Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Association between dentists' awareness of antimicrobial resistance and selection of oral third-generation cephalosporins: a cross-sectional study.","authors":"Tatsuya Tai, Takahiro Motoki, Naohiro Kurokawa, Sayaka Yamashita, Kazunori Yamaguchi, Hiroaki Tanaka, Shinji Kosaka, Yuuichi Muraki","doi":"10.1017/ash.2026.10775","DOIUrl":"10.1017/ash.2026.10775","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobial resistance (AMR) is a global public health concern. In Japan, outpatient dental practice frequently involves antimicrobial prescriptions, with oral third-generation cephalosporins prescribed more often than the guideline-recommended amoxicillin. We examined the association between dentists' multidimensional AMR-related attitudes and selection of oral third-generation cephalosporins.</p><p><strong>Design: </strong>Cross-sectional secondary analysis of a questionnaire survey.</p><p><strong>Participants: </strong>The questionnaire survey was administered to 406 dentists affiliated with the Kagawa Dental Association (November 2024-January 2025), and 111 responses were analyzed (response rate, 27.3%).</p><p><strong>Methods: </strong>The primary outcome was self-reported selection of oral third-generation cephalosporins. AMR attitudes were quantified as overall and domain-specific scores for sense of crisis, self-efficacy, and role awareness. Multivariable logistic regression analysis was performed, adjusting for years of clinical experience, sex, post-treatment prophylactic antimicrobial use, and practice type (in-house vs. external pharmacy dispensing). Domain-specific scores were analyzed separately to avoid multicollinearity.</p><p><strong>Results: </strong>High overall AMR attitude scores were associated with a low likelihood of selecting third-generation cephalosporins (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.72-0.92). Self-efficacy (OR, 0.50; 95% CI, 0.34-0.73) and role awareness (OR, 0.59; 95% CI, 0.42-0.84) showed strong negative associations. Post-I treatment prophylactic antimicrobial use and practice type involving external pharmacy dispensing were positively (OR, 2.69; 95% CI, 1.07-6.75) and negatively (OR, 0.34; 95% CI, 0.15-0.77) associated with selection of third-generation cephalosporins, respectively.</p><p><strong>Conclusions: </strong>Dentists' AMR-related attitudes, particularly self-efficacy and professional role awareness, were strongly associated with antimicrobial prescription choices. Interventions targeting these factors may promote appropriate antimicrobial use in dental practice.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e230"},"PeriodicalIF":0.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632740","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 impact of a commercial multiplex pathogen panel for the detection of bacteria in sputum specimens from non-ICU patients with suspected lower respiratory tract infection.","authors":"Madeline T Gemoules, Tristan T Timbrook, Elizabeth Neuner, Valerie Yuenger, Han Li, Sena Sayood, Tamara Krekel","doi":"10.1017/ash.2026.10793","DOIUrl":"10.1017/ash.2026.10793","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical impact of the BioFire® FilmArray® Pneumonia Panel (BFPP) in sputum specimens from non-intensive care unit (ICU) patients with suspected lower respiratory tract infection.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>1400-bed tertiary referral academic medical center.</p><p><strong>Methods: </strong>Patients who had a sputum specimen with BFPP and standard of care (SOC) culture between 9/1/2022 and 8/31/2024 while on a non-ICU floor were included. An antibiotic change evaluation of actual versus theoretically possible therapy changes was completed at two time points, after BFPP results and after SOC results, overall and by various characteristics, in addition to an assessment of the appropriateness of antibiotic regimens.</p><p><strong>Results: </strong>189 specimens were included. 48.7% of theoretical changes were acted upon based on BFPP results compared to 87.8% of theoretical changes acted upon based on SOC results. Actual compared to theoretical de-escalation of gram-positive agents occurred more frequently compared to gram-negative agents post-BFPP (43.1% vs 32%) and post-SOC (60.5% vs 38.7%). De-escalation was more frequent in non-neutropenic patients compared to neutropenic patients (39.5% vs 26.1% post-BFPP; 54.7% vs 21.1% post-SOC) and in medicine floor patients compared to oncology floor patients (52.5% vs 23.8% post-BFPP; 72.5% vs 30.2% post-SOC). Appropriateness of antibiotic regimens was higher post-SOC results (77.8%) compared to post-BFPP results (66.1%).