Infection Control and Hospital Epidemiology最新文献

{"title":"Parent and caregiver preferences toward antibiotic allergy delabeling in children.","authors":"Alistair Thorpe, Rachael A Lee, William B Petty, Adam L Hersh, Angela Fagerlin, Valerie M Vaughn, Julia E Szymczak","doi":"10.1017/ice.2026.10510","DOIUrl":"10.1017/ice.2026.10510","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"966-969"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric gastrointestinal surgical site infections: a case-control study.","authors":"Vicky Khoury, Erika P Viana Cardenas, Grace M Lee, Julianne E Burns, Jessica Tran, Sneha Krishna, Amy Valencia, Wanda Davis, Gowri Madhavan, Stephanie Chao, Ayelet Rosenthal, Jorge L Salinas, Roshni Mathew","doi":"10.1017/ice.2026.10502","DOIUrl":"10.1017/ice.2026.10502","url":null,"abstract":"<p><strong>Objective: </strong>Surgical site infections (SSIs) remain a significant source of morbidity in children. Elevated standardized infection ratios (SIRs) for pediatric gastrointestinal (GI) procedures persist nationally and at our institution. We assessed pediatric-specific risk factors and the applicability of the adult SIR model.</p><p><strong>Design: </strong>Case-control study of pediatric patients undergoing GI surgery (2019-2022) with 82 SSI cases matched 1:2 with 164 controls by prematurity, age, National Healthcare Safety Network (NHSN) procedure category and year. Data was collected via chart review; socioeconomic risk was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Bivariate and multivariate conditional logistic regression analyses used to estimate adjusted odds ratios (aOR) with 95% confidence interval (CI).</p><p><strong>Setting: </strong>A tertiary pediatric referral center.</p><p><strong>Patients: </strong>Ages 0-21; NHSN reportable GI SSI procedures (appendix, gastric, small bowel, colon, laparotomy).</p><p><strong>Results: </strong>Cases were more likely to speak a language other than English or Spanish aOR 4.26 (95% CI, 1.06-17.11; <i>P</i> = .041) compared to controls. Adult SIR risk factors such as diabetes mellitus, were not significant predictors. Cases had longer hospitalizations (median 17.5 vs 7 days) and higher 30-day readmission rates (26% vs 10%) compared to controls.</p><p><strong>Conclusions: </strong>These findings highlight the importance of language-concordant care and consideration of other social vulnerabilities in pediatric GI surgical care. Adult-based SIR models may not be applicable to children, highlighting the need for pediatric-specific measures that ensure equitable access to preventive care.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"872-880"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in antibiotic prescribing patterns in sixteen in-center dialysis units.","authors":"Ankur Shah, Cheston Cunha, Filipe Monteiro, Erika Dagata","doi":"10.1017/ice.2026.10499","DOIUrl":"10.1017/ice.2026.10499","url":null,"abstract":"<p><strong>Objective: </strong>Patients receiving maintenance hemodialysis are frequently exposed to antibiotics, a proportion of which may not be necessary thereby increasing the risk of antibiotic-associated adverse events. Antimicrobial stewardship programs remain underdeveloped in outpatient dialysis facilities. This study aimed to quantify antibiotic prescribing trends across in-center dialysis units and identify patient- and facility-level factors associated with decreased antibiotic use to inform the future stewardship strategies.</p><p><strong>Design: </strong>Retrospective observational cohort study among 16 in-center hemodialysis units.</p><p><strong>Methods: </strong>Antibiotic prescribing patterns and patient- and unit-level characteristics were analyzed among patients receiving maintenance hemodialysis from April 1, 2021, to March 31, 2024. Antibiotic prescribing trends were analyzed using general linear models. Generalized estimating equations were used to identify factors associated with decreased prescribing.</p><p><strong>Results: </strong>A total of 937 (26.4%) among 3,549 patients received ≥1 antibiotic dose, with an average of 15.36 doses per 100 patient-months, ranging from 4.82 to 30.87 doses/100 patient months. Types and frequency of antibiotics prescribed among units varied considerably. Trends in antibiotic prescribing did not decrease among 10 (62.5%) of the in-center hemodialysis units. Patient-level characteristics in units associated with a decrease in prescribing included Black race, Hispanic ethnicity, age 56-65, and diabetes as the cause of kidney failure.