Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Impact of two antimicrobial susceptibility reporting strategies on treatment of bacteremia caused by low-risk AmpC inducible organisms.","authors":"Jai Mashru, Marion Elligsen, Nick Daneman, Marie-Félixe Granger, Robert A Kozak, Xena X Li, Jerome A Leis, Philip W Lam","doi":"10.1017/ash.2025.49","DOIUrl":"https://doi.org/10.1017/ash.2025.49","url":null,"abstract":"<p><p>In this retrospective study examining the treatment of low-risk AmpC-producing Enterobacterales bacteremia during two periods with different microbiology reporting strategies, reporting of ceftriaxone susceptibility was associated with a statistically significant decrease in carbapenem use as definitive therapy compared to when susceptibility was suppressed (21 vs 50%, <i>p</i> < 0.0001).</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e70"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544658","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":"Utility of urine culture in men with uncomplicated cystitis in ambulatory settings.","authors":"Mackenzie R Keintz, Bryan T Alexander, Katherine Fagan, Trevor C Van Schooneveld","doi":"10.1017/ash.2025.42","DOIUrl":"https://doi.org/10.1017/ash.2025.42","url":null,"abstract":"<p><p>Urinary tract infections (UTI) are common and women with typical symptoms may be treated empirically without culture. We evaluated the utility of urine culture in men presenting with typical symptoms of uncomplicated UTI. Most pathogens isolated retained susceptibility to first-line antimicrobials suggesting urine cultures may be unnecessary in this population.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e69"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544822","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":"Less is more: evaluating the impact of transitions of care pharmacist-led optimization on discharge antibiotic therapy duration in the emergency department.","authors":"Joel Zapata, Sandra Adeife, James B Cutrell, Lindsay Jacobs, Marguerite L Monogue, Michelle Ramos, James Sanders, Chen-Ching Wang, Esther Y Golnabi","doi":"10.1017/ash.2025.22","DOIUrl":"https://doi.org/10.1017/ash.2025.22","url":null,"abstract":"<p><strong>Background: </strong>Patients discharged from emergency departments (ED) with antibiotics for common infections often receive unnecessarily prolonged durations, representing a target for transition of care (TOC) antimicrobial stewardship intervention.</p><p><strong>Methods: </strong>This study aimed to evaluate the effectiveness of TOC pharmacists' review on decreasing the duration of discharge oral antibiotics in patients discharged from the ED at an academic medical center. Pharmacist interventions were guided by an antibiotic duration of therapy guidance focused on respiratory, urinary, and skin infections developed and implemented by the antimicrobial stewardship program. Pharmacist interventions from January 27, 2023, to December 29, 2023, were analyzed to quantify the total number of antibiotic days saved and the percentage of provider acceptance.</p><p><strong>Results: </strong>The ED TOC pharmacists reviewed a total of 157 oral antibiotic prescriptions. 86.6% percent of the reviews required pharmacist interventions. The most common indications for the discharge antibiotics were urinary tract infections (50.0%) and skin infections (23.4%). The total number of antibiotic days saved was 155 days with the provider acceptance rate of 76.5%. In 21% of cases, providers did not count the antibiotic doses administered in the ED, contributing to unnecessarily prolonged duration. 10.2% of patients re-presented to the ED while 6.4% of patients were hospitalized within 30 days of index ED discharge.</p><p><strong>Conclusion: </strong>The transitions of care pharmacist-led intervention was successful in optimizing the duration of discharge oral antibiotics in the ED utilizing prospective audit and feedback based on institutional guidance. The ED represents a high-yield setting for TOC-directed antimicrobial stewardship.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e66"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544660","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":"Role of clinical pharmacist in ensuring safe medication practices for pediatric cardiac care in low- and middle-income countries.","authors":"Aniqa Batool, Rumana Sangi, Jibran Bin Yousuf, Abdul Sattar Shaikh, Muhammad Mohsin","doi":"10.1017/ash.2025.35","DOIUrl":"https://doi.org/10.1017/ash.2025.35","url":null,"abstract":"<p><strong>Background and objectives: </strong>Medication safety is critical for pediatric cardiac care, especially in low- and middle-income countries (LMICs), where limited resources contribute to high rates of medication errors. Studies in LMICs have shown that pharmacist interventions can reduce medication errors by up to 57% and proved that clinical pharmacists are essential for ensuring accurate and optimized medication use. This study aims to evaluate the role of clinical pharmacist interventions to rectify prescription errors in a pediatric cardiac care setting in Pakistan.