Assess clinical outcomes, knowledge, and attitudes about shortage mitigation interventions during a nationwide blood culture bottle shortage. We hypothesized that efforts to target ordering of blood cultures would not change patient-oriented outcomes.

Retrospective, noninferiority, multicenter study

Tertiary, rural healthcare system

Eligible patients had any culture ordered before and after mitigation strategies.

Mitigation strategies were rapidly implemented to preserve the availability of blood culture bottles for high-risk patients. Interventions included best practice advisories, algorithms, cascade questions, hard stops, education, and communication.

The primary composite outcome (death during hospitalization, death within 14 d after discharge, return to the emergency department (ED) or readmission within 14 d after discharge) occurred in 603 of 3,174 patients (19.0%) in the pregroup and 1,496 of 8,232 patients (18.2%) in the postgroup (P = 0.321), meeting noninferiority in inverse probability treatment weight (IPTW) analysis. The groups were similar in secondary outcomes and in the subgroup with severe sepsis or septic shock. 69% of 41 survey respondents answered the case questions correctly. Regulatory pressure and patient status were the strongest drivers of blood culture ordering. Clinicians favored in-person communication, algorithms, and cascade over emails, daily huddles, and hard stops/second signatures.

Implementation of mitigation strategies during the shortage was not associated with differences in outcomes including mortality, return to the ED, readmission, or length of stay. Preliminary evidence suggests that outcomes may not be affected by the absence of blood cultures in high-risk sepsis patients. If proven in future studies, sepsis recommendations could be rewritten to accommodate pretest probability for bacteremia.

To determine the frequency of antimicrobial management changes in response to positive gastrointestinal pathogen multiplex panel (GIP) results in patients with suspected infectious diarrhea, identify predictors of those changes, and assess their guideline adherence.

Single-center, retrospective cohort study

Tertiary referral center, including ambulatory and acute care settings.

Adult and pediatric patients with diarrhea and positive GIP evaluated in emergency department, inpatient, or outpatient settings between January 1 and December 31, 2018, were included. Patients considered immunocompromised due to underlying conditions and/or current/recent immunosuppressive therapies were excluded.

The primary outcome of interest was any change in antimicrobial treatment in response to a positive GIP. The secondary outcome was adherence to pathogen-specific guideline-recommended management. Marginal standardization with logistic regression models was also used to assess predictors of antimicrobial management change.

The analysis included 193 patients with diarrhea and a positive GIP. The most frequently detected pathogens were norovirus, Salmonella, and Campylobacter. The median time from test collection to result was 31 hours [Q1, Q3: 24, 52]. Of the 193 patients, 71 (37%) experienced an antimicrobial management change, 61 of whom (86%) were considered guideline-adherent. In adjusted models, empiric antimicrobial treatment and testing in outpatient settings were significantly associated with experiencing an antimicrobial change.

Around one-third of patients with a positive GIP test experienced a change in antimicrobials, and most of these changes were guideline-adherent. Most GIP tests ordered during the study period were negative, and most positive tests did not require antimicrobial therapy.

Antimicrobial resistance (AMR) is a major global health threat, driven in part by inappropriate antibiotic use. This study assessed the prevalence, patterns, and determinants of antibiotic prescription among inpatients at Tanga Regional Referral Hospital (RRH), Tanzania, using the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology.

A cross-sectional PPS was conducted using the WHO tool. Descriptive statistics summarized prescribing patterns, and logistic regression identified factors associated with antibiotic use.

Tanga RRH in Tanzania among hospitalized patients in April 2023.

Among 205 inpatients (60.5% female), 77.6% (n = 159) received ≥1 antibiotic, with a mean of 2.1 agents per patient. Metronidazole (27.7%) and ceftriaxone (17.6%) were the most frequently prescribed antibiotics. Only 2.4% of prescriptions were supported by antimicrobial susceptibility testing. In multivariate analysis, the absence of a peripheral vascular catheter was independently associated with reduced odds of antibiotic use (aOR 0.16, 95% CI: 0.06–0.43). Although 89% of prescriptions followed the Tanzanian Standard Treatment Guidelines, prescribing patterns diverged from WHO stewardship targets: only 53.8% of antibiotics were from the Access group (below the ≥60% recommended threshold). In comparison, 44.4% belonged to the broader-spectrum Watch group.

Antibiotic use in Tanga RRH was high, with limited microbiological guidance and heavy reliance on broad-spectrum Watch antibiotics, highlighting stewardship gaps. Strengthening antimicrobial stewardship and expanding diagnostic capacity are urgently needed to optimize antibiotic use and curb AMR in resource-limited settings.

