Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

Objectives: To investigate the epidemiology and clinical outcomes of Candida auris (C. auris), reclassified Candidozyma auris, in a Detroit tertiary care center, focusing on mortality, length of stay (LOS), glucose variability, and demographic factors.

Setting: Inpatient admissions in a Detroit tertiary care center, June 2023-March 2025.

Patients: Among 9,025 C. auris tests, 725 (8.03%) were positive. A subpopulation of 242 hospitalized patients was analyzed for outcomes.

Methods: Clinical and demographic data, including infection status, mortality, and LOS, were analyzed. Glucose variability was assessed by the coefficient of variation. ANOVA and Kruskal-Wallis tests evaluated group differences, pairwise Z-tests compared mortality, and a competing-risks survival analysis estimated probabilities of discharge and in-hospital death.

Results: Mortality was highest among colonized/infected patients (31.3%) and significantly associated with race (p = 0.0072) and ethnicity (p = 0.0069). High glucose variability (>190 mg/dL) was linked to increased mortality (27.63%) and prolonged LOS (46.14 days; p < 0.01). Infected patients had the longest LOS (67.9 days), followed by colonized/infected (39.9) and colonized-only (30.2; p < 0.001).

Conclusion: C. auris disproportionately affects African American patients and those with high glucose variability, contributing to higher mortality and longer hospitalization. Infection status and glycemic instability were the strongest predictors of LOS, while racial and ethnic disparities influenced mortality. Strengthened infection control, early identification, and optimized glucose management may improve outcomes in high-risk populations.

Objective: To evaluate the clinical and implementation outcomes of an antimicrobial stewardship program (ASP) intervention to improve antibiotic therapy for a rapid diagnostic test (RDT) for bloodstream infections (BSIs).

Design: Retrospective pre and postintervention study.

Setting: Single pediatric tertiary center from August 2022 to May 2024.

Participants: Patients presenting with a positive blood culture accompanied by the Verigene (VG) Gram-positive Blood Culture Nucleic Acid (BC-GP) assay. Implementation outcomes surveys were completed by infectious diseases (ID) clinicians and non-ID clinicians.

Methods: We implemented a 24 hours a day, 7 days a week (24/7) ASP intervention to improve response to BC-GP assay results. The primary clinical end point was time to optimal antimicrobial therapy (OAT). Secondary endpoints included duration of bacteremia, hospital length of stay (LOS), and mortality. We assessed our intervention's acceptability, appropriateness, and feasibility using validated implementation outcomes surveys.

Results: Among 211 pre and 91 postimplementation BC-GP results, the median time to OAT decreased from 20.3 hours (95% CI:14.2-26.4) to 1.3 hours (95% CI: 0.0-2.7), p = .002. No significant differences were found in duration of bacteremia, LOS, or mortality. Implementation surveys from 23 ID and 47 non-ID clinicians demonstrated over 80% agreement on intervention appropriateness and acceptability. ID clinicians rated feasibility measures lower than non-ID clinicians (3.58 vs 4.51 on a five-point Likert scale, p < .001).

Conclusions: 24/7 ASP intervention paired with RDTs for Gram-positive BSIs is associated with reduced time to OAT. Feasibility differences between ID and non-ID clinicians highlight implementation challenges and the need for future strategy evaluation.

The use of multiplex polymerase chain reaction (PCR) panels for diagnosis of clinical syndromes is rapidly growing despite limited data on optimal use cases. We retrospectively reviewed the clinical impact and consequences of the inclusion of herpesvirus targets on the meningitis/encephalitis PCR panel.

We assessed inpatient antibiotic use over six fiscal years at Tanzania's national cardiac referral hospital. Overall use was 29.9 defined daily doses per 100 bed-days. Carbapenems were dominant. Reserve agents comprised 47.0%, and watch agents comprised 31.7%. Patterns indicate missed access targets and a need to strengthen stewardship in cardiac care.

Objective: To examine how artificial intelligence (AI) has been applied to infection prevention and control in healthcare, identify barriers and risks affecting implementation, and develop a structured checklist to support safe adoption.

Design: Scoping review conducted in line with Joanna Briggs Institute methodology and reported according to PRISMA-ScR.

Methods: PubMed, Scopus, and Web of Science were searched for primary studies (2014-2024) describing real-world AI applications for IPC. Studies reporting implementation experiences, outcomes, or risks were included. Data on study design, AI type, IPC function, integration level, barriers, and outcomes were extracted and synthesized thematically to derive a 41-item decision-support checklist.

Results: Of 2,143 records screened, 100 studies met inclusion. Most were published since 2022, with the United States and China leading output. Machine learning dominated (75%), mainly for predictive analytics (53%), HAI detection (13%), and hand hygiene monitoring (13%). Only 15% of tools were integrated into existing digital infrastructures. Barriers centred on data quality (45%), technical and data related (16%), and economic/technical constraints (16%). Reported risks clustered around operational failures (35%), technical errors (33%), and data security (12%). Evidence was heavily skewed toward high-income countries, with limited prospective validation or implementation science.

Conclusions: AI offers clear promise for IPC, particularly in early detection and compliance monitoring, but its translation into practice remains constrained by data fragmentation, limited integration, and uneven readiness across settings. Our evidence-informed checklist provides IPC teams with a structured tool to assess feasibility, governance, and resource needs before adoption, supporting safer and sustainable innovation.

Background: The presence of insects in hospital environments poses a potential risk for the dissemination of pathogenic bacteria, including multidrug-resistant species. Despite strict sanitation protocols, some arthropod populations persist in less regulated areas, potentially acting as mechanical vectors of bacterial contamination.

