Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

Objective: The purpose of this study is to explore physicians' knowledge, attitudes, and perceptions toward antibiograms and identify perceived barriers and facilitators to their implementation in a low-resource setting in Sri Lanka.

Design: A qualitative study utilizing semi-structured interviews and thematic analysis.

Setting: A public tertiary care hospital in southern Sri Lanka.

Participants: Thirty physicians working in pediatric and adult medical wards were purposively sampled and interviewed between June and August 2023.

Results: Most physicians had limited prior knowledge or experience with antibiograms. However, after receiving a brief explanation, 29 out of 30 participants expressed strong support for implementing antibiograms, citing potential benefits such as improved antibiotic prescribing, reduced antimicrobial resistance (AMR), and enhanced patient outcomes. Approximately one-third of participants expressed concerns about feasibility due to time constraints, limited laboratory infrastructure, and personnel shortages. Participants recommended delivering antibiogram training through small-group sessions led by a multidisciplinary team. Thematic analysis identified three core themes: (1) limited baseline knowledge of antibiograms, (2) perceived clinical value and enthusiasm for implementation, and (3) barriers related to healthcare system constraints.

Conclusions: Physicians in this LMIC setting demonstrated high interest in using antibiograms to guide empiric antibiotic therapy and address AMR. Despite logistical and infrastructural challenges, tailored training and stakeholder engagement may facilitate the successful development and use of antibiograms in similar resource-limited settings.

Background: Bacterial infections complicate COVID-19 and contribute to adverse outcomes. Despite low prevalence, antibiotics are frequently prescribed empirically, raising concerns for antimicrobial resistance. This study aimed to identify risk factors for bacterial infections in hospitalized COVID-19 patients and explore drivers of antibiotic use in those without infection.

Methods: We conducted a retrospective study at Aga Khan University Hospital, Karachi, including 5383 adults hospitalized with PCR- or antigen-confirmed COVID-19. Patients were classified by presence of bacterial infection, defined by positive cultures or procalcitonin > 5 ng/mL. Logistic regression identified predictors of bacterial infection, antibiotic use in patients without infection, and associations with clinical outcomes.

Results: Of 5383 patients, 796 (17.3%) had bacterial infections. Majority were older (median 63.5 vs 57 years) and male (69.2% vs 57.1%). Independent risk factors included severe illness (aOR 5.12, 95% CI: 4.35 - 6.03), malignancy (aOR 1.87, 95% CI: 1.33 - 2.62), chronic kidney disease (aOR 1.95, 95% CI: 1.56 - 2.44), older age (aOR 1.42, 95% CI: 1.20 - 1.69), and male sex (aOR 1.47, 95% CI: 1.24 - 1.74). Among patients without bacterial infections, 61% received antibiotics. Drivers included advanced age, male sex, comorbidities, and severe illness. Antibiotic use in this group was associated with increased mortality (10.4% vs .6%) and longer hospitalization (median 5 vs 2 days).

Conclusion: Bacterial infections in hospitalized COVID-19 patients were linked to severe illness, comorbidities, and male sex, resulting in excess mortality. Widespread antibiotic use in patients without infection was associated with worse outcomes, underscoring the urgent need for antimicrobial stewardship in low-middle-income countries.

Objective: To evaluate the effectiveness of postcaesarean infection surveillance using the Power Business Intelligence (BI) program, focusing on antibiotic prescriptions. Second, to compare the workload between the traditional and new approaches.

Design: A diagnostic accuracy and workload evaluation.

Setting: A tertiary care university hospital in metropolitan Bangkok, Thailand.

Participants: All patients who underwent cesarean section between January 1, 2019, and September 30, 2020.

Method: ICD-10 diagnoses, microbiological cultures, and postcesarean section antibiotic prescriptions in 3,243 medical records were captured by the Power BI program to detect surgical site infections (SSIs). All cases underwent conventional surveillance, which independently performed by infection control nurses. All patients were under surveillance until 45 days after surgery to capture delayed SSI diagnosis. SSIs were compared with sensitivity and specificity used to evaluate the new method. The Wilcoxon signed-rank test was employed to compare workload differences between the two methods in a paired-sample design.

Results: The findings demonstrated the high sensitivity (100%) (95% CI: 66.4-100%) and specificity (93%) (95% CI: 90.5-95.4%) of the Power BI method when focusing on antibiotic prescriptions between 8- and 45-days postoperation. Additionally, the Power BI infection monitoring system significantly reduced the number of cases requiring review from 452 to 39 patients (a 91% reduction), indicating a substantial decrease in workload after implementation (P < .001).

Conclusion: This antibiotic prescription-based, semi-automated surveillance program significantly reduced workload, demonstrating its potential to enhance infection monitoring in postcesarean section cases.

Objective: To compare demographic patterns, diagnosis distribution, and prescribing trends between urgent care and non-urgent care clinics for infectious disease encounters across age groups.

Design: Retrospective cross-sectional study.

Setting: Outpatient encounters from 93 facilities (7 urgent care, 86 non-urgent clinics) in a single Michigan health system, from January 2021 to December 2024.

Participants: A total of 161,328 outpatient encounters involving an antibiotic prescription. Data were stratified by age group, sex, race, insurance type, and care setting.

Methods: Antibiotic prescription and ICD-10 diagnosis data were extracted from the CHARM database and compared across settings using χ², Fisher's exact, and Mann-Whitney tests.

