Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Impact of intravenous push antibiotics on sepsis management at a Veterans Affairs medical center emergency department.","authors":"Mercy Hoang-Nguyen, Kang Lim, Catherine Vo, Luis Tulloch-Palomino","doi":"10.1017/ash.2026.10761","DOIUrl":"10.1017/ash.2026.10761","url":null,"abstract":"<p><strong>Objective: </strong>To detail the impact of transitioning from intravenous piggyback (IVPB) to intravenous push (IVP) antibiotics on median time from sepsis identification to antibiotic administration (minutes), proportion of septic patients who received antibiotics within 60 and 180 minutes of sepsis identification, and Emergency Department (ED) length of stay (LOS).</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Urban, acute-care hospital.</p><p><strong>Participants: </strong>394 patients received IVPB antibiotics (June 2022-June 2023) and 421 patients received IVP antibiotics (June 2023-June 2024), identified through sepsis-related ICD-10 codes, systemic inflammatory response syndrome (SIRS) criteria, and other clinical indicators.</p><p><strong>Methods: </strong>Chart reviews were conducted to obtain sepsis identification and antibiotic administration start times. Statistical process control was used to monitor trends and assess process consistency over time.</p><p><strong>Results: </strong>Following our intervention, median time from sepsis identification to antibiotic administration decreased from 132 minutes (IQR 70, 194) in the IVPB group to 99 minutes (IQR 56,164) in the IVP group (<i>P</i> < .001). The proportion of patients who received antibiotics within 60 minutes of sepsis identification increased from 20.3% to 28.0% (<i>P</i> = .01) and within 180 minutes increased from 70.8% to 79.8% (<i>P</i> = .003). ED LOS decreased from 397 minutes with IVPB to 369 minutes with IVP (<i>P</i> = .004). A sustained downward shift of twelve consecutive months of mean sepsis identification to antibiotic administration start time below the pre-intervention centerline was observed.</p><p><strong>Conclusions: </strong>IVP antibiotics were associated with decreased median time from sepsis identification to antibiotic administration for septic patients, increased adherence to practice guidelines, and reduced ED LOS.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e209"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426884","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 5-day antibiotic stewardship target for uncomplicated community-acquired pneumonia.","authors":"Shuchi Amin, Andrea Call, Jill Bellows, Christopher Noel, Joseph Miles, Andrew LaPoint, Aaron Shaykevich, Ivayla I Geneva","doi":"10.1017/ash.2026.10770","DOIUrl":"10.1017/ash.2026.10770","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotic overuse in community-acquired pneumonia (CAP) persists despite guidelines recommending 5-day treatment for uncomplicated cases. Our pilot quality improvement study aimed to address this problem via an antibiotic stewardship initiative.</p><p><strong>Methods: </strong>Adults admitted to a tertiary care center with uncomplicated CAP were identified using database query and manual chart review, with exclusions for intensive care needs, lack of clinical improvement, or concurrent infections. A 3-month baseline period was compared to a 3-month post-intervention period after provider-targeted interventions were implemented-in-person and email-based provider education on eligibility for the 5-day antibiotic course and pharmacist-driven outreach on day 3 of treatment to encourage guideline-based prescribing. Mean antibiotic duration was compared using Mann-Whitney test. The primary goal was to decrease antibiotic overuse by 25%.</p><p><strong>Results: </strong>Of 647 baseline patients, 222 met criteria with a mean antibiotic duration of 6.75 ± 1.75 days. After the interventions, 170 of 570 patients met criteria with a reduced antibiotic duration of 6.24 ± 1.47 days (<i>P</i> = .001). The antibiotic overuse decreased by 28.7%. Prolonged courses were primarily due to habitual use of traditional longer regimens, unaccounted inpatient or emergency department doses at discharge, and discrepancies between documentation and medication orders.</p><p><strong>Conclusions: </strong>Our pilot study showed that a provider-focused pharmacist-driven strategy can reduce unnecessary antibiotic use in uncomplicated CAP. The intervention encouraged shorter, guideline-driven courses and reduced antibiotic overuse by 28.7%, meeting our primary goal of 25% reduction. Nevertheless, there are opportunities for further improvement in guideline adherence through enhanced discharge prescription stewardship, documentation accuracy checks, and continued provider education.