Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

Necrotizing soft tissue infections (NSTIs) are life-threatening conditions that require prompt surgical and antimicrobial intervention. An upward global trend in invasive group A streptococcal infections, concerning for a synchronous rise in NSTIs, warrants a standardized approach to antibiotic management of NSTIs to optimize care. Emerging data support a shorter antibiotic course following definitive surgical debridement, even in cases with concurrent streptococcal bacteremia. Individualized antibiotic management guided by surgical source control, as opposed to fixed durations, may help minimize unnecessary antibiotic exposure and the resultant adverse events and antimicrobial resistance. The use of clindamycin as an adjunctive anti-toxin antibiotic remains a common practice, though rising resistance and comparative studies suggest linezolid may be a safe alternative. This review aims to offer strategies to optimize antibiotic care in NSTIs by reviewing the growing body of evidence on antibiotic duration, de-escalation strategies, and adjunctive anti-toxin therapy.

Professor Stephan Harbarth obtained his medical degree from the University of Munich in 1993. He completed postgraduate training in internal medicine and infectious diseases in both Munich and Geneva. After serving as a clinical research fellow in infectious diseases at Geneva University Hospitals (HUG), he pursued postgraduate studies in epidemiology at Harvard School of Public Health, earning a Master of Science in Epidemiology in 1999. He continued his research activities at Children's Hospital of Harvard Medical School until 2001. In April 2007, he was appointed Attending Physician in the Infection Prevention and Control Service (SPCI) at HUG and also served as a consultant in the Infectious Diseases Service. He became head of the SPCI in October 2022. A Privat-docent at the Faculty of Medicine since 2006, Professor Harbarth was appointed Associate Professor in 2010 and Full Professor in 2018. His research focuses on the epidemiology and prevention of antibiotic-resistant infections, as well as on antibiotic stewardship. A renowned expert in this field, he serves on numerous national and international expert committees. His work has received multiple awards, including the prestigious Robert Koch Award in 2022 for hospital hygiene and infection prevention. His research group focuses on clinical and epidemiological studies aimed at addressing key issues related to the control of acquisition, transmission, and infection by multidrug-resistant organisms, as well as the associated clinical and public health burden. His work on the impact and control of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamases (ESBL)-producing organisms has significantly improved strategies to combat these pathogens. His additional research interests include the molecular epidemiology of emerging bacteria, pharmaco-epidemiology and antibiotic optimization, and the rapid diagnosis of severe infections. He has been involved in several large-scale, EU-funded studies (REVERSE, ECRAID, COMBACTE) and led the major European project "Drive-AB," which coordinated over 20 public and private partner institutions across 12 European countries to address this public health threat. Professor Stephan Harbarth was included in the Highly Cited Researchers™ 2022 list.

Objective: To describe an outbreak of Burkholderia cepacia complex at a tertiary care hospital in Karachi, Pakistan, highlighting contributing factors, potential sources, and system-level gaps identified during the investigation.

Design: Outbreak investigation.

Setting: A 655-bed tertiary care teaching hospital in Karachi, Pakistan.

Participants: All individuals who had positive blood cultures by non-lactose fermenting, oxidase-positive, Gram-negative rods that could not be further characterized.

Methods: On September 26, 2020, the Department of Infection Prevention and Hospital Epidemiology (DIPHE) was notified of multiple positive blood cultures. An outbreak investigation was initiated, including chart reviews, laboratory analysis, environmental sampling, assessing central line insertion practices, and evaluating the manufacturing site. Clinical Laboratory Standards Institute (CLSI) guidelines were used for microbiological identification and susceptibility testing.

Results: Thirty-five patients with positive cultures were identified between September 15 and October 22, 2020. While environmental sampling did not yield growth, significant breaches at the suppliers' facility were identified in chlorhexidine gluconate (CHG) storage and quality control. Although cultures of CHG were negative, the product's withdrawal led to a marked decline in new cases. Moreover, while resources were unavailable for genomic testing, antimicrobial susceptibility patterns were similar in all the case strains, suggesting a common source.

Conclusion: This outbreak highlights the role of contaminated disinfectants in healthcare-associated infections. It also revealed systemic gaps in disinfectant quality control, storage facilities, and diagnostic capacity, delaying outbreak recognition and response. It is essential to strengthen regulatory oversight, implement standardized testing protocols, and enhance microbiological diagnostic infrastructure to lower the risk of similar outbreaks.

Objective: To evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify areas for improvement in the delivery of stewardship interventions.

Design: Cross-sectional survey study.

Setting: A 1200-bed tertiary care public hospital in Portugal.

Participants: Physicians with antibiotic prescribing privileges in inpatient settings. All physicians with active institutional e-mail addresses were invited to participate.

Methods: An anonymous web-based questionnaire was administered between June and December 2024. The survey addressed six domains: (1) antibiotic knowledge; (2) awareness and use of local prescribing protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of antibiotic restriction policies; (5) use of informal consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions.