</p><p><strong>Conclusions: </strong>Higher rates of theoretical antibiotic changes were acted upon post-SOC results compared to post-BFPP results, suggesting a disconnect between BFPP results and provider action. Further research is needed to assess factors associated with actionability of the BFPP.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e231"},"PeriodicalIF":0.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632919","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":"Indication-based clinical decision support for inpatient urine testing: impacts on utilization, appropriateness, and antibiotic prescribing.","authors":"Mario Luis Valdez Imbert, Allyson Larcena Tipgos, Majd Alsoubani, Maureen Campion, Rachel Erdil, Shira Doron, Gabriela Andujar Vazquez, Kap Sum Foong","doi":"10.1017/ash.2026.10805","DOIUrl":"10.1017/ash.2026.10805","url":null,"abstract":"<p><p>Across a healthcare system, an indication-based clinical decision support (CDS) tool for inpatient urine testing immediately reduced urinalysis-with-reflex-to-culture (-62.7/1,000 patient-days) and urine culture ordering, while increasing urinalysis utilization(41.4/1,000 patient-days). Intervention effect was not fully sustained. Ordering appropriateness remained low, and antibiotics were often prescribed without documented symptoms, suggesting CDS alone is insufficient.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e229"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632942","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":"Popular infection prevention myths related to single-use plastics.","authors":"Pamela S Lee, Shira Abeles, Preeti Mehrotra, Trini Mathew, Preeti Jaggi, Shreya Doshi, Vincent Hsu, Hardeep Singh","doi":"10.1017/ash.2026.10786","DOIUrl":"10.1017/ash.2026.10786","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e227"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632964","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":"Development, implementation, and usability evaluation of an mHealth-based clinical decision-support system for strengthening antimicrobial stewardship among physicians in Pakistan: a mixed-methods study.","authors":"Nosheen Nasir, Saadia Sattar, Asma Riaz, Abdul Muqeet, Noreen Zia, Hina Awat, Zara Nadeem, Saadbin Zafar, Beenish Khalid, Warda Imran Muallim, Salik Sadruddin Merani, Fariha Ahmed, Warda Ghias, Hassan Farooqui, Saleem Sayani, Ayeesha Kamran Kamal","doi":"10.1017/ash.2026.10790","DOIUrl":"10.1017/ash.2026.10790","url":null,"abstract":"<p><strong>Objective: </strong>Antibiotic resistance is a major global health threat, driven by inappropriate antimicrobial prescribing. Mobile health (mHealth)-based clinical decision-support systems (CDSS) may strengthen antibiotic stewardship, but evidence from resource-limited settings remains limited. This study reports the development and implementation of ComBact, an mHealth-based CDSS for seven infectious disease syndromes, examines physicians' perceptions of its clinical utility, and evaluates system-level usability metrics at a private tertiary-care hospital in Pakistan.</p><p><strong>Methods: </strong>A convergent parallel mixed-methods design was used. Semi-structured focus group discussions (FGDs) were conducted with internal medicine physicians who had access to ComBact for one year. Transcripts were analyzed using Braun and Clarke's thematic framework. Quantitative analysis included system-generated data on user registration, uptake, and detailed usage metrics. Findings from both components were integrated using a joint display.</p><p><strong>Results: </strong>61 clinicians registered for ComBact, all accessing the dashboard at least once. The app recorded 134 sessions, with a mean of 1.23 pathway revisits per session and a mean workflow duration of 1 minute 25 seconds; 32.7% of users completed a ComBact plan. Mobile phones accounted for 57.4% of access and desktops for 42.6%. Two FGDs were conducted with fifteen physicians (median age 31 years (IQR: 27-34 yr). Five themes emerged: (1) clinical applicability, (2) user experience, (3) need of the app, (4) content limitations, and (5) recommendations.</p><p><strong>Conclusions: </strong>ComBact was perceived as a user-friendly tool with meaningful potential to support antimicrobial stewardship in LMICs, though significant content and functional enhancements are needed.