Infection and Chemotherapy最新文献

{"title":"Late HIV Presentation Remains High in Korea: 28-Year National Surveillance Trends and the Limits of Inference under Incomplete CD4 Capture, 1998-2025.","authors":"EunKyung Nam, Shin-Woo Kim, Sohyun Bae, Yoonjung Kim","doi":"10.3947/ic.2026.0107","DOIUrl":"10.3947/ic.2026.0107","url":null,"abstract":"<p><strong>Background: </strong>Whether late human immunodeficiency virus (HIV) presentation in Korea has improved is difficult to judge because a CD4 count at diagnosis was captured for only a minority of notified cases until 2025. We examined 28-year trends in late presentation (CD4 <350 cells/µL) and advanced HIV disease (AHD; CD4 <200 cells/µL) among cases with a captured CD4 result, quantified how incomplete and time-varying capture limits inference about population-level trends, and characterized the burden in 2025, the year of highest CD4 capture (80.4%).</p><p><strong>Materials and methods: </strong>We analyzed national HIV/acquired immunodeficiency syndrome (AIDS) notification data from the Korea Disease Control and Prevention Agency (1998-2025). Annual proportions among captured cases were modeled with overdispersion-adjusted logistic regression and adjusted for mean age and for the annual uncaptured fraction; change-points were identified by joinpoint regression. Missing CD4 values were treated as incomplete capture; distribution-free Manski bounds were computed for every year, with a missing-not-at-random tipping-point analysis and a sensitivity analysis for recent infection.</p><p><strong>Results: </strong>Among captured cases, late presentation showed no significant change (odds ratio [OR] per year, 1.008; 95% confidence interval [CI], 0.995-1.021; <i>P</i>=0.259) and the AHD proportion increased (OR per year, 1.027; 95% CI, 1.012-1.042; <i>P</i><0.001), independent of age. These captured-only trends cannot be read as population-level trends: the uncaptured fraction was 0.40-0.83 before 2025, so the Manski bounds do not identify the direction of any trend, and adjusting for the uncaptured fraction (OR per 0.10 increase, 1.059 and 1.062) did not attenuate the year effect. The decrease in the AHD proportion after 2022 coincided with an abrupt increase in capture (uncaptured fraction, 0.83 to 0.20). In 2025, late presentation was 0.596 among captured cases (Manski bounds, 0.480-0.675) and AHD was 0.379 (0.305-0.501); both intervals contain the 2013-2015 Korea HIV/AIDS Cohort estimates (0.564 and 0.356). Reclassifying up to half of recent infections (27.3% of diagnoses) as not late left the 2025 late-presentation proportion at ≥0.460.</p><p><strong>Conclusion: </strong>In 2025, approximately half to two-thirds of new HIV diagnoses in Korea were late and one-third to one-half had advanced disease, above contemporary European levels and far above the World Health Organization European target. Whether this burden has improved cannot be determined from surveillance data, because captured-only trends track the completeness of CD4 capture. Late-presentation indicators should be reported together with capture completeness, and cohort data with complete CD4 ascertainment are needed to establish the trend.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"379-391"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clean Hands: From Semmelweis to Surgical Responsibility-Historical Foundations and Contemporary Implications for Infection Control.","authors":"Kun Hwang","doi":"10.3947/ic.2026.0050","DOIUrl":"10.3947/ic.2026.0050","url":null,"abstract":"","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"398-399"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence Rate and Factors Associated with Antiretroviral Therapy Regimen Change among Adult HIV Patients at Ngoerah Hospital Bali, Indonesia.","authors":"I Ketut Agus Somia, I Made Susila Utama, Anak Agung Ayu Yuli Gayatri, Ni Made Dewi Dian Sukmawati, Cokorda Agung Wahyu Purnamasidhi","doi":"10.3947/ic.2026.0006","DOIUrl":"10.3947/ic.2026.0006","url":null,"abstract":"<p><strong>Background: </strong>The human immunodeficiency virus (HIV) epidemic remains a major global health concern. While antiretroviral therapy (ART) has significantly improved survival rates, regimen changes during long-term treatment are common and may impact clinical outcomes. Data regarding the incidence rate and determinants of ART regimen changes among people living with HIV (PLHIV) in Bali, Indonesia, remain limited.