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e207"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426824","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":"Current status and challenges in the assessment of antibiotic allergy information in electronic health records: a retrospective observational study of perioperative patients.","authors":"Yui Enatsu, Yasuaki Tagashira, Koh Okamoto, Akane Takamatsu, Yoshiaki Gu","doi":"10.1017/ash.2026.10777","DOIUrl":"10.1017/ash.2026.10777","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate antibiotic allergy labeling often leads to the unnecessary avoidance of first-line therapies. The present study aimed to evaluate the current status of antibiotic allergy documentation and its assessment in patients undergoing surgery for which cefazolin was the recommended first-line prophylaxis in a Japanese hospital.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a university hospital in Tokyo from 2021 to 2023; included patients with a history of antimicrobial allergy who underwent surgery for which cefazolin was recommended; and assessed patient demographics, details of the allergies in electronic health records (EHR), and perioperatively administered antimicrobial agents.</p><p><strong>Results: </strong>Of 2,402 eligible patients, 243 (10.1%) had a registered antimicrobial allergy. The drug classes most frequently recorded in the EHR were cephalosporins (25.0%) and penicillins (24.0%). Documentation of allergy assessments by a physician (9.0%) or specialist (7.0%) was rare. Although 51.9% of the labeled patients had received cefazolin, non-first-line agents had also been frequently administered. Notably, clindamycin had been administered to 30% of the cases and had been widely used even among patients with only a penicillin allergy label despite the low risk of cross-reactivity.</p><p><strong>Conclusions: </strong>Antibiotic allergy labels in the EHR were often incomplete, infrequently assessed, and associated with substantial avoidance of first-line prophylaxis. Redesigning the EHR format to allow allergies to be distinguished from adverse events while retaining the standard evaluation pathways is essential to optimizing perioperative antimicrobial stewardship.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e205"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413866","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":"Improving syndromic testing in oncology: performance characteristics of multiplex PCR assays for evaluation of infectious gastroenteritis among hospitalized cancer patients.","authors":"Justin Laracy, Judy Yan, Rich Kodama, Shauna Usiak, Emily Walits, Tania Bubb, Mini Kamboj","doi":"10.1017/ash.2026.10776","DOIUrl":"10.1017/ash.2026.10776","url":null,"abstract":"<p><strong>Background: </strong>Multiplex gastrointestinal polymerase chain reaction (GI-PCR) tests of the stool for the evaluation of infectious diarrhea are prone to false-positive target detections. However, there is no recommended testing approach in immunocompromised cancer patients who are often excluded from diagnostic stewardship protocols. The aim of this study was to evaluate the performance characteristics of the BioFire® FilmArray® GI-PCR and assess whether the findings support a diagnostic stewardship approach to limit testing among hospitalized cancer patients.</p><p><strong>Methods: </strong>A retrospective study of 29,727 GI-PCR tests was performed at Memorial Sloan Kettering Cancer Center in New York City, evaluating data from February 1, 2020, to January 29, 2025. All tests sent from all locations and across all patient types were included in the study.</p><p><strong>Results: </strong>The overall GI-PCR positivity rate was greatest in the outpatient setting at 23.4% and dropped at 15.6% in the early stage of admission (hospital days 0-2) and 10.1% in the late stage of admission (hospital day 3 and beyond). Across all subgroups analyzed, norovirus and Enteropathogenic <i>E. coli</i> (EPEC) were the most frequently detected targets with all remaining targets detected at rates below 2%. The low pathogen detection rate was preserved among patients with neutropenia and recipients of recent cellular therapy.</p><p><strong>Conclusion: </strong>BioFire FilmArray GI panel has low utility in the inpatient setting including for severely immunosuppressed hosts. These observations identify a potential opportunity for diagnostic stewardship and suggest that commonly applied testing restrictions may warrant further evaluation in immunocompromised oncology populations.