Objectives: This study aimed to analyze the bacterial diversity associated with insects collected in hospital settings and assess their potential role in spreading pathogens relevant to public health.

Methods: A descriptive observational approach was employed to identify and classify bacterial taxa associated with hospital-collected insects. High-throughput sequencing was used for taxonomic classification at the phylum, family, and genus levels.

Results: Proteobacteria was the predominant phylum, additionally we found families such as Moraxellaceae and Mycobacteriaceae, known to include clinically relevant species. The genera Acinetobacter and Mycobacterium were particularly abundant in some samples, raising concerns about their potential role in nosocomial infections. Other identified bacteria included Pseudomonas, Escherichia, and Shigella, albeit at lower frequencies. The persistence of these bacteria in hospital environments suggests that insects may contribute to their dissemination.

Conclusions: The findings highlight the need for enhanced arthropod control measures in healthcare facilities as part of routine biosecurity protocols. The presence of multidrug-resistant bacteria associated with hospital-dwelling insects reinforces their role in pathogen transmission, emphasizing the importance of comprehensive vector management strategies to mitigate nosocomial infection risks.

Introduction: Clostridioides difficile is the primary cause of healthcare-associated infectious diarrhea in hospitalized patients. The most common laboratory testing methods for C. difficile infection (CDI) are toxin detection via enzyme immunoassay (EIA) and polymerase chain reaction (PCR), which detect a toxogenic strain. This study examines the impact of Rhode Island's largest hospital system changing from PCR-only to two-step CDI testing.

Methods: A retrospective cohort study of 2,173 adult inpatients was conducted. Patients were grouped into two cohorts: those tested for toxigenic C. difficile via PCR-only (June 2019-May 2021, n = 1,194) and those tested with the two-step algorithm (June 2021-May 2023, n = 979). Cluster analysis identified patient risk groups for hypothesis generation, and complications such as death, colectomy, intensive care unit ICU transfer, and 30-day readmission were compared across these groups.

Results: In the moderate-risk group, there was a significant reduction in ICU transfers and readmission rates with the two-step testing by 5% and 7%, respectively. There were no other significant differences in complications between testing groups. Anti-CDI antibiotics were discontinued in 15% (n = 106) of EIA-negative patients in the two-step testing group. Moderate-risk patients were less likely to have treatment discontinued than severe-risk patients (OR = 2.00, p = 0.016).

Discussion: The two-step testing algorithm did not negatively affect patient outcomes and led to a modest decrease in anti-CDI treatment, supporting the safety of two-step CDI testing in hospitalized patients.

Objective: During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recommended infection prevention practices for preventing transmission in acute healthcare settings included, at a minimum, universal source control with masking and eye protection within six feet of others and using a respirator when caring for individuals with COVID-19.

Methods: A mixed methods study consisting of observations and self-reported infection prevention behaviors among critical care nurses identified high adherence to mask use in a medical intensive care unit (ICU) during the COVID-19 pandemic.

Results: Surveyed nurses reported more barriers to proper use eye protection than with masking. We observed nurses wearing required eye-protection only 20% of the time when within 6 feet of others. Use of eye protection increased in the presence of patients while decreasing near other healthcare workers. In self-reported assessments, these nurses described decreased protective behaviors at work and at home after vaccination for COVID-19. However, self-reported masking in public remained high and was not impacted by vaccination status. Finally, nurses most frequently perceived high transmission risk of SARS-CoV-2 in the community and patient care settings, with lowest risk from co-workers and household members.

Conclusions: Perceived risks of exposure to SARS-CoV-2 likely impact infection prevention behaviors. Differences in perceived risk between patient and peer groups provide insight into strategies for improving infection prevention behaviors in both pandemic and endemic multidrug-resistant organism settings.

Outpatient providers at a large urban academic tertiary care referral center were surveyed regarding their current antibiotic prescribing practices and views on antimicrobial stewardship in their practice setting. Many clinical and non-clinical factors shape providers' decision-making regarding antibiotic prescribing. Electronic medical record based interventions were a favored stewardship strategy.

Objectives: We described the clinical outcomes and estimated cost savings from switching patients to early oral therapy from intravenous (IV) therapy for prosthetic joint infections (PJI) based on predefined criteria.

Methods: Retrospective observational study in a large health authority consisting of 12 acute care hospitals in Canada. Patient demographics, microbiological and treatment data were collected for all patients with first episode of knee or hip PJI in 2022. Treatment failure rates, allergic or adverse reactions to IV or oral treatment, and hospital readmission rates were reported for those who met criteria for early switch to oral therapy.

Results: Fifty-one patients were included. Thirty-seven patients (73%) had knee PJI, with debridement, antibiotics, and implant retention being the most common procedure. Sixteen patients (31%) had IV therapy for the entire duration of treatment, and the mean duration was 44 days. Twenty-three patients (45%) could have been switched to oral therapy. In practice however, only 3 patients (6%) were switched to oral therapy by day 7 following surgical source control. Five patients (22%) had clinical and/or microbiological failure 2 years postsurgery. Four patients (17%) and 6 patients (26%) developed an allergic or adverse reaction to IV and oral therapy, respectively. Five patients (22%) developed line complications. We estimated potential cost savings of almost $70,000 Canadian dollars with early oral therapy.

Conclusion: Almost half of our PJI patients could have been switched to oral therapy within 7 days post-surgical source control. This study highlights a great opportunity for antimicrobial stewardship.