</p><p><strong>Material and methods: </strong>This retrospective cohort study included adult PLHIV receiving ART at Ngoerah Hospital, Bali, Indonesia, from July 2004 to December 2023. A total of 265 eligible patients were selected through systematic random sampling. Multivariable Cox Regression was used to identify factors associated with regimen change.</p><p><strong>Results: </strong>During the study period, the incidence rate of ART regimen changes was 2.22 per 100 person-years (95% confidence interval [CI], 1.760-2.802), with 3,196.7 person-years of observation, and the median follow-up duration for patients was 11.7 years (interquartile range, 11.1-13.7). The median age was 45 years, and the majority were male (64.5%). In multivariate analysis, nevirapine (NVP)-based initial regimens (adjusted hazard ratio [aHR], 1.853; 95% CI, 1.031-3.329; <i>P</i>=0.039) and baseline CD4 < 200 cells/µL (aHR, 1.940; 95% CI, 1.215-3.098; <i>P</i>=0.005) were significantly associated with regimen change. In addition, most regimen changes (87.3%) occurred after more than ten years of treatment. The primary reasons for regimen change were treatment failure (36.6%), medication stockout (23.9%), and adverse effects (21.1%).</p><p><strong>Conclusion: </strong>NVP-based regimens and low baseline CD4 counts were key factors of regimen change. Continuous monitoring, timely detection of treatment failure, and the use of more durable regimens are essential to improve long-term treatment outcomes for the HIV patients in our outpatient clinic in Bali, Indonesia.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"321-331"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Immunogenicity and Safety Profile of the Adjuvanted RSVPreF3 Vaccine in Korean Older Adults: A Sub-analysis of a Phase 3 Trial.","authors":"Seong-Beom Park, Suryaprakash Mishra, Sang-Kyu Shin, Stebin Xavier, Giulia Zigon, Manuel Zocco, Marie Van Der Wielen, Dong-Gun Lee","doi":"10.3947/ic.2026.0016","DOIUrl":"10.3947/ic.2026.0016","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) poses substantial health risks to elderly adults and adults with certain underlying conditions. In a multi-country phase 3 trial (AReSVi-006), the adjuvanted RSVPreF3 vaccine has shown high efficacy against RSV disease. This post-hoc sub-analysis assessed immunogenicity, immunopersistence up to 24 months, and safety of a single dose of the adjuvanted RSVPreF3 vaccine in the Korean cohort.</p><p><strong>Materials and methods: </strong>In the global, randomized, observer-blind, placebo-controlled phase 3 trial (NCT04886596), adults ≥60 years of age were randomized 1:1 to receive a single intramuscular dose of the adjuvanted RSVPreF3 vaccine or placebo. The Korean cohort (12 sites) included 719 participants. Immunogenicity and reactogenicity were evaluated in a subset of participants. Safety data included solicited adverse events (AEs) within four days, unsolicited AEs up to 30 days, and serious adverse events (SAEs)/potential immune-mediated diseases up to six months post-vaccination.</p><p><strong>Results: </strong>In the Korean cohort, 360 participants received the adjuvanted RSVPreF3 vaccine and 359 received placebo; 91 were included in the solicited safety set and 87 in the per-protocol immunogenicity set. By Day 31, neutralizing titers had increased robustly in the RSVPreF3 group with a mean geometric increase (MGI) versus baseline of 7.7 (RSV-A) and 7.2 (RSV-B); RSVPreF3-binding IgG concentrations showed an MGI of 13.4 in the RSVPreF3 group. Reactogenicity was mostly mild; solicited administration-site AEs occurred in 58.7% (predominantly pain) and solicited systemic AEs in 60.9% (predominantly fatigue) of participants in the RSVPreF3 group; no vaccine-related SAEs were reported. RSV-A and RSV-B neutralizing titers and RSVPreF3-binding IgG concentrations remained above baseline until 24 months post-vaccination, with an MGI of 2.2 (RSV-A), 1.3 (RSV-B), and 2.7 (RSVPreF3-binding IgG).