</p><p><strong>Conclusions: </strong>There is substantial variability in antibiotic prescribing across dialysis units. Decreasing trends in prescribing were observed in a subset of units and were associated with patient-level factors. These findings support the need for developing and implementing antimicrobial stewardship programs targeting the outpatient dialysis setting.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"923-930"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of an ICD-10-based algorithm for identifying inappropriate antibiotic prescribing for pediatric outpatients.","authors":"Samantha Ratner, Ziyi Wang, Torsten Joerger, Yun Li, Jeffrey S Gerber","doi":"10.1017/ice.2026.10474","DOIUrl":"10.1017/ice.2026.10474","url":null,"abstract":"<p><strong>Background: </strong>A diagnosis code-based algorithm classifies outpatient antibiotic prescribing as almost always (Tier 1), sometimes (Tier 2), and almost never (Tier 3) appropriate. This algorithm has been leveraged to quantify antibiotic appropriateness and direct stewardship initiatives for adults and children, primarily based on Tier 3 encounters receiving antibiotics, but has not been validated.</p><p><strong>Objective: </strong>To assess the performance of the algorithm for assessing antibiotic appropriateness in pediatric outpatients.</p><p><strong>Methods: </strong>Using a pediatric care network of primary care, urgent care, and emergency departments from January 1-December 31, 2024, encounters were classified into tiers using the ICD10 algorithm. Manual chart review was performed on a stratified random sample of 300 (100 per setting) Tier 3 encounters with antibiotics using a structured protocol derived from local and national guidelines to determine antibiotic appropriateness overall and by location. Survey weights were applied to obtain estimates for all Tier 3 encounters with antibiotic prescriptions. The positive predictive value (PPV) for Tier 3 in identifying inappropriate antibiotic prescribing was calculated.</p><p><strong>Results: </strong>Of 272,698 encounters, 115,508 (42%) had an antibiotic prescription. The algorithm classified 10,370 (9%) as Tier 3. In the stratified manual validation sample, 170/300 were classified as appropriate, corresponding to a survey-weighted estimate of 58% appropriate (95% CI, 52%-64%) and a PPV of 42% for Tier 3 as a marker of inappropriate antibiotic use.</p><p><strong>Conclusions: </strong>The established algorithm did not reliably predict antibiotic appropriateness in this pediatric outpatient population, demonstrating a need for pediatric-focused algorithms for measuring outpatient antibiotic stewardship.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"949-955"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained reduction in blood culture utilization following a crisis-driven diagnostic stewardship intervention.","authors":"Lior Cohen-Yatziv, Alfredo Mena Lora, Alan E Gross, Jenna Adams, Nahed Ismail, Scott Borgetti","doi":"10.1017/ice.2026.10504","DOIUrl":"10.1017/ice.2026.10504","url":null,"abstract":"<p><p>Following a global 2024 blood culture bottle shortage, we implemented a multidisciplinary stewardship intervention to reduce utilization. Upon supply normalization in 2025, a durable 34.8% reduction in utilization was maintained without increasing sepsis-related mortality, demonstrating that crisis-driven shifts can successfully establish a sustainable \"new steady state.\"</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"962-965"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting surveillance: the federalization of healthcare-associated infection reporting in the U.S.","authors":"Julie Kay Reagan, Monika Pogorzelska-Maziarz, Tara Schmidt, Pamela de Cordova, Rodney E Rohde, Patrick Moeller, Sam Swift, Jilian DeGraw, Victoria Zellar","doi":"10.1017/ice.2026.10484","DOIUrl":"10.1017/ice.2026.10484","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze state healthcare-associated infection (HAI) laws and examine the transition from state-driven surveillance to regulatory frameworks substantially shaped by federal policy.</p><p><strong>Methods: </strong>We conducted a systematic public health law review of statutes, administrative regulations, and policies governing HAI surveillance across 50 U.S. states and the District of Columbia as of March 1, 2024. We analyzed the HAI surveillance framework in each jurisdiction to assess the federal influence. To supplement the legal review and clarify state-specific reporting requirements, we administered a survey to state HAI program coordinators.