The treatment of asymptomatic bacteriuria (AB) has been associated with increased in antibiotic resistance and Clostridioides difficile infection, without clinical benefit. One strategy to improve management is to incorporate a recommendation in the microbiological report. The aim of the study was to assess the impact of this intervention on antibiotic prescribing for AB.

Potential cases of AB were identified, and the following comment was included in the microbiology report: “Assess according to clinical findings. In AB, no treatment is recommended”. Patient demographics, sample characteristics, reason for request, isolated microorganism, resistance profile, time to clinician’s review of the report, initiation of treatment and its causes, and repeat urine culture were collected. Factors associated with adherence to the recommendations were evaluated.

A total of 391 possible AB cases were identified. The majority of samples originated, from primary care (96%) and in women over 65 years of age (98%). Antibiotic treatment was initiated in 60% of cases, while the microbiological recommendation was followed in 40%. Factors associated with nonadherence to the recommendation included urine culture request prompted by foul-smelling or cloudy urine, and repeat culture. In contrast, urine cultures requested during routine health checks were more likely to be associate with adherence to the recommendation.

The inclusion of a commentary in the microbiology report contributed to a reduction in antimicrobial prescription in AB. This intervention may be effective in optimising antibiotic prescribing practices and improving urine culture request management policies.

Clostridioides difficile infection (CDI) is common among patients undergoing hematopoietic stem cell transplantation (HSCT). Oral vancomycin prophylaxis may effectively prevent CDI in certain populations. We investigated the effectiveness of oral vancomycin primary prophylaxis in preventing CDI in HSCT patients.

We searched six databases from inception to March 21, 2025, for studies comparing the incidence of CDI in HSCT patients who received oral vancomycin primary prophylaxis versus those who did not. We built a Bayesian random-effects model for meta-analysis. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of positive vancomycin-resistant Enterococcus cultures, blood stream infections, graft-vs-host disease, and length of hospital stay. We also assessed for heterogeneity and publication bias using Robust Bayesian Meta-Analyses.

Six studies met inclusion criteria with a total of 1,236 patients. Four of the studies were of fair to good quality. Oral vancomycin primary prophylaxis reduced the incidence of CDI during hospitalization (OR 0.31; 95%CrI 0.16–0.59). Studies were weakly heterogeneous but had strong publication bias. Oral vancomycin primary prophylaxis reduced the odds of CDI by 12% after accounting for publication bias (OR 0.88; 95%CrI 0.32–1.16), although this reduction was not statistically significant. Secondary outcomes were similar in both groups.

Oral vancomycin primary prophylaxis prevented CDI in HSCT patients without significantly affecting secondary outcomes. However, after controlling for publication bias, these findings were no longer significant. Further studies are needed to provide stronger evidence for or against this intervention, assess long-term safety, and assess potential effects on antimicrobial resistance.

A follow-up survey of Special Pathogen Treatment Centers (SPTCs) was conducted to assess their readiness to provide critical care interventions to confirmed and suspected viral hemorrhagic fever (VHF) patients after the COVID-19 pandemic.

An electronic survey with 54 multiple-choice and free-response questions assessing VHF critical care capabilities was sent to 74 US SPTCs in April 2023.

Fourteen SPTCs (19%) completed the survey. Most respondents were prepared to provide intubation/mechanical ventilation (79%), pharmacologic cardioversion (79%), renal replacement therapy (71%), and defibrillation (71%) to suspected and confirmed VHF patients. Few were ready to provide cricothyrotomy (36%), extracorporeal membranous oxygenation (ECMO) (29%), or code status (14%). Factors impacting institutions’ ability to provide critical care to a VHF patient included staff safety (71%) and clinical futility (50%). Less than half (36%) reported that the COVID-19 pandemic positively affected their facility’s ability to care for VHF patients, while 21% indicated the pandemic prompted their facility to be better prepared to care for a VHF patient.

Most responding SPTCs reported capability for critical care interventions, although fewer had policies governing code status, ECMO, and cricothyrotomy. Institutions were less prepared to manage a VHF patient after the COVID-19 pandemic, highlighting challenges such as staff turnover and less support for training and equipment maintenance. Given that special pathogen outbreaks continue to occur globally, governments and healthcare institutions should institute measures to recruit, support, and retain staff to ensure critical care readiness for special pathogen patients.

This study aims to assess the knowledge and determine the level of compliance with human immunodeficiency virus (HIV) post exposure management (PEM) among dentists.

A descriptive cross-sectional study was done among 114 dentists.

Study was done among dentists in two Nigerian tertiary hospitals.

All dentists available, who consented to the study during the period of data collection were included in the sample. Three cadres of dentists; house officers, residents and consultants, were involved in the study.

Using self-administered questionnaires, information was sought on knowledge of managing exposures-first aid and prophylaxis as well as compliance when exposed. Data was analyzed using the SPSS statistical software.

Nearly all respondents, 111(97.4%), reported having heard about HIV PEM. Exposure incidents most frequently identified by respondents were needlestick injuries, 111(97.4%). Majority of the dentists recognized practices such as flushing exposed mucous membranes with water, 97(85.1%), and washing skin injuries with soap and water, 75(65.8%), as first aid for exposure incidents, while 20(17.5%) endorsed inappropriate measures like applying bleach to the wound. Seventy-one (62.3%) reported awareness of a HIV PEM protocol in their institution while 39(33.3%) were uncertain, with only 25(21.9%) reporting routine practice of the protocol. Fifty-six (49.1%) of the respondents had experienced an exposure of which only 30(53.6 %) reported and 32(57.1%) requested blood tests for the source patient(s).

