Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Impact of a multi-step testing algorithm on hospital-onset <i>Clostridioides difficile</i> rates and clinical outcomes.","authors":"Matthew A Moffa, Dustin R Carr, Nathan R Shively, Adriana Betancourth, Nitin Bhanot, Zaw Min, Charmaine Abalos, Arshpal Gill, Salman Bangash, Thomas L Walsh","doi":"10.1017/ash.2025.180","DOIUrl":"10.1017/ash.2025.180","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of implementing a multi-step <i>Clostridioides difficile</i> infection (CDI) testing algorithm on hospital-onset (HO)-CDI rates and clinical outcomes.</p><p><strong>Design: </strong>Retrospective pre-intervention/post-intervention study.</p><p><strong>Setting: </strong>Two academic hospitals in Pittsburgh, Pennsylvania.</p><p><strong>Methods: </strong>In the pre-intervention period, a standalone polymerase chain reaction (PCR) assay was used for diagnosing CDI. In the post-intervention period, positive PCR assays were reflexed to a glutamate dehydrogenase antigen test and an enzyme immunoassay for toxin A/B.</p><p><strong>Results: </strong>The implementation of a multi-step testing algorithm resulted in a significant reduction in HO-CDI cases per 10,000 patient days from 5.92 to 2.36 (<i>P</i> < 0.001). Despite the decrease in reportable HO-CDI cases, there were no significant differences in clinical outcomes such as hospital length of stay, intensive care unit admissions, and treatment courses. In addition, there was a significant reduction in all-cause 30-day readmissions in the post-intervention group, though CDI-related readmissions remained similar.</p><p><strong>Conclusions: </strong>The multi-step testing algorithm significantly reduced HO-CDI rates without compromising clinical outcomes. The study supports the use of a multi-step CDI testing algorithm to assist healthcare providers with CDI management decisions and potentially to reduce financial penalties burdened on healthcare systems.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e112"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112806","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 use and misuse of procalcitonin in the management of pneumonia: a retrospective analysis at a large tertiary care center.","authors":"Doris C Obimba, Aaron Shaykevich, Danielle R Vitale, Christopher A Rudmann, Heather Korrie, Joseph Miles, Christopher Noel, Ivayla I Geneva","doi":"10.1017/ash.2025.175","DOIUrl":"10.1017/ash.2025.175","url":null,"abstract":"<p><strong>Objective: </strong>Antibiotics overuse leads to bacterial resistance. The biomarker procalcitonin rises with bacterial pneumonias and remains normal in viral respiratory tract infections. Its use can distinguish between these etiologies and thus guide antibiotics use. We aimed to quantify the effect of procalcitonin use on clinical decision-making.</p><p><strong>Design: </strong>A retrospective study, spanning a year at a tertiary care center, where 348 patients hospitalized with aspiration pneumonia and 824 with non-aspiration pneumonia were evaluated with regards to procalcitonin use, the length of stay (LOS) and antibiotics prescribing practices. Descriptive statistics and univariate analyses were applied to the ensemble data. Subsets of cases were manually reviewed and analyzed with descriptive statistics. <i>P</i> < 0.05 indicated statistical significance.</p><p><strong>Results: </strong>21% of both the aspiration and non-aspiration pneumonia cases had procalcitonin checked. In the ensemble analyses, a check of procalcitonin was more likely to happen in prolonged hospitalizations with aspiration pneumonia. The LOS was statistically the same regardless of procalcitonin results (elevated or normal) for both the aspiration and non-aspiration pneumonia cohorts. The overall use of antibiotics was not affected by the procalcitonin results. After excluding two extreme outliers, the per-person antibiotics cost was not affected by the procalcitonin results. Detailed chart reviews of 33 cases revealed that for the vast majority, the procalcitonin results were not used by clinicians to guide the duration of antibiotics use.</p><p><strong>Conclusions: </strong>Despite its promise as a biomarker for antibiotics stewardship, procalcitonin results appeared to not be utilized by clinicians as a decision-making tool in the management of pneumonia.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e115"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112883","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":"Five essential lessons in antimicrobial stewardship and leadership I have learned from running.","authors":"Miranda So","doi":"10.1017/ash.2025.188","DOIUrl":"10.1017/ash.2025.188","url":null,"abstract":"<p><p>As an antimicrobial stewardship pharmacist and an avid runner, I identified the five essential lessons I have learned from running that are transferrable to implementing initiatives, conducting practice-based research and leading an antimicrobial stewardship program. To ensure this commentary will resonate with the reader, I provided an illustrative example connecting each lesson from running with a transferrable concept or practice in antimicrobial stewardship.