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e202"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413957","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 nationwide survey of infection prevention and control and high-level disinfection and sterilization practices in the Dominican Republic.","authors":"Elianet Castillo, Rita Rojas-Fermin, Claudia Blanco, Antonio Villegas, Yeison Reyes, Alfredo J Mena Lora","doi":"10.1017/ash.2026.10788","DOIUrl":"10.1017/ash.2026.10788","url":null,"abstract":"<p><p>Healthcare-associated infections (HAIs) are often preventable and cause significant morbidity and mortality. There is a paucity of data on HAIs in low- and middle-income countries. This study surveyed Dominican Republic hospitals, revealing that 60% had Infection Prevention, and Control (IPC) programs, but gaps remain in IPC committees, training, data tracking, and reporting.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e204"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413912","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":"Plasma microbial cell-free DNA sequencing for detection of <i>Coxiella burnetii</i> aortic endograft infection with vertebral osteomyelitis.","authors":"Ashita Jain, Sarwat Khalil, Muhammad R Sohail, Ahmed Hamdi, Todd Lasco, Ayman A Farag, Mayar Al Mohajer","doi":"10.1017/ash.2026.10782","DOIUrl":"10.1017/ash.2026.10782","url":null,"abstract":"<p><p>Chronic Q fever can present as culture-negative aortic endograft infection with osteomyelitis. Plasma microbial cell-free DNA sequencing unexpectedly detected <i>Coxiella burnetii</i> before serology, prompting exposure reassessment and targeted therapy. Later operative cultures grew <i>Eikenella corrodens</i>, underscoring the need to pair molecular results with serology and source-control microbiology.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e203"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414011","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 plasma cell-free DNA metagenomic next-generation sequencing testing in neonatal and infant populations.","authors":"Neema Pithia, Kalpashri Kesavan, Annabelle Lee, Shangxin Yang, Ishminder Kaur","doi":"10.1017/ash.2026.10774","DOIUrl":"10.1017/ash.2026.10774","url":null,"abstract":"<p><strong>Objective: </strong>Plasma cell-free DNA metagenomic next-generation sequencing (cf-mNGS) tests offer the ability to detect microbial DNA from a single blood sample; however, its clinical utility in infants remains incompletely characterized. This study aims to evaluate the real-world clinical impact of plasma cf-mNGS testing in the neonatal and infant population.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A large academic medical center in Los Angeles, California.</p><p><strong>Patients: </strong>95 hospitalized neonates and infants (≤12 months of age).</p><p><strong>Methods: </strong>Clinical impact was adjudicated using predefined criteria.</p><p><strong>Results: </strong>We reviewed 95 unique plasma cf-mNGS testing episodes performed between February 2018 and August 2024. The mean age at testing was 4.2 months (SD, 3.8). All patients were hospitalized in the intensive care unit at the time of testing. Tests were most frequently performed for evaluation of \"culture-negative sepsis\" (30.5%), unexplained hospital-onset fevers (25.3%), and multiorgan failure (21.1%). Plasma cf-mNGS testing did not influence clinical management in the majority of cases (86.3%; 95% CI, 78.0%-91.8%). Positive clinical impact occurred in 5/95 cases (5.3%; 95% CI, 2.3%-11.7%), where plasma mNGS results assisting in antimicrobial de-escalation/discontinuation or earlier/new diagnoses. Negative clinical impact occurred in 4/95 cases (4.2%; 95% CI, 1.6%-10.3%), with plasma cf-mNGS results prompting unnecessary investigations or treatment.</p><p><strong>Conclusions: </strong>Our findings do not support the routine use of plasma cf-mNGS testing for indications including \"culture-negative sepsis\" in neonatal and infant populations.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e201"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413878","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 and implementation of a nurse-led clinical decision support tool for urinary tract infection.","authors":"Lei A Qin, Marguerite Balasta, Alison Purcell, Cara Curley, Rani Patel, Nathanael Koelper, Rebecca Hamm Feldman, Shafinaz Akhter, Lily A Arya","doi":"10.1017/ash.2026.10772","DOIUrl":"10.1017/ash.2026.10772","url":null,"abstract":"<p><strong>Objective: </strong>Ordering urine cultures in the absence of urinary symptoms contributes to unnecessary antibiotic prescribing for urinary tract infection (UTI). The aim of this study was to develop and implement an electronic health record (EHR)-integrated, nurse-led clinical decision support (CDS) tool for UTI symptom triage to support outpatient antibiotic stewardship.