Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

This commentary informs on key pragmatic contributors to strategic and sustainable surgical IPC and AMS initiatives. Three key recommendations to strengthen and sustain surgical IPC and initiatives are (1) institutional leadership support, (2) a programmatic multidisciplinary implementation plan, and (3) effective communication strategies using motivational interview.

Objective: To identify behavioral factors explored in the literature and the theoretical frameworks used to understand antimicrobial prescribing behaviors of ICU physicians.

Design: Scoping review following the JBI methodology.

Setting: Studies conducted in intensive care units (ICUs) across various healthcare systems.

Participants: Physicians working in ICUs; studies involving other healthcare professionals or aggregating data from multiple specialties were excluded.

Interventions: Not applicable.

Results: From 995 records identified through PubMed, Embase, Scopus, CINAHL, and Web of Science, 18 studies met inclusion criteria. Fourteen were cross-sectional surveys and four used qualitative semi-structured interviews. Knowledge about antimicrobial use and its role in resistance was generally adequate. Attitudes reflected that beliefs, clinical uncertainty, and contextual factors influenced prescribing behaviors. Reported practices highlighted the role of adherence to institutional protocols and guidelines. Despite the behavioral focus, most studies lacked explicit use of theoretical frameworks to guide data collection or interpretation.

Conclusions: Antimicrobial prescribing in ICUs is influenced by behavioral determinants that are not consistently evaluated using theoretical models. Future research on Knowledge, Attitudes, and Practices (KAP) should integrate behavioral science frameworks to enhance understanding and enable better design of stewardship interventions.

Objective: To describe the implementation of an outpatient UTI intervention and its impact on UTI management.

Design: Quasi-experimental retrospective controlled study.

Participants: Outpatient clinicians practicing in emergency and primary care settings within 8 Veterans Affairs Medical Centers.

Methods: An intervention conducted utilizing the CDC Core Elements Antibiotic Stewardship framework between September 2022 and July 2023. Actions included academic detailing, audit feedback, and updated reflex culture procedures. Logistic regression adjusted for covariates (risk ratio [RR], 95% confidence interval [CI]), and a difference-in-differences (DID) analysis compared multiple UTI management metrics between intervention and control facilities.

Results: There were 278,419 and 157,067 genitourinary (GU) tract qualifying visits [mean (SD) age 71.7 (13.9), 92.6% male] within 8 intervention and 8 control sites, respectively. Antibiotic prescribing rates for a broad-based GU tract metric that included UTIs pre/post implementation were [N, (%)] 12,688 (8.0) and 4,062 (8.0) within intervention sites and 5,686 (6.3) and 1,920 (6.8) within control sites, respectively [DID aRR 0.97 (0.92, 1.02)]. Appropriate treatment selection for uncomplicated UTI (uUTI) pre/post implementation was 5,994(76.9) and 1,945(79.9), compared to 2,519(74.6) and 977(82.1) within control sites, respectively [DID aRR 0.94 (0.91, 0.98)]. uUTI appropriate treatment duration pre/post implementation was 5,709 (73.3) and 1,927 (79.2), compared to 2,469 (73.1) and 869 (73.0) within control sites, respectively [DID aRR 1.08 (1.03, 1.13)]. No evidence of diagnostic shifting or return GU visits post-implementation was observed.

Conclusions: Implementation of an outpatient UTI intervention in a predominantly male population was feasible but marginally effective.

Experts conducted a free statewide series on antibiotic stewardship for hospital, outpatient, and long-term care settings. In total, 366 participants from 244 sites represented 66% of counties in the state. Furthermore, 62% worked in nonmetropolitan counties, and 55% were from counties with medium-to-high social vulnerability, demonstrating reach into diverse sites.

Introduction: Antimicrobial resistance (AMR) is a complex One Health problem that requires continuous surveillance to minimize the potential hazards. Information must be disseminated promptly in easily understandable formats to support informed decisions and actions by data end-users. One way to address this is through real-time visualizations, such as dashboards, to help key interest-holders understand and monitor AMR. A scoping review was conducted to understand the current body of evidence surrounding real-time AMR visualizations in both veterinary and human health.

Methods: Twelve sources were searched for relevant citations. 1763 citations were included in the screening process. Citations were screened for four main criteria: (i) the text had to be a primary research article in English (ii) published between 1990 and 2023, and (iii) it had to discuss the methodology of an AMR display (iv) that was updated at least quarterly.

Results: Forty-two publications were identified as relevant. Publication information, information about the data used in the described displays, display information, and user information were charted. Publications were from 25 countries and utilized data from over 40 databases. Various bacterial genera and species were reported; the most common bacterial species were Escherichia coli and Staphylococcus aureus. Displays were most focused mainly on human data.

Conclusions: AMR data visualization has been implemented globally and is a critical component of continued AMR surveillance. Displays are often part of a larger surveillance system. A key challenge is designing a visualization for an intended audience and the information then being utilized by that audience.

Objectives: To evaluate healthcare workers' (HCWs) providing tuberculosis (TB) services knowledge, attitudes, and practices (KAP) regarding infection prevention and control (IPC), assess barriers and facilitators to TB IPC implementation and adherence, and evaluate existing TB IPC policies at public health facilities in Namibia's //Karas region.

Design: Concurrent mixed-methods design.

Setting: Public healthcare facilities in Namibia's //Karas region.

Methods: Quantitative data were collected using an online questionnaire distributed via email and social media platforms to HCWs providing TB services. Descriptive statistics were used to summarize respondent characteristics and KAP scores, followed by bivariate analysis using the Pearson χ² test (P < .05) to assess associations between knowledge scores and respondent characteristics. Focus group discussions (FGDs) were conducted with TB focal persons from District Coordinating Committees, transcribed, and analyzed thematically using a 6-phased approach. Data collection spanned 8 months (April 17-November 10, 2023).

Results: HCWs demonstrated good knowledge (91.2%) and positive attitudes (85.3%) toward TB IPC, with practice scores less optimal (61.8%). Knowledge was associated with district (P = .001), department (P = .036), and education level (P = .010). Staff shortages were the most cited barrier, and training emerged as a key facilitator. FGDs confirmed the implementation of TB IPC policies at institutional level and revealed barriers, including inadequate infrastructure, limited resources, stigmatization, and lack of managerial support. Facilitators included effective communication, health education, and personal protective equipment availability.

Conclusion: Strengthening TB IPC requires investment in infrastructure, training, consistent monitoring, and policy enforcement. Targeted IPC interventions can address key barriers and improve adherence across public health facilities.