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e114"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112847","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":"Knowledge, attitudes, and practices regarding antimicrobial resistance and antimicrobial stewardship among healthcare workers in outpatient medical centers in Kenya: a qualitative study.","authors":"Mary W Kaniu, Wahu R Gitaka, Rupali Jain, Ann N Munyare, Rodney D Adam, Aliza Monroe-Wise","doi":"10.1017/ash.2025.41","DOIUrl":"10.1017/ash.2025.41","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobial resistance (AMR) is a major global health threat with a projected 10 million deaths globally by 2050. Antimicrobial stewardship (AMS) programs are coordinated efforts involving doctors, nurses, pharmacists, and other healthcare providers. Understanding knowledge, attitudes, and practices of health providers is pivotal for implementing strategies to curb the spread of AMR. The aim of this study was to evaluate knowledge, attitudes, and practices surrounding AMR and AMS among healthcare workers in Kenya.</p><p><strong>Design: </strong>A qualitative study using in-depth semi-structured interviews.</p><p><strong>Setting: </strong>12 private outpatient clinics in Kenya.</p><p><strong>Participants: </strong>Healthcare workers including administrators and clinicians.</p><p><strong>Methods: </strong>A thematic analysis approach was used; the Capability, Opportunity, and Motivation for Behavior model was used to understand the knowledge, attitudes, and practices surrounding AMR and AMS.</p><p><strong>Results: </strong>Twenty-four participants were interviewed. They had some knowledge regarding AMR but lacked knowledge about AMS and its components. Although participants did not perceive AMR as a problem in their clinics, they reported it was a major problem in the country and globally. There was lack of prioritization of AMS in the clinics.</p><p><strong>Conclusions: </strong>The lack of knowledge on AMS and its components coupled with failure to recognize AMR as a problem in the facilities led to a lack of prioritization of AMS. There is therefore an urgent need to educate healthcare administrators and clinicians on AMR and AMS to foster a sense of ownership of the problem of AMR and to be pro-active in implementing measures to curb it.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e113"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112814","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 mindfulness training on infection prevention practices in intensive care units.","authors":"Anucha Apisarnthanarak, Panuch Eiamprapaporn, Punchong Hanvivadhanakul, Watcharee Chancharoenrat, Suphannee PhetSaen, Tipanan Tamsuan, Kittiya Jantarathaneewat, Piyaporn Apisarnthanarak, Linda M Mundy, Aunchaya Yeamsukon, Duangrutai Aksarachaipruk, Isaree Naisangunsri, Ven Surapoj Saddhadhigo Bhikkhu, Ven Tawatchai Dhammadipo Bhikkhu","doi":"10.1017/ash.2025.174","DOIUrl":"10.1017/ash.2025.174","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e116"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112879","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":"Epidemiological data on the acquisition of carbapenem-resistant <i>Enterobacterales</i> through weekly rectal swabs in non-critically ill patients undergoing antimicrobial therapy: a short-term surveillance study.","authors":"Naruemit Sayabovorn, Naruemon Maknakhon, Naratchaphan Pati, Teerawit Tangkoskul, Anupop Jitmuang","doi":"10.1017/ash.2025.169","DOIUrl":"10.1017/ash.2025.169","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the connection between non-critically ill hospitalized patients and the acquisition of carbapenem-resistant <i>Enterobacterales</i> (CRE).</p><p><strong>Design: </strong>An observational prospective cohort study from January 2018 to December 2019.</p><p><strong>Setting: </strong>A single tertiary referral center.</p><p><strong>Participants: </strong>Non-critically ill subjects admitted to general medical wards who received antimicrobial therapy <48 h.</p><p><strong>Methods: </strong>Rectal swab cultures at admission and weekly for CRE surveillance. CRE isolates were confirmed using carbapenem disk diffusion susceptibility and genotypic carbapenemase testing. Clinical characteristics and outcomes were also evaluated.</p><p><strong>Results: </strong>Of 110 subjects, 66.4% were women, the mean age was 67 years, and 336 bacterial isolates were detected from rectal swab cultures. 