The level of compliance with post exposure management is inadequate, therefore there is a need to update the knowledge and device methods of encouraging compliance with HIV PEM protocol among dentists.

This study aimed to evaluate the impact of an Antimicrobial Stewardship Program (ASP) on antibiotic consumption and mortality rates in the intensive care units (ICUs) of a national pediatric referral hospital in Lima, Peru.

The study population included patients under 18 years of age admitted to five ICUs during two distinct periods: prior to the implementation of the ASP (2016–2017) and following its implementation (2017–2018). Days of therapy (DOT) per 1,000 patient days were calculated to evaluate antibiotic consumption, and the results were compared between the two periods. Mortality rates and length of stay (LOS) were also assessed and compared. Differences in antibiotic consumption, mortality, and LOS were analyzed using χ2 and t tests.

Following ASP implementation, average antibiotic consumption decreased significantly from 750 DOT to 660 DOT (p = 0.01), indicating a 12% reduction. Notable declines in antibiotic use were observed specifically in the cardiology and burns ICUs, as well as in the subgroups of carbapenems, glycopeptides, and oxazolidinones. However, the analysis revealed no significant reduction in mortality rates or LOS following the implementation of the ASP.

Our findings suggest that the implementation of an ASP in pediatric ICUs is associated with a reduction in antibiotic consumption. These results underscore the critical importance of ASPs in promoting appropriate and rational use of antibiotics. Further research should explore the complex relationship between inappropriate antibiotic use and mortality in pediatric ICUs to clarify how ASP implementation may contribute to reducing mortality in this vulnerable population.

Expanded public health (PH) antimicrobial stewardship (AS) funding to Healthcare-Associated Infections (HAI)/Antimicrobial Resistance (AR) programs led to hiring of pharmacists with AS expertise in health departments. A PH pharmacists’ community of practice (CoP) consisting of pharmacists who work for local, state, and federal PH agencies was initiated to share resources and activities from PH AS interventions and collaborations. The objective of this evaluation was to characterize publications identified by PH pharmacists’ CoP that helped advance AS implementation by PH agencies.

In March 2024, a 34-item electronic questionnaire was developed and distributed to the PH pharmacists’ CoP requesting nominations of articles that highlight interventions and data sources essential to PH AS practice. Respondents were asked to submit 1–10 scientific articles published from 2014 to 2023 most relevant to their work in PH AS implementation and/or in achieving programmatic deliverables. Articles with ≥ 3 nominations were selected for review.

Of 39 PH pharmacists in the CoP, 24 (62%) responded with 106 article nominations. Respondents held state-level positions (83%), had <2 years of PH AS experience (54%), and were often from the southeastern United States (25%). Publications in acute care settings were most frequent (54, 51%), followed by outpatient (47, 44%), and long-term care (45, 42%). A total of eleven articles were selected for review.

Scientific publications impactful to AS PH practice can serve as a valuable resource for AS programs and pharmacists in PH. Dissemination of PH AS activities can inform enhancement of AS programs in the PH sector.

Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.

A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.

The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.

Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.

Urgent care locations remain a target for antimicrobial stewardship initiatives due to high rates of inappropriate antibiotic prescribing, particularly for respiratory tract infections. This study evaluated the impact of an antimicrobial stewardship bundle at urgent care sites on appropriate antibiotic prescriptions.

Retrospective, observational, pre- and post-analysis.

Four advanced urgent care sites affiliated with an academic medical institution.

Urgent care patients evaluated for respiratory tract infections.

An antimicrobial stewardship bundle including clinician-signed stewardship posters, over-the-counter medication prescription pads, and an educational campaign was introduced to advanced urgent care sites from October to November 2024. Respiratory tract infections were tiered by antibiotic appropriateness (1 = always appropriate; 2 = sometimes appropriate; 3 = never appropriate). Adults with tier 2 or 3 diagnoses from December 2023 to January 2024 (pre-group) and December 2024 to January 2025 (post-group) were included. The primary outcome was proportion of appropriate antibiotic prescriptions.

Two hundred and seventy-five patients with tier 2 and tier 3 indications were screened; 200 patients were included. Following implementation of the antimicrobial stewardship bundle, there was no significant difference in rates of appropriate antibiotic prescriptions for tier 2 and tier 3 respiratory infections between the pre- and post-groups (76% vs 74%, respectively; P = 0.68). After implementation, more patients received appropriate antibiotics for tier 2 indications (77% vs 95%; p = 0.13). The most prescribed antibiotic agents amongst both groups were amoxicillin-based antibiotics (15%) and azithromycin (15%).

This study highlights challenges and opportunities for outpatient antimicrobial stewardship practices.

To review the variety of antimicrobial tele-stewardship strategies and their applicability to the rural outpatient context.

Narrative review of antimicrobial tele-stewardship activities and their potential adaptability to rural outpatient settings.

Few studies evaluate implementation and outcomes of antimicrobial stewardship in rural settings. In this review we summarize the variety of methods that have been used in tele-stewardship implementation research, and how each can be adapted to the rural outpatient setting, including: audit and feedback, peer comparison, provider education, guideline creation, consultation with infectious disease providers, and electronic medical record nudges.

Tele-stewardship activities are likely to benefit outpatient rural settings, though further implementation research is needed.