This study aimed to compare appropriateness of restricted antimicrobial prescriptions, as assessed by antimicrobial stewardship program (ASP) prospective audit and feedback (PAF), between those ordered by medical trainees versus staff. Secondary objectives were to determine whether certain timing factors and other independent variables impacted prescription appropriateness.

Single center, retrospective cohort study.

The University of Alberta Hospital a 700-bed tertiary care hospital in Edmonton, Canada.

Prescriptions of six health-authority restricted antibiotics subject to ASP PAF between 2018 and 2023. Cases were excluded if prescriber role or prescription dates or times were unavailable.

Data from a local ASP quality improvement database was extracted. Multiple logistic regression analysis was completed with adjusted odds ratios (aOR) reported.

A total of 3,687 restricted antibiotic prescriptions subjected to PAF were included in this study, of which 1,163 (31.5%) were assessed as not appropriately prescribed. Prescriptions written by medical trainees did not have higher odds of appropriateness compared to staff (aOR 1.09 [95% CI 0.94–1.28], P = .25). Weekend prescriptions had a reduced odds of being appropriate (aOR 0.71 [0.60–0.84], P < .0001). Through the course of the Coronavirus Disease 2019 (COVID-19) pandemic, appropriateness improved from 56.2% (prepandemic), 71.5% (peri-pandemic) to 76.9% (postpandemic).

No differences were noted in restricted antibiotic prescription appropriateness between medical trainees and staff. Weekend prescriptions were less likely to be appropriate. Improved appropriateness over time may be multifactorial, including implementation of ASP preceding the pandemic. Further studies examining timing factors associated with appropriateness are needed.

Infection control practices are essential in any healthcare setting, including the prehospital setting, to protect both patients and healthcare providers. Yet, many unknowns exist about these practices in EMS settings. This review explores infection control practices in emergency medical services by exploring compliance rates and barriers documented in the published literature.

To identify relevant articles, a comprehensive search of the databases Embase, PubMed, and CINAHL was conducted. Furthermore, a hand-search of the reference lists from the included studies was performed to identifyadditional relevant research. The review followed the Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines.

A total of 184 records were initially identified—159 through database searches and 25 through hand-searching the reference lists. After removing duplicates and excluding non-English records and those published outside the specified time frame, 162 records remained. Title and abstract screening narrowed these down to 52 articles for full-text review, of which 16 met the inclusion criteria and were included in the final review.

The findings indicate that compliance rate with infection control practices among EMS providers falls short of the desired levels. However, most of the included studies utilized self-reported methods to assess compliance, which may not accurately reflect actual practices. Therefore, future research should incorporate direct observations to gain a clearer understanding of current practices. Furthermore, this review identified that the barriers faced by EMS providers are complex and multifaceted, necessitating a comprehensive strategy to effectively address these challenges.

Postdischarge antibiotics are often sub-optimal or unnecessary. This study sought to measure the risk of diarrhea in recently hospitalized patients treated with postdischarge antibiotics

Retrospective cohort study.

125 acute-care hospitals in the Veterans Health Administration (VHA).

Patients hospitalized within VHA during 2018–2021.

The primary exposure was postdischarge antibiotics. The primary outcome was time to C. difficile testing, which served as a surrogate marker for clinically significant diarrhea. Only tests that were performed during the 30 days after discharge and before all-cause hospital readmission were captured. We constructed a final Cox proportional hazards model with 27 fixed-effect predictors as well as a random intercept for each hospital.

There were 1,686,819 qualifying admissions, and 333,310 (19.8%) received postdischarge antibiotics. There were 13,387 patients (0.8%) who had a test for C. difficile done. Among those tested, the median time to testing was 6.7 days for those tested while on postdischarge antibiotics and 14.1 days for those tested while not on postdischarge antibiotics. Compared to patients not on postdischarge antibiotics, the hazard ratio for testing was 1.40 (95% CI, 1.29–1.51) among patients on low-risk postdischarge antibiotics and 1.56 (95% CI, 1.42–1.71) among those on high-risk postdischarge antibiotics.

In this national VHA hospital cohort, patients prescribed postdischarge antibiotics had a 40–56% increased risk of C. difficile testing compared to those not prescribed postdischarge antibiotics. Efforts to optimize antibiotic-prescribing at hospital discharge, particularly by reducing excessive duration and avoiding high-risk agents, may help mitigate these risks.

The misuse of antibiotics and the consequential rise in antimicrobial resistance (AMR) represent a significant global health concern. Cyprus currently reports to ESAC-Net the total consumption of antimicrobials, without distinguishing between hospital- and community-based antibiotic use. As a result, these data can only provide generalized insights into antimicrobial trends in the country.

To evaluate antibiotic prescribing patterns in national outpatient services in Cyprus.