</p><p><strong>Results: </strong>As of March 2024, 38 jurisdictions (74.5%) mandate HAI reporting. Early laws were primarily state-driven, while later enactments increasingly incorporated federal standards. Among jurisdictions with HAI reporting laws, 23 (60.5%) reference or incorporate Centers for Medicare & Medicaid Services (CMS) mandates into the state law, enabling sharing of federally reported data. Overall, 41 states (80.4%) modified reporting requirements in response to CMS mandates; nearly all jurisdictions with HAI reporting laws (97.4%) adopt other forms of federal policies.</p><p><strong>Conclusions: </strong>The majority of states have adopted HAI legislation, with state-level reporting laws and policies demonstrating continuous development from 2002 to 2024. Early HAI surveillance efforts, while guided by emerging federal government influences, were primarily based on state policy. However, since 2009, new state laws and policies have increasingly adopted federal policies. Over time, state reliance on federal standards has created a policy shift: state HAI reporting frameworks have expanded and adapted to federal policy, creating a legal environment marked by growing federal-state integration.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"866-871"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of risk-standardized metrics for benchmarking hospitals on their inpatient antibiotic use.","authors":"Daniel J Livorsi, James A Merchant, Hyunkeun Cho, Heather Davila, Tamar F Barlam, Sara E Cosgrove, Dimitri Drekonja, Kelly Echevarria, Matthew Bidwell Goetz, Kevin Hsueh, Kari A Mergenhagen, Lindsay Taylor, Michihiko Goto","doi":"10.1017/ice.2026.10497","DOIUrl":"10.1017/ice.2026.10497","url":null,"abstract":"<p><strong>Introduction: </strong>Benchmarking hospitals on their antibiotic use may be facilitated by metrics that adjust for inter-hospital differences in patient case-mix, such as types of infections, procedures, and comorbidities. Metrics that capture antibiotic spectrum [e.g., days of antibiotic spectrum coverage (DASC)] can be more sensitive to stewardship activities than metrics based on days of therapy (DOT). In this study, we developed risk-standardized metrics for both DOT and DASC.</p><p><strong>Methods: </strong>We performed a mixed-methods study to build risk-standardized metrics for inpatient antibiotic use, using a modified Delphi process integrating expert- and data-driven strategies to identify nonmodifiable risk factors associated with appropriate inpatient antibiotics. These factors were used to create risk-standardized ratios (RSR) for DOT and DASC. A standardized antimicrobial administration ratio (SAAR)-like metric was also constructed.</p><p><strong>Results: </strong>In 2021, there were 497,061 patient-admissions across 121 Veterans Health Administration (VHA) hospitals. The median hospital RSR was 1.00 (interquartile range (IQR) 0.95-1.05) for DOT and 1.00 (IQR 0.96-1.04) for DASC; the median ratio for the SAAR-like metric was 0.85 (IQR 0.68-1.03). The Kendall's tau for RSR-DOT and the SAAR-like metric was 0.48; RSR-DASC and the SAAR-like metric was 0.33; and RSR-DOT and RSR-DASC were 0.48. Compared to the SAAR-like metric, 60 (49.6%) and 80 (66.1%) hospitals ranked in a different quartile for RSR-DOT and RSR-DASC, respectively.</p><p><strong>Conclusions: </strong>Hospital performance on the SAAR-like metric was weakly correlated with the RSR-DASC and moderately correlated with the RSR-DOT. Hospitals' performance on the SAAR-like metric differed from that of the RSR metrics, suggesting the RSR metrics may have added value over the SAAR.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"938-948"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bottlenecks to better practices: systemwide electronic clinical decision support for blood culture stewardship.","authors":"Jessica Seidelman, Michael Yarrington, Stefani Dubea, Jonathon Bae","doi":"10.1017/ice.2026.10515","DOIUrl":"10.1017/ice.2026.10515","url":null,"abstract":"<p><p>A systemwide electronic clinical decision support (CDS) tool for blood culture ordering reduced utilization by 12% across three hospitals (IRR 0.88, <i>P</i> < .01), but the effect waned over time. Low-yield ordering persisted, and contamination rates increased. Sustained diagnostic stewardship likely requires multimodal strategies beyond CDS alone.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"959-961"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the impact of a novel surgical handwashing method on reformation of microbial flora on surgeons' hands.","authors":"Abbas Tokyay, Şehmuz Kaya, Sezai Özkan, Necip Güven, Tülin Türközü, Cihan Adanaş, Mehmet Parlak, Kübra Nur Doğan, Mehmet Ata Gökalp, Gülsüm Kaya","doi":"10.1017/ice.2026.10509","DOIUrl":"10.1017/ice.2026.10509","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of surgical hand antisepsis before surgical or invasive procedures is to suppress microbial flora on the hands. This study aimed to evaluate the effect of a modified surgical hand antisepsis technique on recolonization of microbial flora on surgeons' hands over time.