</p><p><strong>Design: </strong>Exploratory sequential mixed-methods study.</p><p><strong>Setting: </strong>Urban academic family medicine practice.</p><p><strong>Participants: </strong>Eleven nurses.</p><p><strong>Methods: </strong>In the qualitative phase, workflow mapping and semi-structured interviews informed development of an EHR-integrated CDS consisting of a symptom score calculator and triage algorithm. In the quantitative phase, implementation was evaluated using a pre-post design with interrupted time series analysis over 15 months. Implementation outcomes included adoption, fidelity, and usability. Clinical outcomes included symptom documentation, urine testing practices, and antibiotic prescribing. Safety outcomes included pyelonephritis within 30 days.</p><p><strong>Results: </strong>Qualitative analysis identified four barriers: incomplete symptom documentation, reflexive urine testing, medicolegal concerns about missing pyelonephritis, and patient pressure for antibiotics. The CDS was adopted by all nurses, with 77.8% fidelity and high usability. Documentation of ≥2 UTI-specific symptoms increased at implementation with sustained improvement (slope + 2.4%/month; 95% CI, 0.1-4.7). Urine cultures without microscopy showed sustained reduction (slope -5.5%/month; 95% CI, -7.9 to -3.2). Antibiotic prescribing for asymptomatic bacteriuria decreased (20% to 3%; <i>P</i> = .003) with no increase in pyelonephritis.</p><p><strong>Conclusions: </strong>Nurse-led, EHR-integrated clinical decision support for UTI triage was associated with sustained improvements in symptom documentation, reduced unnecessary urine culture ordering, and decreased antibiotic treatment of asymptomatic bacteriuria without compromising safety.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e200"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413906","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":"EcoRxChoice.com- an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship.","authors":"Pamela S Lee, Hugh Gordon, Theresa Ferguson, Tien Dinh, Misty Vu, Marina Nguyen, Chaynor Hsiao, Gary Fong","doi":"10.1017/ash.2026.10398","DOIUrl":"10.1017/ash.2026.10398","url":null,"abstract":"<p><p>Healthcare sustainability is a multidisciplinary field that seeks to mitigate healthcare's environmental consequences. Antimicrobial stewardship and healthcare sustainability both aim to reduce wasteful resource use while maximizing patient safety. However, a strong partnership between antimicrobial stewardship and healthcare sustainability has yet to develop. To facilitate environmentally sustainable decision-making in antimicrobial prescribing, we developed a web-based calculator (EcoRxChoice (www.ecorxchoice.com)) where users can enter different antimicrobial regimens and compare how much plastic waste each regimen creates. This work was supported in part by the Society of Infectious Diseases Pharmacists (SIDP), reflecting SIDP's commitment to strengthening sustainability as a practical extension of antimicrobial stewardship and empowering infectious disease pharmacists to make measurable environmental impact through evidence-based care.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e199"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414001","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":"Regional One Health antimicrobial stewardship networks: a strategic framework for addressing antimicrobial resistance.","authors":"Claudia Huebner, Steffen Flessa","doi":"10.1017/ash.2026.10781","DOIUrl":"10.1017/ash.2026.10781","url":null,"abstract":"<p><p>Regional One Health antimicrobial stewardship networks require coordinated, adaptive strategies across sectors. This conceptual article combines strategic fit theory with the Ansoff matrix to identify key determinants of sustainable network performance and proposes strategic development pathways to strengthen governance, data integration, cross-sectoral collaboration and long-term network development.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e198"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426901","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}