We retrospectively analyzed the national community antibiotic prescriptions in Cyprus for the period 2020 – 2022. Data on community antimicrobial prescription were extracted from the National Insurance Organization (HIO) database. Orally administered dispensed antibiotics were categorized according to the WHO Anatomical Therapeutic Chemical (ATC) classification and by the WHO’s AWaRe (Access, Watch, Reserve) classification of antibiotics. Antibiotic prescriptions were calculated in both packages consumed and per 1000 beneficiaries, overall, by year, age groups, and medical specialty of prescribers.

During the period of 2020 – 2022, in total 1,458,723 antibacterial prescriptions for systemic use were ordered in Cyprus for outpatients. The annual rates of prescriptions per 1,000 beneficiaries demonstrated an increasing trend from 535.7 in 2020 to 653 in 2022, respectively. A decrease by 3.1% in the prescription of WHO “Access” antibiotics was observed, reaching 42.3% in 2022, which is much lower than the WHO’s goal of 60% and the EU’s goal of 70% for “Access” antibiotic consumption.

Between 2020 and 2022, antibiotic prescriptions in the community of Cyprus showed an overall increase, accompanied by a declining trend in the proportion of “Access” antibiotics prescribed.

This study assessed the perception and practice regarding Antimicrobial Stewardship (AMS) and knowledge about antibiotics among Community Pharmacy Dispensers (CPD) in selected municipalities of Kavrepalanchowk district, Nepal.

A cross-sectional study was conducted among CPD of the community pharmacies of Banepa, Dhulikhel, and Panauti in Kavrepalanchowk district, Nepal.

A structured self-administered questionnaire was administered to 58 CPD selected through census sampling technique. The questionnaire comprised of questions assessing the knowledge of antibiotics, perception, and practice regarding AMS. A bivariate analysis was done to determine association between demographic variables and dependent variables.

Majority of respondents (60.3%) had medium level of knowledge regarding antibiotics, 46.6% of the respondents had low practice scores, and 50% of the respondents had positive perceptions of AMS. A positive correlations of knowledge with perception (p = 0.0001) and practice (p = 0.019) was seen. Education level had a significant association with knowledge levels (p = 0.035) and perception about AMS (p = 0.043). A significant association between gender with AMS practice was also observed (p = 0.002).

The practice of AMS in community pharmacies is low despite of medium level of knowledge on antibiotics among the community pharmacy dispensers. Establishing AMS protocols specific to community pharmacies in Nepal can lead to standardized practices and improve adherence to AMS principles.

To characterize the incidence of contact precautions (CPs) on a palliative care unit (PCU) at a tertiary hospital in Canada.

Descriptive retrospective chart review.

Palliative care unit.

Adults admitted to the PCU who were placed on CPs during admission.

A retrospective chart review was conducted on all PCU admissions for 25 months from September 24, 2022, to October 29, 2024. Patient orders, clinical notes, medication records, microbiology results, and transport documentation were reviewed. A descriptive and basic comparative statistical analysis was performed.

CPs were used in 13 of 549 patient encounters (2.37%), with an incidence of 2.02 per 1,000 PCU patient-days. Indications included known MRSA (5/13), suspected CPO (4/13), new MRSA (3/13), and known vancomycin-resistant Enterococcus (1/13). The mean duration of CPs was 15.4 ± 14.1 (range 0.2–47.8) days. Mean hospital and PCU lengths of stay in the CP group were 24.8 ± 14.7 and 14.6 ± 14.8 days, respectively, compared to 23.8 ± 31.3 and 11.7 ± 11.7 days in the non-CP group (P = .816 for hospital stay; P = .491 for PCU stay). No significant differences were observed between groups in age, sex, or length of stay. Antibiotics were used in 9/13 patients, and 5/13 patients remained on CPs until death on the PCU.

This study is the first known retrospective review of CP use in palliative care. Further research is needed to explore its impact on infection outcomes, mortality, and patient-centered measures.

This study aimed to evaluate the impact of a pharmacist-led support system on the administration rate of vancomycin (VCM) loading dose, 0–24-hour area under the concentration–time curve (AUC0–24), incidence of acute kidney injury (AKI), and all-cause mortality in hospitalized patients.

This retrospective study with interrupted time series analysis was conducted from January 2021 to May 2024.

A public tertiary referral center providing acute and specialized inpatient care in Japan.

Among the 587 hospitalized patients who received VCM during the study period, 326 were evaluated.

The intervention comprised implementation of a pharmacist-led support system involving prospective prescription review and direct intervention when a VCM loading dose (25–30 mg/kg) was not prescribed.