</p><p><strong>Conclusion: </strong>In Korean adults aged ≥60 years, a single dose of the adjuvanted RSVPreF3 vaccine elicited a robust immune response, which persisted for up to 24 months post-vaccination, with an acceptable safety profile.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04886596.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"332-342"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making Antibiotic Guidance Work in the Emergency Department.","authors":"Hae Suk Cheong","doi":"10.3947/ic.2026.0113","DOIUrl":"10.3947/ic.2026.0113","url":null,"abstract":"","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"395-397"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergistic Effect of Bacteriophage vB_KpnS_Pey and Antibiotic Combinations against Clinical Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Isolates.","authors":"Parva Farmehr, Salehe Sabouri, Roya Ahmadrajabi, Saereh Mohammadpour, Hossein Hosseini-Nave, Sanaz Rastegar","doi":"10.3947/ic.2025.0156","DOIUrl":"10.3947/ic.2025.0156","url":null,"abstract":"<p><strong>Background: </strong>The global rise of antimicrobial resistance, particularly among carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP), presents a serious therapeutic challenge. This study aimed to isolate and characterize a bacteriophage effective against prophage-free CRKP and to evaluate its potential synergistic effects with ciprofloxacin, meropenem, gentamicin, and colistin.</p><p><strong>Materials and methods: </strong>A total of 30 non-duplicate clinical <i>bla</i>_NDM-positive CRKP isolates were collected from hospitalized patients in Kerman, Iran. Prophage-free isolates were identified using mitomycin C induction assays. A bacteriophage was isolated from hospital wastewater using enrichment and double-layer agar methods. Phage morphology was identified by transmission electron microscopy (TEM). Host range and efficiency of plating (EOP) were determined using spot assays. The optimal multiplicity of infection (MOI) was assessed by optical density at 600 nm (OD₆₀₀), and phage replication dynamics, including latent period and burst size, were evaluated using a one-step growth curve. Antibiotic susceptibility profiles and minimum inhibitory concentrations (MICs) for ciprofloxacin, meropenem, gentamicin, and colistin were determined by disk diffusion and broth microdilution. Phage-time-kill experiments were used to evaluate antibiotic interactions.</p><p><strong>Results: </strong>TEM revealed that phage vB_KpnS_Pey is a member of the class Caudoviricetes, with an icosahedral head and a long, non-contractile tail. This phage produced clear, halo-form plaques and exhibited lytic activity against 13.3% of CRKP isolates. It showed high EOP against most susceptible strains, a latent period of approximately 30 minutes, and a burst size of 315 plaque-forming units (PFU) per infected cell. The optimal MOI was determined to be 1,000 PFU/colony-forming unit. Combination assays demonstrated phage-antibiotic synergy between vB_KpnS_Pey and subinhibitory concentrations of ciprofloxacin and meropenem, resulting in enhanced bacterial clearance in time-kill experiments. No synergistic effect was observed with gentamicin and colistin.</p><p><strong>Conclusion: </strong>These findings highlight the therapeutic potential of phage vB_KpnS_Pey, particularly when combined with ciprofloxacin and meropenem, as an alternative or combined strategy for treating infections caused by CRKP. Further research is required to fully understand the bacteriophage's mechanisms of action and its associated limitations.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"306-320"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Clinicians' Needs for User-Centered Antibiotic Guideline: Insights from a Focus Group Interview.","authors":"Heejeong Kwon, Heun Choi, Soyoon Hwang, Ki Tae Kwon, Song Mi Moon, Myung Jin Lee, Raeseok Lee, Se Yoon Park, Yong Chan Kim, Bongyoung Kim","doi":"10.3947/ic.2026.0044","DOIUrl":"10.3947/ic.2026.0044","url":null,"abstract":"<p><strong>Background: </strong>Institution-specific antibiotic guidelines are core components of effective antibiotic stewardship programs; however, their practical use in emergency departments (EDs), where empirical antibiotic decisions are made under time pressure and diagnostic uncertainty, remains limited. This study explored ED clinicians' perspectives on antibiotic prescribing and identified key elements for developing ED-specific antibiotic guidelines.