Infection Control and Hospital Epidemiology最新文献

Background: Penicillin allergy reporting is common in U.S. healthcare systems, but true allergies and clinically significant reactions are inaccurately reported. Validated tools like PEN-FAST score allow for structured risk assessment; however, many clinicians remain unfamiliar with how to utilize the score to inform decision-making and prescribing. Integrating the PEN-FAST tool into the electronic health record (EHR) admission workflow may promote awareness and improve clinical utility.

Methods: We integrated the PEN-FAST tool into the admission navigator of our hospitals' electronic health record to be completed by nursing staff. Over a seven-month period, completed PEN-FAST scores across our health system were analyzed to evaluate the overall opportunity for allergy assessment and delabeling. The study population consisted of patients with a documented penicillin class allergy and a completed PEN-FAST score. Patients with incomplete scores or responses marked as unknown for every item were excluded.

Results: A total of 13,121 patients were included in the final evaluation. There were 10,309 (78.6%) patients with low-risk scores (PEN-FAST score of 0-2), indicating they were potential candidates for direct antibiotic challenges. The remaining 2,812 (21.4%) patients were categorized as high-risk (PEN-FAST score of 3+), who were likely not eligible for a challenge without prior skin testing.

Conclusion: A substantial opportunity remains to improve the assessment and documentation of penicillin allergies throughout the healthcare system. Utilizing the electronic health record to prompt frontline staff to use validated risk assessment tools may improve documentation of allergies and support better management of patients with penicillin allergy labels.

Objective: Vancomycin overuse in pneumonia should be a key target for antimicrobial stewardship according to Centers for Disease Control and Prevention. High negative predictive value of nasal Methicillin Resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) (nMP) screening for pneumonia has been shown. We implemented informatics-based ASP intervention to reduce vancomycin use in pneumonia by 20% in 6 months.

Design: Quasi-experimental: Pre-intervention period (P1: 4/1/24-9/30/24) compared with post-intervention period (P2: 10/15/24-3/15/2025).

Setting: Quality improvement (QI) initiative in a tertiary-care center in Upper Midwest.

Patients: Hospitalized pneumonia patients.

Interventions: Automated default nMP order was incorporated in pneumonia order-set in electronic medical record while ordering vancomycin for hospital acquired/ventilator associated pneumonia, severe community acquired pneumonia.

Results: Outcome measures declined significantly: Average vancomycin use density as reported with days of therapy (DOT)/1,000 patient days decreased by 49.5% (from 72.2 DOT/1,000 patient days in P1 to 36.3 DOT/1,000 patient days in P2; p < .0001). Average vancomycin drug inventory cost decreased by 50% (from 1,089.5 U.S. Dollars (USD)/1,000 patient days in P1 to 546.3 USD/1,000 patient days in P2; p < .0001). All process measures showed significant changes: nMP ordering increased to 100% in P2 (p < .0001); proportion of pneumonia patients with negative PCR results with discontinuation of vancomycin within 48-72 hours increased to 71% (p < .0001) and time to vancomycin discontinuation declined by 46% (p < .001). Balancing measures (readmissions; nMP order-to-result time) remained unchanged.

Conclusions: Informatics-based ASP intervention was transformative leading to significant decline in vancomycin utilization, considerable healthcare-cost savings and significant increase in nMP screening among pneumonia patients.

Objective: To quantify antibiotic-related misinformation across major social networking platforms and examine its potential relevance to antimicrobial stewardship(AMS) and healthcare epidemiology.

Design: A retrospective, Cross-platform infodemiology study (2015-2025).

Setting: Public data from Twitter/X, Reddit, and Facebook were analyzed, and a temporal association with global antimicrobial-resistance measures from the World Health Organization's Global Antimicrobial Resistance(AMR) Surveillance System.

Methods: We extracted 1.8 million posts containing antibiotic-related key terms. Natural-language processing and transformer-based classification identified misinformation themes, sentiment polarity, and diffusion dynamics. Topic modeling and network analysis (Gephi) characterized echo-chamber structures. Temporal associations between misinformation intensity and antimicrobial-resistance indicators were examined using cross-correlation and Granger lead-lag analysis.

Results: Misinformation comprised 19.3% of posts, spreading 2.4 times faster than factual content (p <.001). Four dominant themes were identified: self-medication advocacy, natural-remedy promotion, misinformation alleging hidden motives or suppressed evidence, and anti-medical discourse. Misinformation intensity correlated strongly with antibiotic search intent (ρ = .74; p <.001) and preceded resistance trends by 6-9 months for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus.