55 (16.4%) isolates from 25 subjects exhibited phenotypic resistance to carbapenem. <i>Klebsiella pneumoniae</i> (50.9%) and <i>Escherichia coli</i> (30.9%) were common CRE, harboring New Delhi metallo-beta-lactamase (NDM) (50.9%), oxacillinase-48 (OXA-48) (12.7%), and co-NDM/OXA-48 (20.0%). Subjects with acquired CRE had higher APACHE II scores (<i>P</i> = 0.030), received piperacillin-tazobactam (<i>P</i> = 0.004), underwent prolonged antimicrobial therapy (<i>P</i> = 0.009), and experienced longer hospital stays (<i>P</i> = 0.001) compared to CRE-negative subjects. None of the CRE-positive subjects developed an acquired infection.</p><p><strong>Conclusions: </strong>Acquired CRE colonization is prevalent among non-critically ill patients. Factors such as disease severity, the type and duration of antimicrobial therapy, and the length of hospital stays may increase the risk of CRE acquisition in non-critically ill populations.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e105"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103410","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":"Things I wish I knew when implementing an ambulatory antimicrobial stewardship program at an urban health system: lessons learned and future directions.","authors":"Michael P Veve, Christen J Arena, Rachel M Kenney, Brian M Church, Steven T Fried, Anita B Shallal","doi":"10.1017/ash.2025.187","DOIUrl":"10.1017/ash.2025.187","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e109"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103414","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":"Guidance for infectious disease care in the face of human conflict: a case-based narrative review.","authors":"Tessa Adžemović, Rachel Croxton, Payal Patel, Joseph Ladines-Lim, Elizabeth Scruggs-Wodkowski","doi":"10.1017/ash.2025.170","DOIUrl":"10.1017/ash.2025.170","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e107"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103411","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":"Investigating socioeconomic deprivation and antibiotic prescribing among older medicare patients using an instrumental variable approach.","authors":"Mayar Al Mohajer, David Slusky, David Nix, Catia Nicodemo","doi":"10.1017/ash.2025.185","DOIUrl":"10.1017/ash.2025.185","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic deprivation has been associated with antibiotic overprescription in the US; however, prior studies could not quantify a causal relationship due to endogeneity. This study examines how socioeconomic deprivation is related to the rate of antibiotic days supplied to older Medicare Part D beneficiaries, utilizing an Instrumental Variable (IV) approach.</p><p><strong>Methods: </strong>Data from the Medicare Part D and the Social Deprivation Index (SDI) repositories were analyzed. To address potential endogeneity and omitted variable bias in the relationship between SDI and antibiotic prescribing, we used the maximum Earned Income Tax Credit as an IV. Bivariate Moran's <i>I</i> assessed the spatial correlation between SDI and antibiotic prescribing across geographic regions. The IV analysis then examined the relationship between predicted SDI and antibiotic days supplied (ln). Linear regression models estimated associations between SDI and its components, and antibiotic days supplied, adjusting for prescriber, beneficiary, and geographic factors.</p><p><strong>Results: </strong>Among 161,164, there was no significant spatial dependence between SDI and antibiotic days supplied (<i>P</i> = 0.0656). In the IV model, a one-unit increase in SDI was associated with a 0.582 (SE = 0.164, <i>P</i> < 0.0005) increase in antibiotic days supplied (ln). Higher unemployment and single-parent family rates were linked to increased antibiotic days supplied, while crowded housing was associated with a reduction.</p><p><strong>Conclusion: </strong>This study identified that socioeconomic deprivation may influence antibiotic days supplied to Medicare Part D beneficiaries. Findings highlight the need for targeted public health interventions to address the socioeconomic factors contributing to excess antibiotic use.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e110"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112811","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":"Public health response to a tuberculosis exposure in a daycare: lessons on transmission risk and intervention.","authors":"Kari Neemann, Caleb Kuddes, Chad Wetzel, Alice I Sato, Justin Frederick","doi":"10.1017/ash.2025.184","DOIUrl":"10.1017/ash.2025.184","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e106"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103413","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}