</p><p><strong>Materials and methods: </strong>Focus group interviews were conducted between October 12 and October 26, 2022, at four tertiary hospitals in Korea. A total of 16 physicians participating directly in ED antibiotic prescribing were enrolled including Emergency medicine and internal medicine physicians. Interviews were recorded, transcribed and analyzed using thematic analysis by two infectious disease specialists.</p><p><strong>Results: </strong>Clinicians reported substantial challenges in prescribing empirical antibiotics, including diagnostic uncertainty, complex clinical scenarios, and practical prescribing issues such as dosing and administration details. Antibiotic decision-making was influenced by patient-related factors and institutional culture, including department-specific prescribing preferences. Existing antibiotic guidelines were infrequently used due to poor usability and limited applicability to real-world ED practice. Participants emphasized the need for concise, algorithm-based guidelines incorporating practical prescribing information and better integration into clinical workflows.</p><p><strong>Conclusion: </strong>ED clinicians perceived existing antibiotic guidelines as poorly aligned with ED practice. User-centered, institution-specific antibiotic guidelines may enhance applicability and support appropriate empirical antibiotic prescribing in the ED.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"370-378"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Recommendations for the Treatment of <i>Candida auris</i> Infection in Korea.","authors":"Su-Yeon Lee, Jae-Hoon Ko, Nam Yi Kim, Tae Hyong Kim, Jae Woo Park, In Young Yoo, Mi-Kyung Lee, Seung Gul Lee, Tong Ryoung Jung, Yong Pil Chong, Joon-Sik Choi, Chang Young Ha, Dong-Gun Lee","doi":"10.3947/ic.2026.0109","DOIUrl":"10.3947/ic.2026.0109","url":null,"abstract":"<p><p><i>Candida auris</i> is an emerging multidrug-resistant fungal pathogen associated with invasive infections and high mortality. In Korea, <i>C. auris</i> infections have historically been caused predominantly by Clade II isolates; however, recent reports of invasive infections due to Clade I indicate an evolving epidemiology with potential implications for antifungal resistance and treatment strategies. To provide practical guidance for clinicians, we developed evidence-based recommendations for the management of <i>C. auris</i> infections in Korea through review of current international guidelines and available epidemiologic and clinical data, with multidisciplinary expert consensus. Antifungal therapy is not recommended for asymptomatic colonization. Echinocandins are recommended as first-line therapy for suspected or confirmed invasive <i>C. auris</i> infection, whereas amphotericin B deoxycholate is preferred for neonates and young infants. Antifungal susceptibility testing should be performed whenever invasive infection is suspected, although initiation of empirical therapy should not be delayed while awaiting results. Treatment should be reassessed according to susceptibility results, infection sites, and clinical response, with specialist consultation for refractory or complicated infections. These recommendations are based on the currently available evidence and epidemiology, warranting continued surveillance of epidemiologic changes and emerging clinical data.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"300-305"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Respiratory Syncytial Virus Infection in Korean Children: An 11-Year Multicenter Retrospective Study.","authors":"Young Hwa Lee, Yoon Lee, Young June Choe, Jue Seong Lee, Young Yoo, Hyeon-Jong Yang, Jeong-Won Oh, Jinseop Kim, Eunseo Jo, Sujin Choi, Hyun Jung Kim, Lorenzo Bertizzolo","doi":"10.3947/ic.2026.0023","DOIUrl":"10.3947/ic.2026.0023","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections in children. This study investigates the clinical characteristics, factors descriptively associated with severity, and shifts in age distribution of RSV infection in Korean children over an 11-year period.