Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

Background: Antimicrobial stewardship programs (ASPs) are critical for optimizing antibiotic use and addressing antimicrobial resistance (AMR). Urinary tract infections (UTIs) frequently require antibiotics, yet inappropriate prescribing remains high.

Objective: To assess how a structured audit process, supported by information technology (IT), influences antibiotic prescribing practices for UTIs in the Urology Department at Prime Hospital.

Design: A 12-month quasi-experimental study was conducted in two phases: preintervention and intervention. A customized module in the electronic medical record (EMR) system monitored UTI prescriptions. Alerts for restricted antibiotics were reviewed daily by the antimicrobial stewardship (AMS) team, with immediate feedback to prescribers. The audit emphasized adherence to empirical guidelines, reducing fluoroquinolone use, promoting Access group antibiotics, and minimizing restricted agents.

Patients: All adult UTI patients in the Urology Department were included; pediatric patients under 12 and pregnant women were excluded.

Results: The intervention improved guideline adherence increased the use of Access group antibiotics and reduced restricted antibiotic prescriptions by approximately 50%. Daily multidisciplinary feedback reinforced rational prescribing; however, sustaining long-term behavioral change remained challenging.

Conclusion: Despite growing awareness of AMR, inappropriate antibiotic use persists. IT-enabled audits, combined with multidisciplinary collaboration, effectively enhance guideline adherence, promote rational antibiotic use, and improve patient care outcomes in hospital-based UTI management.

Background: The incidence of community-onset (CO) symptomatic urinary tract infection (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales is increasing worldwide. Our study aims were to explore the independent predictors for CO-ESBL SUTI and to compare the effectiveness of several oral therapeutics, which are used for this indication in community health settings.

Methods: Retrospective matched case-case-control and case-case studies, among insurers of Maccabi health maintenance organization, Shfella district, Israel (10-11/2019). Patients with CO-ESBL (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis) SUTI were matched to patients with CO-non-ESBL SUTI and to uninfected controls (1:1:1). Matched analyses (logistic regressions) were used to model predictors for CO-ESBL SUTI. A composite parameter for worse SUTI outcomes was compared among patients who were managed with a single, supposedly effective (ie, in vitro), oral agent.

Results: The study consisted of 1,455 patients (ie, three matched groups of 485 patients). The independent predictors for CO-ESBL SUTI were certain recent exposures: (1) hospitalization (3 months), (2) past carriage of multidrug-resistant organisms (2 years), (3) exposure to any antimicrobial (3 months), and (4) prior SUTI (6 months). Among 331 patients with CO-ESBL SUTI, resistance rates were lowest for fosfomycin (4.9%), while outcomes were worst for patients managed with oral amoxicillin-clavulanate.

Conclusions: CO-ESBL SUTI independent predictors in this community region were recent hospitalization, known MDRO carriage, exposure to antimicrobials and prior SUTI. Amoxicillin-clavulanate should be avoided, even for ESBL susceptible isolates.

Objective: To describe the prevalence, patterns, and quality indicators of antimicrobial use (AMU) in Burkinabe hospitals and identify priorities for stewardship.

Design: Multicentre, cross-sectional point prevalence survey (PPS) following the Global Point Prevalence Survey protocol.

Setting: Eight public hospitals across six cities in Burkina Faso (3 primary, 3 secondary, and 2 tertiary), February-June 2019.

Participants: All inpatients present on the survey day at 8:00. Medical records were reviewed for those receiving systemic antimicrobial agents.

Methods: Standardized ward- and patient-level data were collected on indications, agents, routes, and WHO AWaRe categories, alongside quality indicators (documented indication, stop/review date, guideline compliance, and targeted vs empirical therapy). Descriptive analyses compared hospital tiers.