Results: Urgent care encounters involved younger patients (median age 45 vs 55 yr, p < .001), with more visits among children aged 0-5 years (9.0% vs 5.3%, p < .001). Non-urgent care encounters had more patients aged ≥ 60 years (43.8% vs 34.1%, p < .001). Upper respiratory tract infections (URTIs), including acute pharyngitis and otitis media, were more frequent in urgent care (15.0% and 11.9% vs 6.7% and 7.6%, p < .001). Urinary tract infections (UTIs) were more common in non-urgent care (15.2% vs 13.8%, p < .001). Amoxicillin was the most prescribed antibiotic in urgent care (17.4% vs 11.4%, p < .001), while cephalexin led in non-urgent care (13.5% vs 11.5%, p < .001).

Conclusions: Comparatively, a larger proportion of urgent care visits were for patients under the age of 18 and for patients with URTIs. Meanwhile, a greater proportion of non-urgent care encounters were for patients over the age of 60 years old and patients with unspecified UTI.

In this randomized experimental study, Tru-D iQ and Legacy UV-C systems both reduced environmental contamination in hospital rooms. Both systems significantly reduced contamination, with the Tru-D iQ achieving comparable efficacy overall and significantly shorter cycle times.

Objectives: To evaluate the quality of systemic antifungal prescribing in Australian hospitals using point-prevalence survey data from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS).

Methods: Data were extracted from the Hospital NAPS dataset from January 2014 to December 2024. Systemic antifungal prescriptions were analyzed for antifungal use, guideline compliance, appropriateness, and reasons for inappropriateness according to the Hospital NAPS methodology. Demographic factors, hospital classifications, antifungals, and antifungal indication were compared.

Results: A total of 7,830 systemic antifungal prescriptions from 372 healthcare facilities across all Australian states and territories were included. Overall 88.4% were guideline compliant and 92.3% of prescriptions were deemed appropriate. Fluconazole was the most commonly prescribed antifungal but had one of the lowest percentage appropriateness (88.4%). In contrast, mold-active azoles, echinocandins, and amphotericin B demonstrated appropriateness rates exceeding 90%. Prescriptions with approval through local antimicrobial stewardship (AMS) processes had significantly higher appropriateness than those without (95.9% vs. 82.9%, p < 0.001). Specialized facilities managing immunocompromised populations showed both higher antifungal use and higher prescribing quality compared to general acute public hospitals.

Conclusion: This national evaluation highlights the overall high quality of systemic antifungal prescribing in Australian hospitals, reflecting the strength of AMS programs. However, variation across hospital types, specialties, and antifungal agents-particularly fluconazole-indicates opportunities for targeted stewardship interventions to further optimize antifungal use.

Objectives: Prolonged antibiotic therapy is associated with an increased risk of antimicrobial resistance and adverse events. We evaluated the implementation of a multifaceted antimicrobial stewardship (ASP) initiative aimed at reducing antibiotic duration for respiratory tract infections (RTIs) in outpatient settings.

Designs: Quasi-experimental study.

Settings: Academic medical center in Riyadh, Saudi Arabia.

Patients: Patient with RTIs in outpatient settings.

Methods: A multifaceted ASP intervention-including a clinical decision support tool and an educational session-was implemented to guide physicians in prescribing the shortest effective duration of oral antibiotics. We compared antibiotic utilization and adherence to evidence-based duration prescribing in a preintervention phase (June 2021-December 2021) and a postintervention phase (January 2022-June 2022) .

Results: We included 2320 patients in our study, of which 1359 were in the preintervention period and 961 in the postintervention period. Following implementation of the multifaceted stewardship initiative, the days of therapy (DOT) per 1,000 outpatient visits decreased from 131 to 50 and the mean duration of antibiotic therapy declined from 6.4 to 6.0 days (p < 0.001). Adherence to the recommended duration improved, with the percentage of prescriptions meeting recommended duration increasing from 49.7% to 56.3% (p = 0.002).

Discussion: The multifaceted ASP initiative can reduce unnecessary antibiotic exposure and improve the adherence to the recommended duration.

Objective: To evaluate the potential sources and current screening strategies for the multidrug-resistant fungal pathogen Candida auris in the US Military Health System (MHS).

Methods: Utilizing the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), 6 instances of C. auris colonization or infection were identified within the MHS in 2024. Relevant medical and social history, drug susceptibilities, and next-generation genetic sequencing were obtained from MRSN and the electronic medical record. Hospital screening protocols for C. auris were reviewed in the affected facilities.

Results: One case of C. auris infection and 5 cases of C. auris colonization in 2024 were identified in the MHS. Only 1 case of colonization was likely related to international travel; 5 patients had no recent travel history before infection or colonization. One patient was an active duty service member. Prior hospitalizations and infections were the most common risk factors present in each case. Two isolates had antimicrobial susceptibilities analyzed, both of which suggested resistance to fluconazole. Two of the 3 facilities had C. auris screening protocols in place to screen select individuals with risk factors; however, only 1 of the 6 cases presented was identified through these screening protocols. No cases of nosocomial transmission were found.

Conclusions: C. auris remains a formidable threat to the MHS, with 6 cases identified in 3 treatment facilities, with 2 isolates demonstrating resistance to azoles. Screening protocols should reflect the domestic and international threats of this pathogen.

Expanding public and policy maker knowledge, coupled with decisive action, is key to addressing antimicrobial resistance (AMR). These strategies provide a pathway to move beyond the AMR echo-chamber and drive meaningful change globally: (1) Improve knowledge translation, (2) Invest in public engagement, (3) Leverage One Health partners, and (4) Develop science-policy partnerships.