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e228"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632939","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":"Retrospective multicenter evaluation of oral step-down versus intravenous carbapenem treatment of extended-spectrum beta-lactamase-producing <i>Escherichia coli</i> urinary tract infections.","authors":"Margarita Bellon, Alice Margulis Landayan, Jorge Morales, Jorge Murillo, Stephen Breazeale, Timothy P Gauthier","doi":"10.1017/ash.2026.10794","DOIUrl":"10.1017/ash.2026.10794","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated whether treatment with oral step-down therapy compared with intravenous carbapenems alone for extended-spectrum beta-lactamase (ESBL)-producing <i>Escherichia coli</i> urinary tract infections (UTIs) impacted patient venous catheter days and clinical outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective study at six different hospitals in a large health system included adults (≥ 18 years) admitted for ≥ 24 hours with ≥ 1 documented UTI symptom, a ceftriaxone-resistant <i>Escherichia coli</i> urine culture, and receipt of ≥ 1 dose of meropenem or ertapenem between August 2022 and July 2025. The primary outcome was median venous catheter line days directly associated with antibiotic use inpatient and outpatient. Secondary outcomes included pharmacist antibiotic intervention, incidence of antibiotic-related adverse events, hospital length of stay, duration of therapy, inpatient catheter line days, projected outpatient catheter line days, presence of peripherally inserted central catheter or midline, central line-associated bloodstream infection, and treatment failure (defined as escalation of antibiotics, in-hospital mortality, urgent care/emergency department visit or readmission, or recurrence of symptomatic UTI with ESBL <i>Escherichia coli</i> within 30 days).</p><p><strong>Results: </strong>120 patients were included, with 60 in the oral step-down and carbapenem groups, respectively. Primary outcome of median venous catheter days in the oral step-down group was 0 (IQR 0-0) vs 5 (IQR 0-7) in the carbapenem group, <i>p</i> < .001. Secondary outcome of treatment failure in the oral step-down group was 2 (3%) vs 8 (13%) in the carbapenem group, <i>p</i> < .09.</p><p><strong>Conclusions: </strong>Oral step-down therapy for ESBL <i>Escherichia coli</i> UTIs was associated with a significant reduction in venous catheter line use.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e225"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632903","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":"Utilization of prospective, pharmacist-driven restriction criteria to improve appropriateness of empiric intravenous vancomycin use.","authors":"Kinsey McClure Johannemann, Mark Jumper, Blain Thayer, Djeunou Tchamba","doi":"10.1017/ash.2026.10808","DOIUrl":"10.1017/ash.2026.10808","url":null,"abstract":"<p><strong>Objective: </strong>This objective of this study is to evaluate the impact of a prospective, pharmacist-driven restriction protocol on the appropriateness of IV vancomycin use in a community hospital setting.</p><p><strong>Methods: </strong>This single-health system, multi-site, quasi-experimental study compared pre-intervention (January-March 2024) and post-intervention (January-March 2025) groups. The intervention was a mandatory pharmacist-driven protocol requiring review of every empiric vancomycin order against pre-defined, evidence-based criteria. Inappropriate orders were proactively discontinued, and providers were notified with supporting rationale. The primary outcome was the percentage of appropriate empiric vancomycin orders, assessed by chart review of 100 random patients per group. Key secondary outcomes included vancomycin days of therapy per 1,000 patient days and trough levels ordered per 1,000 patient days.</p><p><strong>Results: </strong>Analysis of 200 patients (100 per group) showed that the appropriateness of empiric IV vancomycin orders significantly increased from 55% pre-intervention to 97% post-intervention (P < .001). Days of therapy per 1,000 patient days decreased from 69.3 to 64.2 (P < .041), and vancomycin trough levels ordered per 1,000 patient days decreased by 41% (52.3 vs. 31.1, P < .001). Crucially, no significant differences were observed in 30-day mortality, suggesting the improvements were achieved without compromising patient safety in patients who received vancomycin.