Results: A total of 154 prescribing physicians responded (response rate: 10%), including specialists (75.3%) and residents (24.0%). Most respondents were aware of institutional protocols (78.6%), but 66.9% reported rarely or never consulting them, citing accessibility and reliance on personal knowledge as key barriers. Participation in case discussions was limited (25.3%) but viewed as highly useful. Awareness of restrictive antibiotic policies was low; however, 69.5% indicated that these policies influenced their prescribing behavior. Respondents expressed strong interest in regular feedback on antimicrobial use and resistance trends.

Conclusions: Key areas for improvement in ASP implementation include enhancing access to protocols, expanding case-based discussions, clarifying communication around restrictions, and establishing regular feedback mechanisms. These findings may inform efforts to align ASP strategies with clinical realities in similar hospital settings.

While Centers for Medicare and Medicaid Services-mandated Antimicrobial Stewardship Programs are now in place across U.S. skilled nursing facilities, reported high rates of compliance may mask persistent gaps in clinical effectiveness. This review summarizes evidence-based antimicrobial stewardship interventions, their impact, and practical tools to support implementation. Resources from Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, other frameworks, and proposed metrics are highlighted to guide effective stewardship in resource-variable nursing home settings.

A ceftriaxone safety alert prompted a review of rapid response and cardiac arrest events in relation to the timing of intravenous cephalosporin administrations across a large health system. Despite high utilization, we found a low rate of significant ceftriaxone-related adverse events with a similar incidence as other intravenous cephalosporins.

Background: Efforts to address overuse of antibiotics for RTIs are important to limit antimicrobial resistance. Leaflets used during GP consultations can empower patients to self-manage respiratory infections (RTIs) and support a reduction in unnecessary antibiotic prescribing.

Objectives: This study aimed to assess the feasibility and acceptability of a Treat Your RTI (TY-RTI) patient leaflet for GP consultations in Ireland.

Methods: A single-arm mixed-methods feasibility study was conducted. Six GPs in daytime practice and three GPs in out-of-hours (OOH) services were recruited to use the TY-RTI leaflet during routine RTI consultations where an immediate antibiotic was not deemed necessary. GPs and patients completed questionnaires to assess the feasibility and usefulness of the leaflet during the consultation. Ethical approval was obtained.

Results: The TY-RTI patient leaflet was used by GPs in 201 RTI consultations (57 in OOH, 28%), and 84 (42%) patients/parents completed the questionnaire (9/84 in OOH, 11%). For over 90% (182/201) of consultations, GPs reported the leaflet was useful, supported communication, safety-netting, and did not increase consultation time. All patients/parents found the leaflet easy to read and useful. They reported the leaflet gave them confidence to self-manage RTIs without antibiotics (88%, 74/84), and it changed their views of the need for antibiotics (81%, 68/84).

Conclusions: This study demonstrates the feasibility and acceptability of the TY-RTI leaflet for GPs and patients, supporting its wider implementation. The leaflet supports improved communication and safety netting in the consultation and empowers patients in the self-management of RTIs, with potential to reduce patients' antibiotic-seeking behavior.

In this cross-sectional study of 136 antimicrobial prescriptions at a rehabilitation hospital with recent implementation of electronic medication order entry and no mandatory requirements, we found incomplete documentation of both indication (37%) and duration (75%). An accompanying survey identified potential solutions including reminders, improved choice architecture, and forced functions.

Background: Outbreaks of vancomycin-resistant Enterococcus faecium (VRE) are often difficult to contain. In this study, we developed and implemented a set of control measures, which resulted in a relatively limited outbreak in a secondary care hospital in Sweden.

Methods: VRE screening was performed by rapid polymerase chain reaction (PCR) on fecal swabs, reported within 1-3 h. Vancomycin-resistant isolates PCR-positive for the vanA/vanB gene were further analyzed with whole-genome sequencing (WGS). Cleaning efficiency was evaluated directly after cleaning by using adenosine triphosphate (ATP) swabs, detecting organic live material. The hospital management appointed a task force consisting of experts in infectious diseases, microbiology, hospital hygiene, cleaning and representatives of the affected unit.

Results: A total of 22 VRE-positive patients were identified, of which 12 isolates belonged to the same clone (ST 203) in a surgical ward. VRE screening by PCR shortened the turnaround time. The combination of rapid PCR and WGS could rule in or out cases from the outbreak within less than a week. The new cleaning routine indicated that 3 approved quality-controlled discharge cleanings were required to reduce VRE acquisition. The fast lane to decision-making on control measures resulted in rapid introduction of the above routines.

Conclusions: With prompt infection control measures, the VRE outbreak was contained after 4 months. To prevent further outbreaks of VRE, active rapid screening, improved cleaning, and restriction of multiple-bed rooms are efficient measures to implement.