</p><p><strong>Materials and methods: </strong>Using electronic medical records from 21 referral hospitals, we conducted a retrospective observational study of children aged 0-4 years with RSV infection between 2012 and 2023. Data were converted to the Observational Medical Outcomes Partnership-Common Data Model. We compared clinical characteristics between those who received oxygen therapy or mechanical ventilation and those who did not.</p><p><strong>Results: </strong>Of 9,625 children who tested positive for RSV, 79.3% were under two years of age and 99.2% were born at term. Among the 1,828 children who received oxygen therapy, 70.2% were aged 0-11 months and 98.8% were full-term, mirroring the overall cohort composition. Among the 104 children who received mechanical ventilation, 79.8% were aged 0-11 months. Within-group comparisons showed that age 0-11 months, male sex, preterm birth, developmental delay, perinatal lung disease, and cardiovascular disease were more frequently observed among children receiving oxygen therapy or mechanical ventilation than among those who did not.</p><p><strong>Conclusion: </strong>RSV infection in our cohort predominantly affected young infants, with a post-pandemic shift toward older age groups. The high proportion of full-term infants without underlying conditions among severe cases reflected cohort composition rather than enriched risk. These hypothesis-generating findings suggest that broader prevention strategies covering all infants, alongside high-risk groups, warrant population-level evaluation.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"343-351"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Clinical Pathway Pop-Up Window Insertion in Computer-Based Prescription System for Antibiotic Stewardship in Acute Diarrhea.","authors":"Kotchawan Khumduang, Nattawat Larbsida, Wantin Sribenjalux","doi":"10.3947/ic.2026.0036","DOIUrl":"10.3947/ic.2026.0036","url":null,"abstract":"<p><strong>Background: </strong>Acute diarrhea is highly prevalent in Thailand, and inappropriate antibiotic use remains common. The effectiveness of a clinical pathway pop-up integrated into a computerized prescription system for antibiotic stewardship has not been previously evaluated.</p><p><strong>Materials and methods: </strong>We conducted a quasi-experimental study following implementation of a clinical pathway pop-up on 21 December 2021. Outpatient records from Srinagarind Hospital and two nearby primary care units were reviewed from November 2021 to January 2022. Patients were divided into pre- and post-intervention groups. Factors associated with antibiotic prescribing and appropriate antibiotic management were analyzed.</p><p><strong>Results: </strong>A total of 460 patients were included (230 per group); 26.7% were male, with a mean age of 34.8, and 82% of patients were treated in the emergency department. Antibiotics were prescribed to 30.9% of patients in both pre-intervention and post-intervention groups (<i>P</i>>0.999). Rational antibiotic use was 76.5% before and 75.7% after the intervention (<i>P</i>=0.827). Segmented linear regression analysis demonstrated no significant change in prescription rates or appropriate antibiotic management before and after the intervention. Care provided by a resident physician was independently associated with lower odds of appropriate antibiotic management (adjusted odds ratio, 0.38; 95% confidence interval, 0.15-0.85; <i>P</i>=0.020).</p><p><strong>Conclusion: </strong>The implementation of a clinical pathway pop-up window in a computerized prescription system did not significantly reduce inappropriate antibiotic use or improve rational prescribing in patients with acute diarrhea. Resident physicians as primary care providers were independently associated with inappropriate antibiotic management.</p><p><strong>Trial registration: </strong>Thai Clinical Trials Registry: TCTR20210420002.</p>","PeriodicalId":51616,"journal":{"name":"Infection and Chemotherapy","volume":"58 3","pages":"360-369"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}