time-varying Cox proportional hazards models to evaluate associations between oral care and mobility performance with NV-HAP and in-hospital mortality risk, adjusting for patients’ demographics, comorbidities, hospital service, daily vital signs, and daily laboratory measures.

Among 1,744,811 hospitalizations (9.6 million hospital-days), median patient age was 68 (IQR 55–78) and 50.6% were female. Persistent oral care for ≥3 days was associated with 16% less NV-HAP (hazard ratio (HR) 0.84; 95% CI: 0.82–0.86) and 6% lower mortality (HR 0.94; 95% CI: 0.92–0.96), with stronger effects in the ICU than outside the ICU. Persistent walking for ≥3 days was associated with 18% less NV-HAP (HR 0.82; 95% CI: 0.79–0.85) and 80% lower hospital-mortality (HR 0.20; 95% CI: 0.19–0.21), with stronger effects outside the ICU than in the ICU.

In a large hospital network, both oral care and mobility were associated with lower risk of NV-HAP and hospital mortality, with differential effects inside and outside of the ICU. Prospective trials are needed to confirm these potential benefits.

Antibiotics prescribed at hospital discharge are difficult to capture electronically for surveillance purposes unless patients are discharged to home with oral antibiotics. Our goal was to estimate the proportion of post-discharge antibiotics that are administered either in post-acute care facilities or via outpatient parenteral antibiotic therapy (OPAT) programs among patients discharged from Veterans Health Administration (VHA) hospitals.

We performed a retrospective study of all acute-care VHA admissions discharged during 2018–2021. The primary outcome was post-discharge antibiotic length of therapy, defined as the number of days of antibiotic exposure prescribed or recommended by inpatient providers at hospital discharge. Data on post-discharge antibiotic use was measured electronically for some discharge locations and estimated by performing manual chart reviews in randomly selected cases discharged to other locations.

129 VHA hospitals.

There were 1,972,940 admissions, and 42.6% received inpatient antibiotics; 89.8% of patients were discharged to the community and 10.2% to post-acute care. The frequency of receiving post-discharge antibiotics varied by discharge location. Based on our calculations, 32.8% of all post-discharge days of antibiotic exposure occurred in post-acute care or via OPAT. Overall, 43.9% of all hospital-associated days of antibiotic exposure were administered during the hospital stay and the remaining 56.1% qualified as post-discharge.

A third of all post-discharge antibiotics were dispensed in post-acute care facilities or by OPAT programs. These findings have implications for comparing hospitals on their post-discharge antibiotic use, because antibiotic data for patients discharged to these locations is often missing or difficult to collect.

Urinary tract infections are commonly overdiagnosed. To minimize overdiagnosis, some laboratories utilize reflex algorithms that use urinalyses as preliminary screening before potentially proceeding to urine culture. However, the optimal urinalysis cutoffs for this diagnostic stewardship intervention remain poorly defined.

We performed a retrospective, cross-sectional analysis from 2/1/21–1/31/23 in the Los Angeles County Department of Health Services healthcare system. We examined patient encounters in which urinalysis was ordered synchronously with urine culture. We categorized urine culture isolates as uropathogens or non-uropathogens. We calculated receiver operating characteristic curves of urinalysis parameters’ ability, singularly or in combination, to identify uropathogens.

Among 80,949 paired urinalysis and urine cultures (17,488 inpatient, 20,716 emergency department, 42,745 outpatient), cultures yielded 35% (n = 28,993) uropathogens, 4% (n = 2960) non-uropathogens, 37% (n = 29,951) contaminants, and 24% (n = 19,045) no growth. Among urinalysis parameters, white blood cells (WBCs) had the highest diagnostic accuracy (area under the curve (AUC)=0.722, [95% CI 0.718–0.725]), followed by leukocyte esterase (AUC = 0.700, [95% CI 0.690–0.701]), bacteria (AUC = 0.673, [95% CI 0.670–0.677]), nitrite (AUC = 0.627, [95% CI 0.625–0.630]), and squamous epithelial cells (AUC = 0.530, [95% CI 0.526–0.534]). WBC AUC values were consistent across healthcare settings (outpatient, emergency department, and inpatient). The urinalysis parameter combination with the highest AUC, WBC plus bacteria, performed worse than WBCs alone (AUC = 0.711 vs. AUC = 0.722, p = 0.001).

WBC on microscopic urinalysis demonstrated the highest diagnostic accuracy for predicting uropathogens in urine cultures. Stewardship programs should consider prioritizing urinalysis WBC count as the screening tool to optimize urine culture utilization.

This study aimed to update the incidence of device-associated healthcare-associated infections (DA-HAIs), and to characterize pathogen distribution and carbapenem-resistant Enterobacteriaceae (CRE) detection among ICU patients in Shanghai, China.

Prospective surveillance in 223 ICUs using standardized International Nosocomial Infection Control Consortium methodology (INICC) protocols collected patient-level data on demographics, microbiology, device use, and DA-HAIs. Trends, annual percent change (APC) and average annual percent change (AAPC) were estimated using Joinpoint regression models.

