Acinetobacter baumannii is known to cause global outbreaks and routine surveillance to prevent nosocomial transmission has historically been limited. A longitudinal surveillance study of Acinetobacter isolates using whole genome sequencing (WGS) and whole genome multilocus sequence typing (wgMLST) was performed to map the distribution of sequence types (STs) and intrahospital transmission.

All Acinetobacter clinical isolates were collected in two hospitals (H1, H2) from fifteen units between 2017 and 2021 in Southeast Michigan and analyzed. The isolates were subjected to WGS using the NextSeq instrument (Illumina). The contigs were de novo assembled using SPAdes (v3.7.1) and wgMLST analysis was performed using BioNumerics software v7.6. Minimum spanning tree (MST) and dendrograms were created to map distribution of STs and putative transmissions.

ST2Pas was the most prevalent in both hospitals (H1:47.2% and H2:59.7%), followed by ST406Pas (H1:11.1%, H2:8%). ST15Pas (H1:9.7%) was only found in H1. Transmission was mapped for ST2Pas, ST406Pas (H1, H2), and ST15Pas for H1 and mainly located in the ICU settings.

Presence of several STs (ST2Pas, ST406Pas, and ST15Pas) prevalent from both hospitals suggest that these are common circulating strains in the area. Sporadic transmission events mainly in the ICU settings in both hospitals (H1 and H2) were noted indicating attention to enhanced infection prevention and control measures. Given that Acinetobacter infections are predominantly hospital acquired, an effective surveillance plan incorporating WGS and wgMLST may improve the ability to identify and track trends rapidly, implement effective infection control intervention, and reduce healthcare-associated infections (HAIs).

Days of antibiotic spectrum coverage (DASC) is a novel metric that incorporates the antibiotic spectrum into consumption metrics, addressing the limitations of traditional metrics such as days of therapy (DOT). This study aimed to evaluate the feasibility of integrating DASC into the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system.

Retrospective observational study.

Hospitals voluntarily participating in J-SIPHE.

Inpatients from 1,833 hospitals between January 2019 and December 2022.

Antibiotic use was assessed using DOT, DASC, and DASC/DOT. Antibiotic spectrum coverage scores were assigned based on published data or expert consensus. Annual trends were assessed using median values, and hospital-level variation was explored by hospital size. Proportional use of antibiotic classes by DOT and DASC was compared using 2022 data.

As the number of hospitals participating in J-SIPHE increased over time—particularly small and medium-sized hospitals—median DOT and DASC per 1,000 patient-days declined by 21.2% and 19.1%, respectively, from 2019 to 2022, while DASC/DOT remained stable. In 2022, proportional use of antibiotic classes varied by hospital size, and rankings differed when comparing DOT- and DASC-based measures. Broad-spectrum agents such as carbapenems and fluoroquinolones ranked higher by DASC than DOT. Hospital-level distributions of DOT and DASC/DOT showed substantial variation across hospital sizes.

Integration of DASC metrics into national surveillance is feasible. DASC and DASC/DOT complement DOT by incorporating spectrum breadth, providing more comprehensive insight into antimicrobial use patterns and supporting stewardship benchmarking and intervention planning.

Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) of the perineum. Recent retrospective studies from quaternary centers suggest improved outcomes and a potentially less aggressive clinical course for FG than non-perineal NSTIs. However, comprehensive nationwide data remain limited.

This retrospective cohort study analyzed the National Inpatient Sample (2016–2020) to compare outcomes between FG and non-perineal NSTIs. Adult patients undergoing surgical debridement with a diagnosis of FG or NSTI were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), hospital costs, and home discharge rates. Multivariable regression analyses adjusted for patient demographics, comorbidities, and hospital characteristics.

A total of 5,007 FG and 24,782 non-perineal NSTI patients were identified. Crude in-hospital mortality rates were 5.8% for FG and 5.4% for non-perineal NSTIs, with stable trends observed over five years. After adjustment, no significant difference in mortality was observed (adjusted odds ratio [aOR]: 1.04; 95% CI: 0.90–1.20). However, FG was associated with longer LOS (adjusted mean difference: 1.99 days; 95% CI: 1.53–2.46) and higher hospital costs ($37,809 higher; 95% CI: $29,540–$46,077). Home discharge rates were similar between groups (aOR: 0.97; 95% CI: 0.89–1.05).

