Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Guilty by gown: reconsidering contact precautions for COVID-19.","authors":"David Zamora Diaz","doi":"10.1017/ash.2025.10055","DOIUrl":"10.1017/ash.2025.10055","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e137"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562124","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":"Trends in inpatient antibiotic use in Indonesia and the Philippines during the COVID-19 pandemic.","authors":"Amara Z Fazal, Olivia L McGovern, Garrett W Mahon, Fernanda C Lessa, Maria Tarcela Gler, Jemelyn Garcia, Mark John Festin, Kuntaman Kuntaman, Ida Parwati, Cherry Siregar, Jay Christian D Muere, Gina De Guzman Betito, Maya Montemayor, Arleen De Leon, Emmeline Borillo, Mark Ramon Victor Llanes, Regina Berba, Musofa Rusli, Mariyatul Qibtiyah, Bambang Pujo Semedi, Rosantia Sarassari, Leonardus Widyatmoko, Basti Andriyoko, Adhi Kristianto Sugianli Md, Dewi Kartika Turbawaty, Ivo Dhanitri Ranita, Franciscus Ginting, Rahmadania Marita Joesoef, Made Ananda Krisna, Twisha S Patel","doi":"10.1017/ash.2025.48","DOIUrl":"10.1017/ash.2025.48","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e134"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499618","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":"The impact of less restrictive quarantine for exposed COVID-19 patients in inpatient psychiatric settings: a cohort analysis.","authors":"Krishnendu Mangal, Mikaela Kluver, Graham M Snyder, Janina-Marie Huss","doi":"10.1017/ash.2025.10041","DOIUrl":"10.1017/ash.2025.10041","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the impact of a changing cohort strategy on COVID-19 transmission in an acute inpatient behavioral health facility.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Patients: </strong>Behavioral health inpatients exposed to COVID-19.</p><p><strong>Interventions: </strong>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.</p><p><strong>Results: </strong>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%, <i>P</i> < 0.001) and per 1,000 patient-days at risk (1.44 vs 0.27 conversions per 1,000 patient days, <i>P</i> < 0.001), but not per exposure (3.44% vs 3.13%, <i>P</i> = 0.68).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e136"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499617","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":"Association between in-hospital antibiotic use and long-term outcomes in critically ill patients.","authors":"Parker Burrows, Ruth-Ann Brown, Abigail Samuelsen, Anthony S Bonavia","doi":"10.1017/ash.2025.10054","DOIUrl":"10.1017/ash.2025.10054","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>611-bed, quaternary care academic medical center in the United States.</p><p><strong>Patients: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days (<i>P</i> < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, <i>P</i> = 0.739) or readmission (OR 1.01, <i>P</i> = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes (<i>P</i> = 0.0033), with higher exposure among patients experiencing two or more secondary infections (<i>P</i> = 0.026 and <i>P</i> = 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, <i>P</i> = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e135"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499615","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":"Striking a balance: strategies for addressing single-use surgical equipment in infection prevention.","authors":"Steven S Doerstling, Paige M Fox, Jorge L Salinas, Mindy M Sampson","doi":"10.1017/ash.2025.186","DOIUrl":"10.1017/ash.2025.186","url":null,"abstract":"<p><p>Single-use surgical equipment is a standard strategy to reduce the risk of pathogen transmission in the operative room. However, this practice is associated with a great environmental impact. Reusable surgical tools represent an opportunity to reduce this impact, with many studies showing a 50% or greater reduction in carbon emissions by switching to reusable alternatives. While the safety of reusable equipment depends on strict sterilization protocols, the risk of infection is minimal when guidelines are followed. To advance sustainability in healthcare, we must balance infection prevention priorities, operational challenges, and the environmental considerations.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e132"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499616","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":"Assessing hospital antibiotic stewardship program (ASP) implementation: validation of an implementation science-informed survey.","authors":"Jorie Michaela Butler, Ellen Childs, Tamar Barlam, Mari-Lynn Drainoni, Caitlin Reardon, Yue Zhang, Laura Damschroder, Peter Taber, Karl Madaras-Kelly, Matthew Goetz, Shana Burrowes, Eddie Stenehjem, Jincheng Shen, Chong Zhang, Angela Presson, Matthew Howard Samore","doi":"10.1017/ash.2025.65","DOIUrl":"10.1017/ash.2025.65","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong></p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e133"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499614","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":"Variation in veterans affairs hospitals' UV-C surface disinfection systems guidance documents: a qualitative content analysis.","authors":"Julia Friberg Walhof, A M Racila, Stacy Hockett Sherlock, Cassie Cunningham Goedken, Daniel Suh, Bernardino Guerrero, Trina Zabarsky, Kimberly Dukes, Eli N Perencevich","doi":"10.1017/ash.2025.10047","DOIUrl":"10.1017/ash.2025.10047","url":null,"abstract":"<p><p>The Department of Veterans Affairs (VA) does not have system-wide standardized policies or procedures for ultraviolet-C (UV-C) use. Qualitative researchers performed content analysis of VAV UV-C guidance documents. We observed that lack of specificity and uniformity across guidance documents is a potential barrier to UV-C implementation and future quality control.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e131"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499619","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":"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}