The overall DA-HAIs incidence density in ICUs was 1.67 per 1000 catheter-days for catheter-associated urinary tract infection (CAUTI) (95% CI: 1.62–1.73), 0.59 per 1000 central line-days for central line-associated bloodstream infection (CLABSI) (95% CI: 0.56–0.63), and 4.63 per 1000 ventilator-days for ventilator-associated pneumonia (VAP) (95% CI: 4.51–4.76). Significant reductions were observed in VAP (AAPC: −15.36%; P < 0.001) and CLABSI (AAPC: −11.23%; P < 0.001). Pathogen distributions varied by infection type, with Enterococcus faecium (17.22%) and Klebsiella pneumoniae (16.63%) predominating in CAUTI patients, Klebsiella pneumoniae (26.87%) in CLABSI patients, and Acinetobacter baumannii (37.60%) in VAP patients. The overall CRE detection rate was 33.67% in CAUTI patients, 37.56% in CLABSI patients, and 35.24% in VAP patients.

Although DA-HAI rates showed significant declines, the persistently high CRE prevalence underscores substantial antimicrobial resistance challenges in Chinese ICUs.

In Staphylococcus aureus the qacA/B and smr genes have been associated with elevated MICs to antiseptics with such organisms often termed antiseptic tolerant S. aureus (ATSA). The impact of repeated healthcare or antiseptic exposure on colonization with ATSA is uncertain.

Prospective longitudinal cohort study.

The high-risk cohort included children with a new diagnosis of malignancy recruited from a pediatric oncology clinic. The low-risk cohort were otherwise healthy children enrolled from general pediatrics clinics.

Subjects had anterior nares and axillary cultures collected at 3-month intervals for one year. Identified S. aureus isolates underwent PCR for qacA/B and smr. The primary outcome was colonization with ATSA at least once during study follow-up. Logistic regression models were utilized to adjust for confounding across cohorts.

226 subjects were evaluable for the primary outcome. It was noted that 93.5% of high-risk subjects reported regularly using chlorhexidine gluconate (CHG) antiseptic products. Colonization with ATSA was found in 15.5% of subjects. In univariable analyses, subjects in the low-risk cohort more frequently had ATSA colonization; following adjustment for confounders, the rates of overall ATSA colonization were similar in the high- and low-risk cohorts. Only 2 subjects had colonization with an ATSA strain at more than one encounter.

Pediatric oncology patients do not experience higher rates of ATSA colonization than healthy children. In addition, ATSA colonization is transient relative to strains negative for smr/qacA/B. These findings suggest that repeated use of infection prevention strategies including CHG do not predispose to colonization with ATSA in the ambulatory setting.

To evaluate the impact of reported β-lactam allergy on the risk of surgical site infections (SSIs), given that most reported cases are unverified and may lead to suboptimal antibiotic prophylaxis.

Systematic review and meta-analysis.

Four databases were systematically searched for studies reporting SSI rates in patients with and without β-lactam allergy. The primary outcome was SSI incidence; secondary outcomes included mortality, length of hospital stay (LOS) and adverse events. Subgroup analyses were conducted to explore potential sources of heterogeneity. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed using the ROBINS-I tool.

Twenty-five retrospective observational studies comprising 460,284 patients were included. Reported β-lactam allergy was associated with a significantly increased risk of SSI (RR = 1.55, 95% CI = 1.24–1.94). This association remained consistent across sensitivity and subgroup analyses, particularly in studies relying on self-reported allergies. Patients receiving β-lactam antibiotics had a significantly lower SSI risk than that of patients receiving non-β-lactam alternatives (RR = 0.63, 95% CI = 0.42–0.94). No significant differences were found in LOS or hypersensitivity reaction rates. Mortality was not reported in any of the included studies.

Reported β-lactam allergy is associated with an increased risk of SSI, highlighting the importance of accurate allergy assessment. Selective administration of β-lactam agents, such as cefazolin, may offer a safe and effective option for preoperative prophylaxis in patients without a history of severe hypersensitivity.

Antimicrobial resistance (AMR) is a global health challenge, highlighting the need for antibiotic stewardship policies. We evaluated the impact of the National Action Plan to Contain Antimicrobial Resistance (2022–2025) on antibiotic use among primary healthcare institutions (PHIs) in Central China.

A segmented interrupted time-series analysis from January 2021 to December 2023.

We collected data from 1510 PHIs, by region, types of healthcare institutions and medication type, assessing antibiotic consumption using defined daily doses per 1000 inhabitants per day and the quality by the percentage of broad-spectrum antibiotics.

Post-intervention, antibiotic consumption declined by −35.96% (95%CI: –49.34 to –22.57), and the proportion of broad-spectrum antibiotic use decreased by –41.97% (–61.74 to –22.20). Consumption dropped significantly in both moderately developed areas and underdeveloped areas, while highly developed areas saw the largest reduction in broad-spectrum antibiotic use. Rural PHIs also showed notable declines in both overall antibiotic consumption and broad-spectrum usage.