Despite similar mortality rates, FG hospitalizations were associated with increased LOS and higher costs compared to non-perineal NSTIs. These findings may suggest potential nationwide disparities in FG care quality, particularly outside specialized referral centers. Further research is needed to understand if standardized care pathways tailored to FG may optimize management and reduce resource utilization.

To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.

Retrospective cohort study.

PINC-A1 Healthcare Database (2008–2021).

Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.

We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.

We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0–37.6%; full range: 0%–98.0%]; median odds ratio [95% CI]: 84.7 [63.3–115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%–0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04–1.31], P = .007).

Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.

Infection control measures like contact precautions may conflict with patient-centered palliative care principles, but their efficacy and harms in this context remain understudied. This review evaluates how contact precautions affect quality of life, social connectedness, and infection control efficacy in palliative care.

Systematic scoping review.

Palliative care settings (eg, palliative care units and hospices)

Adults and children receiving palliative care, with no restrictions on age or comorbidity.

English-language studies on contact precautions in palliative care were included. Ovid MEDLINE and Ovid Embase were searched from inception to December 20, 2024, using terms related to antimicrobial resistance, contact precautions, and palliative care. No publication type or status restrictions were applied. The protocol was registered on the Open Science Framework and followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Fifteen studies were included, primarily from Germany (73%) and using qualitative methods (80%). Most focused on patients in palliative care units or hospices, though geographic and methodological limitations restrict generalizability. Common challenges included fear, loneliness, disrupted intimacy, and inconsistent protocols. Contact precautions were often bundled with other infection prevention interventions, limiting the ability to assess their specific impact. Terminology varied widely. No study directly evaluated the efficacy of contact precautions in reducing antimicrobial-resistant organism (ARO) transmission, though one pediatric study reported liberal protocols and no nosocomial ARO infections.

A case-by-case approach is needed to balance infection control with patient dignity and quality of life. Consistent terminology and more robust, mixed-methods research are essential to inform evidence-based protocols in diverse settings.

To describe antimicrobial use in Tennessee from 2017 to 2023.

Retrospective analysis of antimicrobial use using data from the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option.

Acute care and critical access facilities in Tennessee.

From 2017 to 2023, 97 facilities in Tennessee submitted data to the NHSN AU Option. The number of reporting facilities increased from 25 to 95. During this time, the statewide average antimicrobial use significantly rose from 593 days of therapy (DOT)/1000 days present (DP) to 621 DOT/1000 DP (P = .0478). The All-Antibacterial Standardized Antimicrobial Administration Ratio (SAAR) values remained near 1.0, indicating overall use was as predicted. However, the All-Antibacterial SAAR values, particularly in small facilities, revealed that they utilized antibiotic agents more than predicted during the study period. Additionally, the SAAR trends varied by patient care locations, with the oncology unit (ONC) experiencing a significant increase from 0.73 to 1.12 (P-value<.0001). West Tennessee had the highest antimicrobial use rate at 736 DOT per 1000 DP, and an All-Antibacterial SAAR of 1.21. The top antimicrobial agents—vancomycin, ceftriaxone, piperacillin/tazobactam, cefepime, and cefazolin—accounted for 54% of the total antimicrobial use.

This statewide analysis of AU and SAAR trends identifies areas where additional antimicrobial stewardship efforts may be targeted to improve antimicrobial use. Facilities of different sizes and geographic locations have unique demographics that can affect antimicrobial use, requiring specialized antimicrobial stewardship techniques.

The objective of this systematic review and meta-analysis (SRMA) was to synthesize literature on the differences in risk of community-acquired third-generation cephalosporin resistant (3GC-R) uropathogens across racial and ethnic groups.

This SRMA builds on a completed scoping review of the association between race, ethnicity, and risk of colonization or community-acquired infection with ESKAPE pathogens. A literature search was conducted for the earlier scoping review in January 2022 and updated in March 2024. Following PRISMA guidelines, titles and abstracts were screened before advancing to full-text review and data extraction. A customized extraction form in Covidence captured relevant information from each study. For this SRMA, studies identified in the scoping review that reported case counts or effect measures related to colonization or community-acquired infection with 3GC-R uropathogens across distinct identities were included. Separate random effects meta-analyses assessed differences in risk of 3GC-R uropathogens between each minority racial/ethnic group and White/Caucasian persons.