Results: Of 994 inpatients, 729 (73.3%) received ≥1 antimicrobial (range by tier: tertiary 69.7%, secondary 79.2%, primary 79.2%). Community-acquired infections accounted for 96.0% of therapeutic indications. Leading reasons were skin/soft tissue infections (12.2%), gastrointestinal infections (10.7%), and pneumonia (10.4%). Parenteral administration predominated. The most used agents were ceftriaxone (27.8%), metronidazole (15.7%), and gentamicin (9.4%). By AWaRe, Access agents comprised ∼ 50%, Watch agents ∼ 50% overall, with higher Watch use in tertiary hospitals; no Reserve antibiotics were recorded. Quality indicators were suboptimal: the indication was documented in 15.6%, the stop/review date was absent in 93.0%, and 41.1% of prescriptions were guideline-compliant. Therapy was largely empirical (98.5%). Prolonged surgical prophylaxis (>1 day) represented 86.8% of prophylaxis courses.

Conclusions: Antimicrobial use (AMU) prevalence in Burkinabe hospitals is high, dominated by empirical therapy and Watch-class ceftriaxone. Deficits in prescribing quality and limited diagnostic use highlight urgent needs for context-adapted antimicrobial stewardship: enforce guideline-concordant care, curb prolonged prophylaxis and unnecessary Watch-class use, and expand affordable microbiology capacity to enable targeted therapy.

Objective: To describe the revised Asia Pacific Society of Infection Control (APSIC) Guidelines for Prevention of Central Line Associated Blood Stream Infections (CLABSI) 2024.

Design: The revised guidelines was developed by infection prevention and control experts and key opinion leaders from Asia Pacific.

Setting: Emphasis on practical implementation of Central Line Insertion and Maintenance Bundles using quality improvement approach is recommended towards the goal of achieving zero CLABSI in any healthcare setting.

Patients or participants: Any patients with a central line in a healthcare setting.

Interventions: Literature search was done for recent international updates in CLABSI prevention. Recommendations were evaluated for practical and feasible implementation in low resourced settings.

Results: The key recommendations are listed in the APSIC CLABSI insertion and maintenance guidelines. Additional measures are recommended for use where CLABSI rates remain high despite implementation of all preventive strategies to achieve institutional goals.

Conclusions: A surveillance program is recommended to monitor outcomes and compliance with bundles. Ongoing review of the performance data with appropriate interventions made should facilitate efforts towards zero CLABSI rate.

Background: Congenital infections cause stillbirth, prematurity, birth defects, and neonatal death, representing a major preventable cause of infant morbidity and mortality. In Brazil, data on their hospital burden remain limited.

Methods: This retrospective, population-based time series study analyzed hospitalizations of infants (<12 mo) primarily associated with congenital syphilis, toxoplasmosis, rubella, cytomegalovirus, or herpes in Brazil's Unified Health System (SUS) from 2008 to 2024. Data were extracted from the SUS Hospital Information System (SIH). Hospitalizations were evaluated by annual volume, population-adjusted rates, mean and total costs, intensive care unit (ICU) use, length of stay (LOS), and in-hospital mortality, stratified by region. Temporal trends were examined using Spearman's correlation and group differences using one-way ANOVA.

Results: A total of 194,531 hospitalizations were recorded, representing a 394% increase from 4,449 in 2008 to 20,971 in 2024. Congenital syphilis accounted for 88% of admissions and increased across all regions, while toxoplasmosis and cytomegalovirus rose moderately and rubella declined following immunization. National hospital expenditures reached US$49.1 million, rising 170% over the period. Mean LOS decreased modestly (-.8 d), and ICU use remained low except for herpes (up to 32%). In-hospital mortality declined from .73% to .13%, but 29.5% of patients were hospitalized outside their municipality of residence, indicating persistent regional disparities.

Conclusions: Hospitalizations due to congenital infections-predominantly syphilis-have increased substantially in Brazil, reflecting gaps in prenatal screening, partner management, and maternal-child health coordination. Despite declining mortality, regional inequalities in hospitalization rates, access, and costs persist.

