This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.

This retrospective study compared pediatric patients’ MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.

The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.

Pediatric patients receiving care within MHN with Medicaid coverage.

MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.

MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.

To estimate the cost-effectiveness of methicillin-resistant Staphylococcus aureus (MRSA) nares poymerase chain reaction (PCR) use in pediatric pneumonia and tracheitis.

We built a cost-effectiveness model based on MRSA prevalence and probability of empiric treatment for MRSA pneumonia or tracheitis, with all parameters varied in sensitivity analyses. The hypothetical patient cohort was <18 years of age and hospitalized in the pediatric intensive care unit for community-acquired pneumonia (CAP) or tracheitis. Two strategies were compared: MRSA nares PCR-guided antibiotic therapy versus usual care. The primary measure was cost per incorrect treatment course avoided. Length of stay and hospital costs unrelated to antibiotic costs were assumed to be the same regardless of PCR use. Both literature data and expert estimates informed sensitivity analysis ranges.

When estimating the health care system willingness-to-pay threshold for PCR testing as $140 (varied in sensitivity analyses) per incorrect treatment course avoided, reflecting estimated additional costs of MRSA targeted antibiotics, and MRSA nares PCR true cost as $64, PCR testing was generally favored if empiric MRSA treatment likelihood was >52%. PCR was not favored in some scenarios when simultaneously varying MRSA infection prevalence and likelihood of MRSA empiric treatment. Screening becomes less favorable as MRSA PCR cost increased to the highest range value of the parameter ($88). Individual variation of MRSA colonization rates over wide ranges (0% – 30%) had lesser effects on results.

MRSA nares PCR use in hospitalized pediatric patients with CAP or tracheitis was generally favored when empiric MRSA empiric treatment rates are moderate or high.

To quantify the impact of a changing cohort strategy on COVID-19 transmission in an acute inpatient behavioral health facility.

Cohort study.

Behavioral health inpatients exposed to COVID-19.

This cohort project compared COVID-19 conversion rates during two periods. In the first period (July 2020–April 2022), exposed patients (regardless of vaccination status) were cohorted separately from unexposed individuals. In the second period (May 2022–September 2022), exposed vaccinated patients remained with unexposed patients. COVID-19 conversion was identified through post-exposure asymptomatic testing or test-confirmed symptom development, with rates quantified per all admissions, per 10,000 patient days at risk, and per patient-specific exposure.

The 27-month project included 11,761 admissions and 164,762 patient days of care. The proportion of patients up-to-date on COVID-19 vaccination at admission and discharge ranged from 11%–19%. The second period showed an increased risk of SARS-CoV-2 conversion per admission (1.87% vs 0.36%, P < 0.001) and per 1,000 patient-days at risk (1.44 vs 0.27 conversions per 1,000 patient days, P < 0.001), but not per exposure (3.44% vs 3.13%, P = 0.68).

Reducing the population of patients cohorted after a SARS-COV-2 exposure is associated with increased risk of SARS-COV-2 transmission in inpatient psychiatric settings.

To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.

Prospective observational study.

611-bed, quaternary care academic medical center in the United States.

126 critically ill adults (mean age 68.1 ± 15.6 yr, 51.6% male, median APACHE II score 20.5 [IQR 15–25]); 71.4% met sepsis criteria.

Secondary infection was defined as ≥3 consecutive antibiotic days within a year after the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, BMI, and glucocorticosteroid dose. Time-to-event analysis employed Cox proportional hazards modeling; cumulative infection burden was assessed via nonparametric tests using normalized antibiotic exposure (AD as a proportion of days alive).

Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days (P < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, P = 0.739) or readmission (OR 1.01, P = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes (P = 0.0033), with higher exposure among patients experiencing two or more secondary infections (P = 0.026 and P = 0.036, respectively). Cox regression showed a significant association between AD and time to first secondary infection (HR 1.10, 95% CI: 1.04–1.15, P = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.

Extended AD, in critically ill patients, prolongs hospitalization without reducing mortality or readmission rates. These findings highlight the importance of robust antibiotic stewardship practices, where shorter, targeted regimens may minimize unintended complications.

Increased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines.

We evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018–February 2020) and pandemic periods (March 2020–February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis.

Significant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%–63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%–161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40–1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time.

We observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.

Antibiotic stewardship programs (ASPs) are crucial to prevent the emergence of antibiotic resistance and to improve outcomes for patients. A validated instrument rooted in a theoretically derived implementation science framework will increase our understanding of ASP implementation and enable comparisons across implementation sites.

Antibiotic stewards (infectious disease pharmacists and physicians) were recruited from Veterans Affairs (VA) hospitals to complete a survey on stewardship implementation. We used the Consolidated Framework for Implementation Research (CFIR) to guide development of an ASP implementation survey assessing 22 potential determinants of implementation across five domains of CFIR. We conducted confirmatory factor analyses (CFA) to assess construct validity of 8 construct measures and evaluated internal consistency.

A total of 150 stewards completed the survey from 110 VA hospitals. CFA for most CFIR constructs exhibited good fit. Internal consistency for CFIR construct subscales (Cronbach’s alpha) ranged from 0.54–0.96, indicating modest to strong internal consistency. Determinants that were rated highly present at the sites (across site means ≥ 4.0 or above) included Self-Efficacy, Engaging, Evidence Strength and Quality and Relative Advantage, indicating stewards found ASP evidence compelling and felt their personal involvement was effective in engendering positive results for the ASP.

Psychometric properties indicate validity of the first CFIR-based survey of determinants for ASP implementation outcomes. Clinical, quality improvement, and research teams can use this survey to identify contextual determinants of ASP implementation and use this information to guide selection of strategies and compare results across multiple sites.

Approximately 95% of patients with a beta-lactam allergy noted in their medical record are not truly allergic when tested. These patients may unnecessarily avoid first-line antibiotics, resulting in increased treatment failure, higher costs, and antibiotic resistance. Bone marrow transplant (BMT) patients may be at higher risk for these adverse outcomes due to weakened immune systems and high risk for severe infections. Our objective was to evaluate beta-lactam allergy labels and their influence on BMT patient outcomes.

We conducted a retrospective cohort study of adult inpatients undergoing BMT during April 2018-March 2020. Eligibility for penicillin allergy testing/de-labeling was evaluated. Multivariable logistic regression was performed to measure independent effects of beta-lactam allergy labels on 100-day outcomes: mortality, ICU admission, rehospitalization, and intravenous antibiotic use.

Among 358 BMT patients, 75 (21%) had a beta-lactam allergy label at baseline. Mortality was higher in patients with an allergy label (14.7% vs 7.8%, P = 0.067). In multivariable analysis, patients with allergy labels were not at a significantly greater risk of mortality (OR = 1.60; 95% CI = 0.68 – 3.78) but were significantly more likely to receive carbapenems (OR = 6.27; 95% CI = 2.81–13.98). All patients with penicillin-class allergy labels were eligible for allergy testing/de-labeling.

We did not observe a significant increased risk of mortality in BMT patients with beta-lactam allergy labels; however, increased carbapenem use was observed. Penicillin allergy de-labeling programs may help optimize antibiotic prescribing in BMT patients. Larger studies are needed to quantify the impact of beta-lactam allergy labels on BMT patient outcomes.

To investigate a cluster of surgical site infections (SSIs) in patients who underwent coronary artery bypass graft (CABG) procedures, identify risk factors for infection, and implement measures to prevent new cases.

The investigation comprised a retrospective case–control study and an observational review of infection control practices between the fall of 2018 and 2019 (study period).

Tertiary care medical center in Florida, USA.

Patients who acquired an SSI following CABG during the study period were defined as case-patients. Control-patients were randomly selected patients who did not acquire a post-CABG SSI.

We recorded clinical and epidemiologic details on a standardized form and analyzed data with SAS statistical software. Odds ratios and 95% confidence intervals were calculated.

Seven patients met the case definition and 21 control-patients were identified. While multiple variables were significant on univariate analysis, after controlling for confounding using multivariate analysis/logistic regression, only lower age (P < 0.0001) and meeting the requirements for appropriate perioperative temperature management (SCIP measure 10) (P = 0.01) were identified as independent risk factors for SSI. Per observational review, measures to reduce operating room traffic and limit door opening/closing were implemented and wound vacuum-assisted closure (VAC) use was phased out. Our institutional SSI rate returned to baseline and no additional clusters were seen in the following three years.