Five studies comprising 13,527 subjects were included in the SRMA, among which there was generally a higher risk of 3GC-R uropathogens among Hispanic/Latinx and Asian persons compared to White persons. Only the meta-analysis of Hispanic/Latinx versus White/Caucasian persons yielded a statistically significant pooled risk ratio; specifically, Hispanic/Latinx persons had a 27% higher risk of harboring 3GC-R uropathogens (95% CI: 1.04, 1.55).

As antibiotic resistance rises in community settings, our findings support the need to understand the structural issues that underpin differential risk of 3GC-R uropathogens across race and ethnicity.

To analyze antibiotic prescribing trends and guideline concordance in outpatient settings using electronic health records (EHRs).

This quality improvement study utilized data from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, which integrates antibiotic prescribing data extracted from the EHRs of various outpatient facilities.

The study was conducted across 352 outpatient facilities in the United States.

The study included oral antibiotic prescribing data from outpatient encounters from January 2021 to June 2023, encompassing 823,938 prescriptions.

The primary outcomes were the rate of antibiotic prescribing per 1 000 prescription-related outpatient visits and identifying frequently prescribed antibiotics in adults and children. Secondary outcomes were the prescribing patterns for selected diagnoses and the concordance of these prescriptions with published guidelines.

The study estimated approximately a 20% increase in antibiotic prescribing per year, with an overall rate of 121.26 prescriptions per 1 000 prescription-related outpatient visits (95% confidence interval 121.01–121.50). Amoxicillin-clavulanate, amoxicillin, doxycycline, and cephalexin were most frequently prescribed. Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and Group A Streptococci. 51% of ciprofloxacin prescriptions were for patients aged 60 or older.

The findings stress the need for strengthened antimicrobial stewardship in outpatient settings. The increasing rate of antibiotic prescriptions and discrepancies in guideline concordance reiterate the importance of ongoing monitoring and targeted interventions.

Penicillin allergies are reported in 10–15% of the US population, but the actual rate is less than 1%. Inappropriate penicillin allergies are associated with adverse patient outcomes, poor antimicrobial stewardship, and increased healthcare costs. Direct oral provocation testing (DOPT) is a safe and cost-effective way to remove false penicillin allergy labels (PAL). However, widespread implementation is currently limited due to inadequate safety data and protocol variations. This systematic review evaluates the safety of single-dose, nongraded DOPT by the nonallergist.

Systematic review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to May 2025.

Inpatient (Intensive care unit (ICU) and general medical ward) and outpatient

Adults with self-reported penicillin allergies deemed low risk by a validated scoring system.

DOPT by nonallergists with single-dose oral amoxicillin 250 mg with a 60-minute observation period.

3 352 studies were identified, 15 were included in the analysis. Of the 1786 patients who completed DOPT, 66 (3.7%) experienced any reaction: 27 (1.5%) immediate rashes, 24 (1.3%) delayed rashes, and 15 (.8%) other reactions. No cases of anaphylaxis, angioedema, or epinephrine use were reported.

The use of single-dose DOPT in patients deemed low risk, using a validated risk scoring tool, is safe, with low rates of mild reactions and no serious adverse events. A nonallergist can significantly improve penicillin delabeling rates and patient outcomes using this approach.

Daptomycin is preferred in outpatient parenteral antimicrobial therapy (OPAT) due to daily dosing. Elevations in creatine phosphokinase (CPK) of 3%–10% and musculoskeletal adverse events have been described with daptomycin, but data regarding risk factors and frequency of monitoring in the OPAT setting is limited. We evaluated the incidence and risk factors for CPK elevation and musculoskeletal adverse effects in patients receiving daptomycin OPAT.

This was a single-center, retrospective cohort study of adults on OPAT with daptomycin and at least two CPK values. The primary outcome was the incidence of CPK values greater than 500 U/L.

We included 127 patients. Most patients were male (55.1%), and the median age was 56 years (IQR 46–63). The most common indication was bone/joint infections (73.2%, n = 93). The median daptomycin dose was 7.4 mg/kg/day (IQR 6.1–8.1) and duration of therapy was 37 days (IQR 21–44). Fifteen patients (11.8%) experienced a CPK greater than 500 U/L within a median 13 days (IQR 9–16). Five patients (3.9%) developed rhabdomyolysis. Independent predictors of CPK>500 U/L included male sex (OR, 4.2 [95% CI, 1.05–16.61]; P = .0424) and cerebrovascular disease (OR, 11 [95% CI, 1.21–99.86]; P = .0332).