</p><p><strong>Conclusions: </strong>Implementation of a prospective, pharmacist-driven empiric IV vancomycin restriction protocol offers a practical, effective strategy for institutions seeking to increase appropriateness of empiric IV vancomycin orders.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e224"},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632901","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 intersection of sexually transmitted infections and antimicrobial stewardship: opportunities for synergy.","authors":"Aditi Ramakrishnan, Sheetal Kandiah, Shawnalyn Sunagawa, Jonathan Ryder","doi":"10.1017/ash.2026.10754","DOIUrl":"10.1017/ash.2026.10754","url":null,"abstract":"<p><p>Following the introduction of doxycycline post-exposure prophylaxis (doxy PEP), concerns regarding associated antimicrobial resistance have emerged. In this piece, we discuss a range of collaborative strategies between the historically siloed fields of antimicrobial stewardship and sexually transmitted infections to guide the stewardship of doxy PEP and diagnostics for STI care.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e221"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632911","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":"Respiratory multiplex PCR and antimicrobial treatment modification in hospitalized patients with community-acquired pneumonia.","authors":"Hülya Çaşkurlu, Halenur Vural Akbal, Hatice Kübra Uçar, Esra Koçoğlu, Özlem Aydın, Pınar Ergen, Yasemin Çağ","doi":"10.1017/ash.2026.10760","DOIUrl":"10.1017/ash.2026.10760","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) is a major cause of hospitalization, and pathogen identification is often limited by low diagnostic yield of conventional microbiological methods. Respiratory multiplex PCR (mPCR) enables rapid pathogen detection, but its role in antimicrobial treatment modification for inpatients with CAP remains unclear. This study evaluated the association between mPCR testing and antimicrobial modification in hospitalized patients with CAP.</p><p><strong>Methods: </strong>This retrospective, single center cohort study included hospitalized patients with CAP identified using ICD-10 codes between July 2023 and February 2025. Respiratory mPCR was performed within the first 24 hours of admission using combined nasopharyngeal/oropharyngeal (NP/OP) swabs. The primary outcome was antimicrobial treatment modification guided by mPCR results and documented by physicians. Secondary outcomes included antimicrobial de-escalation and hospital length of stay.</p><p><strong>Results: </strong>In this cohort of 145 patients, mPCR detected a pathogen in 56 patients (38.6%): viral pathogens in 30 (20.7%) and bacterial pathogens in 26 (17.9%). Overall antimicrobial treatment was modified in 54 patients (37.2%). Modification guided by mPCR results and documented by physicians occurred in 37 patients (25.5%). Among these 37 modifications, 35 (94.6%) were classified as antimicrobial de-escalation. Hospital length of stay did not differ significantly across mPCR results.</p><p><strong>Conclusions: </strong>In hospitalized patients with CAP, mPCR facilitates targeted antimicrobial treatment modification and drives high rates of de-escalation. These findings demonstrate the significant utility of mPCR in optimizing clinical decisions and enhancing antimicrobial stewardship.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e222"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632928","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 decision-making and documentation gaps associated with influenza antiviral treatment in hospitalized children.","authors":"Christina B Felsen, Erin Licherdell, Maria A Gaitan, Ghinwa Dumyati, Brenda Tesini","doi":"10.1017/ash.2026.10791","DOIUrl":"10.1017/ash.2026.10791","url":null,"abstract":"<p><p>Influenza antivirals are recommended for all hospitalized children. During 2023-2024, only 42% of hospitalized children with influenza in 7 counties in Western NY were treated. Comorbidities, illness severity, and symptoms predicted treatment. Parental declination, emphasis of treatment risk, and providers' application of outpatient guidelines to inpatients also played a role.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e223"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632959","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}