Conclusions: Antibiotic misinformation may function as a measurable behavioral exposure with potential relevance to AMS and infection prevention goals. The inclusion of digital-behavioral surveillance in AMS reporting platforms would offer warning signs for potential risks associated with antibiotic resistance.

Background: Clostridioides difficile infection (CDI) requiring colectomy carries substantial mortality risk, with optimal timing of surgery remaining poorly defined. We examined temporal trends in colectomy among inpatients with CDI, identified predictors of surgical intervention and postoperative mortality, and evaluated the association between surgical timing and patient outcomes.

Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2018 to 2022. We compared patients undergoing colectomy with those managed medically. To minimize confounding by hospital-onset cases, the analysis of surgical timing and mortality was restricted to patients undergoing colectomy within 8 days of admission. Predictors were identified using survey-weighted logistic regression and LASSO regression models.

Results: Among 240,564 CDI hospitalizations (representing 1,207,995 weighted nationally), 717 patients underwent colectomy (3,585 weighted). CDI prevalence declined from 0.99% (2018) to 0.76% (2022), while colectomy rates increased from 0.28% to 0.34%. Peritonitis (OR 5.42; 95% CI, 4.46-6.59), coagulopathy (OR 4.96; 95% CI, 3.76-6.55), and sepsis/septic shock (OR 3.89; 95% CI, 3.39-4.47) were the strongest predictors of colectomy. Among patients undergoing colectomy within 8 days (2,830 weighted), in-hospital mortality was 26.5% overall, increasing from 21.0% (2018) to 30.7% (2022). Sepsis/septic shock (OR 8.20; 95% CI 2.92-23.07) and coagulopathy (OR 7.27; 95% CI 3.31-15.97) predicted mortality. Each additional day from admission to colectomy was associated with a 16% (OR 1.16; 95% CI 1.04-1.28) increased mortality risk.

Conclusions: In this nationally representative cohort, surgical timing was an independent and modifiable determinant of survival in patients with CDI requiring colectomy. Our findings underscore the importance of early surgical consultation for CDI patients with peritonitis, sepsis, and coagulopathy.

Objective: Although preterm infants are prone to healthcare-associated infections (HAI), HAI surveillance in neonates is still not widely practiced. In this paper, we present the HAI rates subsequent to nationwide implementation of NEO-KISS, the German national surveillance system for HAI in high-risk neonates. We also report on risk factors for the development of HAI in this population.

Design: Observational study.

Setting: German National Reference Centre for Surveillance of Nosocomial Infections, responsible for the maintenance of NEO-KISS.

Patients: Infants with a birth weight of less than 1500 g.

Methods: NEO-KISS data from the years 2008-2022 was analyzed retrospectively and incidence densities were calculated (in five-year reference periods) for different types of healthcare-associated sepsis (HAS), healthcare-associated pneumonia (HAP), and necrotizing enterocolitis (NEC). Rates were analyzed with Cox-proportional hazard regression models.

Results: A total of 118,214 infants with a birth weight of less than 1500 g from 251 neonatology departments were included. They comprised 15,254 HAS, 1,657 HAP, and 2,786 NEC. The incidence densities of HAS and HAP were 33.3% and 46.7% lower in the admission period 2018-2022 compared to 2008-2012 (2.98 vs. 4.47 HAS, 0.3 vs. 0.56 HAP, per 1,000 patient days). In the multivariable regression analysis, the period of admission remained significant after adjustment for independent risk factors for HAS, HAP, and NEC.

Conclusions: In Germany, the surveillance data for neonates in NEO-KISS between 2008 and 2022 showed a nationwide decrease in incidence densities of HAS, HAP, and NEC. The continuous engagement with NEO-KISS surveillance data may have contributed to this reduction.

Asymptomatic bacteriuria (ASB) frequently results in inappropriate antimicrobial use. Urinalysis (UA)-driven reflex urine culture order sets can reduce inappropriate urine cultures. Most special indications on free text overrides within a (UA)-driven reflex culture protocol were inappropriately defined and rarely symptom-based. Eliminating the "other" indication could strengthen diagnostic stewardship and reduce unnecessary urine cultures.

The clinical outcomes associated with using commercial versus open ISDTs (initial specimen diverting techniques) remain unclear. This multicenter study showed that switching from the commercial to open ISDT did not change blood culture contamination rates, length of stay, or days of therapy with antibiotics, but did reduce laboratory-associated costs.

Contact precaution policies are used to prevent the spread of pathogenic organisms. We aimed to test whether AI-assisted cameras could monitor aspects of compliance with these policies. Testing in both simulated and real patient care settings yielded exceptional sensitivity and good specificity, indicating potential to monitor adherence to contact precautions.