The incidence of CPK elevation was similar previously reported rates. This expands the literature to patients with daptomycin doses>6 mg/kg and prolonged durations of therapy. The incidence of CPK elevation and time to onset of 9–16 days supports the current recommendations for weekly lab monitoring.

Antimicrobial resistance (AMR) is a significant public health threat. Understanding public knowledge and attitudes toward antibiotic usage is essential for educational campaigns combating AMR. This study evaluates public knowledge and awareness about antibiotics and AMR in Vietnam.

A cross-sectional survey was conducted online in December 2021, featuring 20 questions on antibiotics, AMR, and participants’ habits, attitudes, and potential solutions. The survey was distributed via social media platforms such as Facebook, Zalo, Viber, and WhatsApp. The target sample included Vietnamese working adults above 18 years old. Responses were coded and analyzed using SPSS version 21 and Microsoft Excel version 16.5. Participants were categorized into high, intermediate, and low knowledge levels based on their scores (>80%, 51–79%, and <50%).

A total of 866 Vietnamese adults participated. Most participants (90%) had moderate to high knowledge of antibiotics and AMR. However, only 32.8% knew that 75% of antibiotics are used in agriculture. Knowledge levels varied significantly across demographics such as gender, age, education, profession, and antibiotic use history. Healthcare-related professionals had significantly higher knowledge of antibiotics and AMR than nonhealthcare professionals (p < 0.001). Those with health-focused educational backgrounds also had higher knowledge levels (p < 0.001). Despite being aware that it was inappropriate, many participants reported discontinuing antibiotics before completing the course prescribed by their doctors.

Age, education, profession, and antibiotic use history positively influenced AMR knowledge. However, even among health-related fields, understanding was only moderate. This indicates a need for enhanced public education to improve knowledge and attitudes toward antibiotics and AMR.

To describe Candida auris infections from two different geographical regions within a large health-system, both of which have experienced a significant increase in the occurrence of C. auris.

Multicenter, retrospective, descriptive analysis across a large healthcare system.

Patients were included in this study if they were admitted as an inpatient between January 1, 2021 and September 30, 2022 and had a clinical specimen that grew C. auris.

A total of 321 patients were included. The clinical outcomes of included patients were comparable between geographical regions (Western and Eastern), with the exception of patients who experienced mortality or transitioned to hospice care at discharge (Western 32.1% vs Eastern 19.1%, P = .014). Over one-third of patients required mechanical ventilation at any point during their admission, while greater than half of the total study population had receipt of a blood transfusion. Approximately 25.2% of all patients received hemodialysis, while 24.3% received total parental nutrition during their hospital stay. More than 50% of patients in both regions required an admission to the intensive care unit at any time-frame during their stay. Fluconazole-resistant isolates were more prevalent in the Western region, but both regions demonstrated a high prevalence of resistance.

Patients identified with C. auris were characterized by significant underlying morbidity and disease burden. Further studies are warranted to identify infection prevention best practices to reduce transmission and reduce mortality through earlier identification and appropriate antifungal therapy.

Burkholderia cenocepacia is an environmental Gram-negative bacterium, resistant to many antibiotics and antiseptics, that can survive in aqueous hospital environments. We investigated an outbreak of B. cenocepacia in the intensive care unit (ICU) of Ng Teng Fong General Hospital, aiming to identify the source and prevent further transmission.

The outbreak was detected after two ICU patients developed B. cenocepacia bacteremia. Environmental samples, including ultrasound gels, and disinfectants, were collected. Whole genome sequencing (WGS) was used to determine clonality between clinical and environmental isolates. Immediate actions were taken, including a recall of ultrasound gel batches and the use of sterile gel sachets for high-risk procedures.

Ultrasound gels from opened and unopened bottles from multiple hospital areas, including ICU and Radiology, were found to be contaminated with B. cenocepacia, with a specific batch (Brand A) linked to the outbreak. WGS analysis confirmed the genetic relatedness of clinical and environmental isolates. A hospital-wide recall of affected gel batches was implemented. Through our regional networks, notification of countries in our immediate region along with alerting our local health authorities for further investigation was also undertaken. Additionally, we continued surveillance of gels and identified further contaminated products.

This outbreak highlights the risks of contaminated medical products, specifically ultrasound gels. Effective environmental sampling, rapid identification, and clear communication with health authorities were key to controlling the outbreak. We have since revised our protocols to mandate the use of sterile gel for invasive procedures and continue monitoring for potential contamination in ultrasound gels.