The loading dose administration rate increased significantly by 43.2% immediately introducing the support system (95% confidence interval: 8.40–77.90; P = 0.0156), without significant trend change thereafter. AUC0–24 also increased significantly (241.0 vs 307.0; P < 0.001); there were no significant differences in AKI incidence or 90-day mortality.

The support system improved the loading dose administration rate and AUC0–24 without significantly increasing AKI or mortality. The improvement was immediate and sustained over 122 weeks, supporting its use in institutions aiming to optimize VCM loading doses where evidence remains limited.

Healthcare has deleterious impacts on the environment through production of massive amounts of waste leading to generation of greenhouse gas (GHG) emissions. Single-use materials used for preparation and administration of intravenous (IV) medications are a large component of hospital waste. Transitioning medications from the IV-to-oral (PO) route, called switch therapy, may be a means of decreasing unnecessary waste and associated emissions arising from hospital care.

This was a retrospective cohort study involving adult patients receiving IV antimicrobials with a highly bioavailable PO equivalent at a large academic medical center. For a randomly selected subset of patients, the mean number of IV days of therapy (DOT) for which PO therapy could have been administered based on our institution’s policy was determined for each antimicrobial. This proportion was applied to the full cohort to estimate the total unnecessary IV DOT. A GHG emissions estimation tool was used to estimate the emissions generated from the excess antimicrobials.

During the study period, 15,037 IV DOT were administered, of which 9,694 DOT (64%) were estimated to be unnecessary. This was estimated to have generated 2,049 kilograms of total waste and 0.353 metric tons of carbon dioxide equivalents, equivalent to 904 miles driven.

Optimizing IV-to-PO antimicrobial switch policies may be an effective way to decrease hospital environmental impact through reduction of single-use supply waste and associated emissions. Future work should prioritize evaluating other potential antimicrobial stewardship interventions as a means to reduce GHG emissions.

This study evaluated the impact of a multimodal antimicrobial stewardship intervention on fluoroquinolone (FQ) use for prophylaxis in outpatient urologic procedures.

This single-center retrospective cohort study included patients from the South Texas Veterans Affairs (VA) outpatient urology clinic who underwent procedures between December 1, 2020, and February 29, 2024. Interventions included academic detailing, provider-specific FQ use reports, and prospective urine culture reviews with feedback. One pre-intervention cohort (PRE) and three post-intervention cohorts (POST2021, POST2022, POST2023) were analyzed. The primary outcome was FQ days of therapy (DOT); secondary outcomes included inappropriate prescriptions, post-operative complications, emergence of FQ resistance within 1 year, and Clostridioides difficile infection within 30 days of prophylaxis.

This analysis included data from 548 patients (150 PRE, 139 POST2021, 168 POST2022, 91 POST2023). Median age was similar across groups (p = 0.20), with over 90% male in each cohort (p = 0.07). Over one-third in each cohort received pre-operative oral antibiotics, 25% of which were FQs. More than 90% received pre-operative IV antibiotics, and over 50% received post-operative oral antibiotics. A significant reduction in FQ DOT/100 procedures was noted from pre- to post-intervention groups (98.6 PRE, 49.6 POST2021, 53.5 POST2022, 45.1 POST2023). No significant differences were observed in the secondary clinical outcomes.

A multimodal stewardship initiative reduced FQ use before urologic procedures, mainly due to decreased IV use. Further efforts are needed to optimize pre-operative FQ use and address drivers of post-operative antibiotic prescribing.

Antimicrobial resistance (AMR) poses an escalating global threat, transforming once-treatable infections into major health challenges. Although antibiotic misuse is a well-known driver of AMR, particularly in low- and middle-income settings, the silent epidemic may be fueled by socioeconomic disparities even in high-income countries. This systematic review investigates the relationship between socioeconomic status (SES) and AMR prevalence across high-income nations based on the World Bank classification.

The studies included in this review span multiple observational designs (cross-sectional, cohort, and case-control) across various high-income nations, assessing the association between SES indicators (eg, income, education, and household crowding) and AMR strains, primarily methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Escherichia coli.

Findings consistently indicate that lower SES correlates with higher AMR prevalence, particularly in MRSA infections (r = 0.76, Blakiston et al). The review highlights that indices of SES (often derived from government census data) are consistently associated with lower income, lower educational attainment, and increased household density with elevated AMR prevalence.

The variability among studies in SES metrics, including income measures and deprivation indices, limits generalizability. Exceptions to this trend, noted in select studies focusing on distinct AMR strains like ceftriaxone-resistant E. coli, underscore the complexity of SES-related AMR mechanisms. This review supports public health initiatives aimed at targeting low-SES communities with AMR mitigation strategies, advocating for continued monitoring and intervention to curb AMR spread in vulnerable populations.