The policy was associated with a reduction in antibiotic use across PHIs, though regional disparities in its implementation suggest uneven benefits.

Admission to shared hospital rooms are a risk factor of healthcare-associated (HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.

Multicenter test-negative study of patients exposed to SARS-CoV-2 in shared rooms across five hospitals between January and October, 2022. Independent variables tested were measured air changes per hour (ACH), presence of any room mechanical ventilation (RMV), or portable high-efficiency particulate air (HEPA) filter. Covariates included facility (number of beds in room, outbreak status of unit), source patient (presence of symptoms, RT-PCR cycle threshold (Ct) value), and exposed patient factors (age, sex, time from last SARS-CoV-2 vaccine, previous SARS-CoV-2 infection, exposure duration). Multilevel logistic mixed models used to estimate the impact of engineering controls on transmission.

Among 468 exposed patients, secondary attack rate was 26.3% (range 7.5–33.3% across hospitals). In multivariable analysis, increased ACH was associated with decreased odds of infection (adjusted odds ratio (aOR) 0.88, 95% CI 0.78–1.00; p=.046) as were exposure duration and Ct value of source patient. Presence of RMV was also associated with decreased odds of infection (aOR 0.51, 95% CI 0.27–0.95; p=.034) while use of portable HEPA filter was not significant (aOR 0.58, 95% CI 0.26–1.31; p=.18).

Improved ventilation was independently associated with lower odds of SARS-CoV-2 infection among exposed roommates. Ensuring RMV is present and optimizing ACH may significantly mitigate the risk of HA-SARS-CoV-2. Future prospective studies should assess optimal ACH thresholds and the impact of portable HEPA filters.

The utility of routine environmental sampling to monitor the airborne fungal load (AFL) in healthcare settings is uncertain.

AFL was measured by monthly cultures at a tertiary-care pediatric hospital from November 2018 through October 2023 on eleven units caring for patients at risk for invasive mold infection (IMI). Surveillance for healthcare-associated IMI was conducted for all patients in the healthcare system using locally developed definitions for possible, probable, and definite hospital-onset infections. Poisson regression was used to analyze the association between AFL and monthly IMI rates.

78 cases of IMI were identified during the period of AFL monitoring. Of these, 51 infections were classified as healthcare-associated probable or proven IMI and were tested for association with AFL measurements. There was not a significant facility-wide association between the average monthly AFL and the overall IMI rate. On units where hematology/oncology patients were treated, however, an increase in average monthly local AFL for opportunistic fungal pathogens of 1 CFU/m3 was associated with a 1.48-fold increase in the IMI rate for these patients (95% CI 1.00–2.19, P = .05). The AFL for Aspergillus species on these units showed a particularly strong association with the hematology/oncology IMI rate (15.9-fold elevation for an increase of 1 CFU/m3 [95% CI 2.8–90.7, P = .002]). Neither hematology/oncology nor facility-wide IMI rates showed comparable associations with changes of the AFL in outdoor air.

Regular monitoring of AFL on targeted hospital units may identify periods when hematology/oncology patients are at increased risk for IMI.

To describe trends in the prevalence of healthcare-associated infections (HAIs) and antibiotic-resistant organisms (AROs) in Canadian acute-care hospitals.

Repeated point prevalence surveys.

Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.

Trained infection control professionals reviewed medical records of eligible adult patients and applied standardized definitions to collect demographic data and information on HAIs, AROs, and additional precautions from 39 to 62 hospitals in 2002, 2009, 2017, and 2024.

The prevalence of adult patients with at least one HAI increased from 10.4% (95% CI: 9.6%–11.2%) in 2002 to 12.4% (95% CI: 11.7%–13.2%) in 2009, declined to 8.4% (95% CI: 7.8%–9.0%) in 2017, and stabilized in 2024 (8.1%, 95% CI: 7.6%–8.6%) despite 3.1% of HAIs being due to SARS-CoV-2. Between 2017 and 2024, there were increases in bloodstream infections (1.0% to 1.5%, p = 0.002), viral respiratory infections (VRI) (0.3% to 0.6%, p < 0.001), and in the prevalence of patients on additional precautions for carbapenemase-producing organisms (0.1% to 1.7%, p < 0.001) and VRIs (2.1% to 3.6%, p < 0.001). In 2024, AROs were responsible for 6.6% of infections. One-third of HAIs were device-associated, and the prevalence of central line-associated bloodstream infections (CLABSIs) doubled from 0.4% in 2017 to 0.7% in 2024, p = 0.02.

A point prevalence survey performed in Canada in 2024 following the COVID-19 pandemic identified a stable prevalence of HAIs and AROs despite the inclusion of SARS-CoV-2. Concerning trends were observed including the increased prevalence of certain HAIs such as CLABSIs and VRIs highlighting the need for ongoing efforts in hospital infection prevention.