Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Impact of beta-lactam allergy labels on bone marrow transplant patients.","authors":"Benjamin M Haxby, Kendall J Tucker, Caitlin M McCracken, YoungYoon Ham, Jon P Furuno, Jessina C McGregor","doi":"10.1017/ash.2025.172","DOIUrl":"10.1017/ash.2025.172","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%, <i>P</i> = 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e130"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318837","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":"Challenges in monitoring vancomycin in outpatient parenteral antimicrobial therapy: opportunities for mitigation utilizing OSHA's framework for mitigating workplace hazards.","authors":"Dominic C Regli, Seth Warner, Ethan Wilcox, Jennifer Zimmerman, Marvin J Bittner","doi":"10.1017/ash.2025.10052","DOIUrl":"10.1017/ash.2025.10052","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e129"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318834","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":"Academic children's hospital partnership with public health to address mass pediatric community tuberculosis exposure.","authors":"Alice I Sato, Bradford Becken, Arthur J Chang, Shirley F Delair, Lourdes Eguiguren, Andrea Green Hines, Clayton Mowrer, Gwenn L Skar, Jennifer Zwiener, Kari Neemann","doi":"10.1017/ash.2025.10040","DOIUrl":"10.1017/ash.2025.10040","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Setting: </strong>A multidisciplinary team rapidly established a dedicated TB Exposure Clinic to evaluate and screen exposed children requiring window prophylaxis.</p><p><strong>Patients: </strong>The exposure affected 592 individuals, including 359 children under five-those at highest risk for severe disease.</p><p><strong>Interventions: </strong>Given the vulnerability of young children to TB infection, timely evaluation and initiation of window prophylaxis were prioritized.</p><p><strong>Results: </strong>Over two days, 162 children were assessed for TB window prophylaxis, and 110 additional children underwent TB screening.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e126"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318832","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":"Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy.","authors":"Kayla Godfrey, Deanna McDanel, Kelly Percival, Noelle Bowdler, Donna Santillan, Amy Dowden","doi":"10.1017/ash.2025.10033","DOIUrl":"10.1017/ash.2025.10033","url":null,"abstract":"<p><strong>Objective: </strong>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 <i>Streptococcus</i> (GBS).</p><p><strong>Design and setting: </strong>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.</p><p><strong>Patients: </strong>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.</p><p><strong>Results: </strong>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%, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318857","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":"A retrospective case-control study of a cluster of surgical site infections after coronary artery bypass grafting at a tertiary medical center.","authors":"Alaina S Ritter, Vidya Kollu, Amanda Aspilcueta, Jennifer D Connolly, Eddie Manning, Lennox Archibald","doi":"10.1017/ash.2025.164","DOIUrl":"10.1017/ash.2025.164","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>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).</p><p><strong>Setting: </strong>Tertiary care medical center in Florida, USA.</p><p><strong>Patients: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i> < 0.0001) and meeting the requirements for appropriate perioperative temperature management (SCIP measure 10) (<i>P</i> = 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e127"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318831","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":"Healthcare utilization and outcomes of patients discharged to skilled nursing facilities on parenteral antimicrobial therapy.","authors":"Madeline Langenstroer, Christopher Crnich, Sally A Jolles, Jon P Furuno, Brie N Noble, Rosemary C Bailey","doi":"10.1017/ash.2025.171","DOIUrl":"10.1017/ash.2025.171","url":null,"abstract":"<p><p>Hospitalized patients are commonly discharged to skilled nursing facilities (SNFs) on outpatient parenteral antimicrobial therapy (OPAT). In this study, 101 patients discharged to a SNF on OPAT required considerable post-hospital care coordination and experienced high readmission and mortality rates within 90 days, contributing to literature characterizing OPAT patients in other settings.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e128"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318836","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":"Does serial procalcitonin monitoring predict clinical outcomes in children with sepsis? A diagnostic stewardship study.","authors":"Beenish Rubbab, Samuel Davila, Jessica Moreland, Sarah Firmani, Zachary Most","doi":"10.1017/ash.2025.10032","DOIUrl":"10.1017/ash.2025.10032","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>One primary-to-quaternary care pediatric healthcare system from May 2020 to May 2022.</p><p><strong>Participants: </strong>Encounters for children 1 to 18 years old with a sepsis ICD-10 diagnosis code and clinical sepsis were included.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Procalcitonin clearance at 48 hours after admission did not predict early clinical stability in children with sepsis.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e124"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318835","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":"Prioritizing isolation precautions: a patient-centered approach to infection prevention and control.","authors":"Emine Alp Meşe, Elena Carrara, Ermira Tartari, Nico T Mutters, Constantinos Tsioutis, Gabriel Birgand, Evelina Tacconelli","doi":"10.1017/ash.2025.173","DOIUrl":"10.1017/ash.2025.173","url":null,"abstract":"<p><p>Healthcare-associated infections (HAIs) and multidrug-resistant (MDR) pathogens present significant challenges to global health, exacerbated by emerging threats such as SARS-CoV-2 and the growing immunocompromised population. While isolation precautions are critical for infection prevention and control (IPC), their indiscriminate application can strain resources and impact patient well-being. This review proposes a patient-centered framework for optimizing isolation strategies by integrating pathogen-related factors, individual patient risks, and healthcare facility resources to optimize isolation precautions. By incorporating targeted risk assessments, advanced analytics (e.g., omics and machine learning), and infection preventionist leadership, this approach aligns isolation measures with clinical and operational realities. It aims to enhance IPC efficacy while balancing patient needs and resource efficiency. We highlight strategies to ensure isolation precautions remain evidence-based, adaptable, and sustainable within healthcare settings. A patient-focused approach to isolation improves both infection prevention and overall quality of patient care.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e123"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318838","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":"Carbapenem-resistant <i>Enterobacterales</i> peri-rectal colonization prevalence on admission to two intensive care units in an academic hospital in India.","authors":"Armaghan-E-Rehman Mansoor, Fabia Edathadathil, Devendhu Suresh, Yathu Krishna, Anu George, Jacaranda van Rheenen, Ige A George, Jennie H Kwon, Emily E Petersen, Matthew Westercamp, Anil Kumar, Sudheer O Vayoth, Margaret A Olsen, Surbhi Leekha, Sanjeev K Singh, David K Warren, Sumanth Gandra","doi":"10.1017/ash.2025.10036","DOIUrl":"10.1017/ash.2025.10036","url":null,"abstract":"<p><p>This study from a South Indian tertiary care hospital found a 41% peri-rectal Carbapenem-resistant <i>Enterobacterales</i> colonization prevalence at intensive care unit admission, with New Delhi metallo-β-lactamase as the predominant carbapenemase. It underscores the need for contextually appropriate, cost-effective infection prevention strategies to mitigate the spread of resistant organisms in Indian healthcare settings.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e120"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318833","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":"<i>Staphylococcus aureus</i> Bacteremia Electronic Reminder: an effective and accepted alert to consult infectious disease.","authors":"Julie A Keating, Joseph Perzynski, Benjamin Schnapp, Nasia Safdar, Meghan B Brennan, Alexander J Lepak","doi":"10.1017/ash.2025.176","DOIUrl":"10.1017/ash.2025.176","url":null,"abstract":"<p><p>Infectious disease consultation improves outcomes for <i>S. aureus</i> bacteremia. We developed an electronic health record alert (SABER) to automatically encourage consultation and replace manual intervention. In a pre-post evaluation, high rates of consultation and optimized patient management, shorter time to consult, and high provider-reported satisfaction were observed during SABER implementation.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e121"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200907","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}