</p><p><strong>Methods: </strong>Participating surgeons were randomly assigned to one of two study groups. In both groups, surgical hand antisepsis was performed using 10% povidone-iodine followed by rinsing of the hands and forearms. In Group 1, surgeons dried their hands after rinsing according to the conventional method. In Group 2, surgeons applied an additional layer of 10% povidone-iodine to the still-wet hands and forearms after rinsing and then allowed the solution to dry without further rinsing. Hand cultures were obtained immediately after antisepsis (0 hour) and at 1 and 2 hours thereafter. Colony-forming units (CFUs) were counted and compared between groups and sampling periods.</p><p><strong>Results: </strong>Fourteen surgeons participated in the study, with seven surgeons allocated to each group. No significant difference in bacterial growth was observed between the groups at 0 hour (Group 1: mean CFU 41.59 ± 72.53 vs Group 2: 18.63 ± 24.27, <i>P</i> = .27). At 1 hour, bacterial growth was significantly lower in Group 2 compared with Group 1 (8.43 ± 20.65 vs 25.44 ± 53.62 CFU, <i>P</i> = .001). Similarly, at 2 hours, Group 2 demonstrated significantly lower bacterial growth than Group 1 (16.37 ± 34.25 vs 32.88 ± 52.55 CFU, <i>P</i> = .022).</p><p><strong>Conclusion: </strong>Compared with the conventional surgical handwashing technique, reapplication of povidone-iodine without a final rinse resulted in significantly reduced bacterial recolonization on surgeons' hands at 1 and 2 hours after hand antisepsis. These findings suggest that this modified technique may provide prolonged antimicrobial activity during surgical procedures. Further large-scale studies are warranted to confirm its clinical utility.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"881-884"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural ventilation performance for airborne diseases management in a deployable treatment facility.","authors":"Luca Fontana, Gino Cortellessa, Giorgio Grossi, Anna Silenzi, Michele Di Marco, Antoine Chaillon, Robert Wunderlich, Giorgio Buonanno","doi":"10.1017/ice.2026.10508","DOIUrl":"10.1017/ice.2026.10508","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether wind-driven natural ventilation in the Infectious Diseases Treatment Module (IDTM) can achieve ventilation performance consistent with airborne precaution requirements [160 liters per second (L/s)] and to estimate associated pathogen-specific infection risks.</p><p><strong>Methods: </strong>An experimental campaign of air velocity measurements and CO₂ decays were conducted to validate the developed computational fluid dynamics (CFD) model. The validated CFD model simulated wind-driven natural ventilation (1-4 m/s) for an L-shaped IDTM configuration under four structural scenarios defined by the presence or absence of patient porches and mosquito nets. Airborne infection risk was estimated using a Wells-Riley quanta-based model for seven representative airborne pathogens under short-duration healthcare worker exposure and prolonged patient co-exposure.</p><p><strong>Results: </strong>Ventilation performance varied widely based on wind speed and structural configuration. Airflow ranged from 7 L/s in the most restricted configuration (porch and mosquito nets present at 1 m/s) to over 3,100 L/s when mosquito nets were removed at 4 m/s.When mapped to infection-risk estimates, ventilation rates at 160 L/s substantially reduced short-duration healthcare worker infection risk for all pathogens (≤1%), whereas prolonged co-exposure remained associated with high risk for high-emission pathogens despite high ventilation.</p><p><strong>Conclusion: </strong>Under favorable wind conditions and optimized configurations, the IDTM can achieve ventilation rates consistent with the 160 L/s recommendation for airborne precautions. While this provides substantial protection for healthcare workers, individual-room isolation remains essential for patient management. Operationally, removing window-mounted nets is the most effective way to ensure safety targets are met; hybrid ventilation measures should be considered during low-wind conditions.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"894-900"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}