Intra-abdominal infections (IAIs) are common in both the inpatient and outpatient setting but are not often a target for antimicrobial stewardship programs (ASP). However, IAIs provide ASPs an opportunity to translate evidence into practice while also addressing empiric broad-spectrum antibiotic use and establishing relationships with surgical stakeholders. In this review, we analyze five areas of emerging evidence within this heterogeneous field that merit close attention from ASPs, including spontaneous bacterial peritonitis prophylaxis, antibiotic management of appendicitis and biliary tract infections, and optimal amoxicillin-clavulanate and metronidazole dosing.

This review examines barriers and facilitators to implementing infection prevention and control (IPC) practices in behavioral health settings. Among 63 studies identified, environmental design, staffing/training limitations, patient behaviors, and therapeutic conflicts were common barriers. Facilitators included targeted training, collaboration, and adaptable IPC policies, underscoring the need for tailored interventions.

Background: Hospital-attributable central line-associated bloodstream infections (HA-CLABSI) are associated with severe patient outcomes. Published data on HA-CLABSI epidemiology in hospitals locally remains limited. This study aimed to determine the HA-CLABSI incidence and risk factors to inform targeted infection prevention practices.

Methods: Retrospective, nested case-control study was performed at Singapore General Hospital from January 2018 to December 2020, involving 127 cases and 252 controls. HA-CLABSI cases developed CLABSI ≥ 3 calendar days of hospitalization. Controls had central line inserted but did not develop CLABSI. Cases and controls were matched on 1:2 ratio for central line insertion date. Multivariable conditional logistic regression was performed to identify independent risk factors for HA-CLABSI, with adjusted odds ratio (aOR), 95% confidence intervals (CI) and p-values reported. Variables with p-value < 0.05 were statistically significant. HA-CLABSI incidence rate was calculated per 1,000 central line-days.

Results: HA-CLABSI incidence rate during the study period was 8.4/1,000 central line-days. Independent risk factors for HA-CLABSI were transfer to high-risk areas (aOR: 2.03, 95% CI: 1.05-3.92), immunocompromised health status (aOR: 4.62, 95% CI: 2.20-9.69), antibiotic administration (aOR: 7.41, 95% CI: 3.24-16.92), and total parenteral nutrition (aOR: 3.61, 95% CI: 1.49-8.77) being included as indications for central line insertion, insertion of PICC (aOR: 13.61, 95% CI: 3.12-55.53), presence of non-tunneled central lines (aOR: 2.95, 95% CI: 1.48-5.87) and prior MRSA acquisition (aOR: 3.41, 95% CI: 1.83-6.35).

Conclusion: HA-CLABSI remains a significant concern despite on-going infection prevention efforts. Risk factors identified facilitate development of targeted, evidence-based interventions.

Background: Effective antibiotic stewardship programing in clinical settings necessitates a good understanding of local prevalences of antimicrobial resistance and important patient and community risk factors. However, most studies are limited in sample size and geographic coverage.

Methods: This study utilized phenotypic resistance data of Escherichia coli from the Veteran's Health Administration of the United States (U.S.), incorporating 126,777 unique cultures from veteran outpatients from seven Midwest states from 2010 to 2023, to examine the spatial pattern and important individual- and county-level risk factors for resistance to four important classes of antibiotics. We utilized Bayesian conditional autoregressive zero-inflated Poisson regression models to generate smoothed rates of resistance in each county and multilevel logistic regression models to detect risk factors for resistance.

Results: High overall rates of resistance were seen for fluoroquinolone (29%) and TMP-SMX (22%). Geographic variation was seen among and between antibiotic classes. Certain urban regions in the southern parts of Illinois, Indiana, and Ohio had higher local resistance rates for fluoroquinolone and TMP-SMX. Being male, having diabetes, and previous exposure to antibiotics are significant risk factors for all classes of antibiotics while the significance of other risk factors varied across classes.

Conclusion: Diverse geographic patterns of resistance level may reflect differences in local prescribing practices, while the differential correlations with risk factors likely reflect their clinical indications and prescribing patterns in clinical settings. The local resistance rates and risk factors for different classes of antibiotics should provide important guidance in practicing empirical prescribing and antibiotic stewardship in clinical settings.