Multiple potential risk factors exist for SSI after coronary artery bypass grafting. At our institution, minimizing operating room traffic and reducing wound VAC use may have successfully addressed these healthcare-associated infections.

To illustrate how a partnership between an academic medical center and a public health department successfully responded to a large tuberculosis (TB) exposure at a community daycare center.

A multidisciplinary team rapidly established a dedicated TB Exposure Clinic to evaluate and screen exposed children requiring window prophylaxis.

The exposure affected 592 individuals, including 359 children under five—those at highest risk for severe disease.

Given the vulnerability of young children to TB infection, timely evaluation and initiation of window prophylaxis were prioritized.

Over two days, 162 children were assessed for TB window prophylaxis, and 110 additional children underwent TB screening.

By leveraging clinical expertise, interdisciplinary collaboration, and informatics infrastructure, the TB Exposure Clinic delivered rapid, comprehensive care while minimizing disruption to local healthcare systems. This model underscores the essential role of academic medical centers in supporting public health responses.

To assess the safety of penicillin allergy evaluation and testing in obstetric patients utilizing oral drug challenges with or without prior penicillin skin testing (PST) depending on characteristics of the patient’s medication reaction, and to determine whether removal of the drug allergy label led to an increased use of guideline-recommended antibiotic prophylaxis for group B Streptococcus (GBS).

This retrospective cohort study evaluated obstetric patients cared for at the University of Iowa Health Care who were identified as having a penicillin allergy label between June 1, 2021 and July 1, 2023.

A total of 728 patients were identified to have a penicillin allergy and 299 patients were seen in the drug allergy clinic (DAC) for allergy evaluation.

Of patients seen in the DAC for allergy evaluation, 270 (90.3%) had their allergy de-labeled after undergoing an oral drug challenge with or without PST. No patients experienced an IgE-mediated anaphylactic reaction to an oral drug challenge. Patients received penicillin G more often for GBS prophylaxis during labor when they had their drug allergy removed in the DAC compared to those who were not seen for allergy evaluation (87.5% vs 24.5%, P < 0.001).

This study supports the safety of drug allergy testing in obstetric patients. Most patients are appropriate candidates for a direct oral challenge only or PST followed by an oral challenge. Identifying and testing penicillin allergic obstetric patients prior to delivery resulted in an increase in use of first-line guideline-recommended antibiotic prophylaxis for GBS during labor.

To determine if the initial procalcitonin level and the serial trend of procalcitonin levels in blood were predictive of clinical outcomes in children with sepsis.

A retrospective cohort study

One primary-to-quaternary care pediatric healthcare system from May 2020 to May 2022

Encounters for children 1 to 18 years old with a sepsis ICD-10 diagnosis code and clinical sepsis were included.

Procalcitonin clearance at 48 hours (CL-PCT48) was defined as the difference in procalcitonin values drawn on admission and at 48 hours divided by initial procalcitonin value. The primary outcome was early clinical stability. Receiver operating characteristic analysis was performed to measure the correlation of CL-PCT48 and initial procalcitonin value (PCT0) with the outcomes.

320 unique encounters met the clinical criteria of sepsis with at least two procalcitonin values. 187 encounters had procalcitonin collected at eligible times. The mean age of the participants was 9 years and 8 months, 103 (55%) were male, and 74 (40%) were Hispanic. 78 (41.7%) individuals had good early clinical response, and 177 (94.7%) survived. There was no correlation identified between CL–-PCT48 and early clinical stability (area under ROC curve [AUC] = 0.57, 95% CI 0.48–0.65) or mortality (AUC = 0.60, 95% CI 0.43–0.76). There was also no correlation between PCT0 and early clinical stability (AUC = 0.47, 95% CI 0.39–0.56) or mortality (AUC = 0.50, 95% CI 0.29–0.72).

Procalcitonin clearance at 48 hours after admission did not predict early clinical stability in children with sepsis.