</p><p><strong>Methods: </strong>This single-center retrospective study was conducted from January to August 2022 in a pediatric cardiac ward at the National Institute of Cardiovascular Diseases. Pediatric patients of all age groups and genders diagnosed with acquired, inherited, or congenital heart diseases were included. We reviewed patient files for any prescription changes made by the clinical pharmacist, based on a comprehensive review of the patient profile, treatment regimens, and laboratory results, to ensure safe and effective pharmacotherapy.</p><p><strong>Results: </strong>260 pharmacist interventions were observed among 2754 patients over eight months, demonstrating a significant role in mitigating medication errors. The interventions addressed wrong doses (126), incorrect frequencies (101), redundant coverage (23), and therapy duration errors (8). Antibiotics were the most frequent source of prescription errors, accounting for 81% of the interventions.</p><p><strong>Conclusion: </strong>Clinical pharmacists' involvement in pediatric cardiac care significantly reduces medication errors in LMICs, as demonstrated by this study. These findings underscore the need to integrate clinical pharmacists into multidisciplinary teams to enhance medication safety and improve patient outcomes.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e67"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544708","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":"Single center, retrospective evaluation of requiring 48 hours versus 24 hours before a pharmacist-driven protocol-based IV to PO conversion of azithromycin.","authors":"Abraham Felix, Winifred Pardo, Wilbert Fuerte, Laura Morales, Timothy P Gauthier","doi":"10.1017/ash.2025.8","DOIUrl":"https://doi.org/10.1017/ash.2025.8","url":null,"abstract":"<p><p>Shortening a pharmacist-driven policy to allow a switch from IV to PO azithromycin after 24 hours instead of 48 hours led to 26% increase in oral azithromycin days of therapy (<i>P</i> < 0.001) and was associated with a shorter length of stay.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e65"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544712","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":"Macro- and micro-influencers of antimicrobial costs…What do stewardship programs need to know?","authors":"Sheetal Kandiah, Sarah Altamimi, Kristy M Shaeer, Marisa Holubar, Jamie L Wagner","doi":"10.1017/ash.2025.38","DOIUrl":"https://doi.org/10.1017/ash.2025.38","url":null,"abstract":"<p><p>The high cost of antimicrobials presents critical challenges for healthcare providers managing infections amidst the growing threat of antimicrobial resistance (AMR). High costs hinder access to necessary treatments, disproportionately affecting disadvantaged populations and exacerbating health disparities. High drug prices necessitate the use of less effective or more toxic alternatives, leading to suboptimal outcomes and prolonged hospitalizations. This, in turn, increases healthcare costs and undermines efforts to combat AMR. Equitable policies, national formularies, and cost caps for essential antimicrobials can ensure universal access to life-saving treatments and enable antimicrobial stewardship programs to ensure the best possible outcomes.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e68"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544662","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":"Antimicrobial resistance and virulence in <i>Klebsiella pneumoniae</i>: a four-month study in Osogbo, Nigeria.","authors":"Taofikat Olatundun Akintoyese, Jude Oluwapelumi Alao, Elijah Kolawole Oladipo, Omolanke Temitope Oyedemi, Olubukola Monisola Oyawoye","doi":"10.1017/ash.2025.21","DOIUrl":"https://doi.org/10.1017/ash.2025.21","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobial resistance (AMR) is a growing global health crisis, with <i>Klebsiella pneumoniae</i> being a key pathogen due to its multidrug resistance (MDR). This study aimed to investigate the resistance profiles, demographic correlations, and molecular characteristics of MDR <i>K. pneumoniae</i> at UNIOSUN Teaching Hospital, Osogbo, Nigeria.</p><p><strong>Methods: </strong>From January to April 2022, 99 clinical isolates (<i>K. pneumoniae</i>) were collected from various specimen types (blood, sputum, urine, wound, stool, and oral cavity). Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method, and virulence genes were analysed using multiplex polymerase chain reaction.</p><p><strong>Results: </strong>All isolates exhibited resistance to ceftriaxone, cefotaxime, and colistin, with high resistance observed for cefepime and carbapenems (meropenem, imipenem, and ertapenem). Molecular characterization revealed the presence of virulence genes <i><b>K1, K2,</b></i> and <i><b>mrkD</b></i> in 15 isolates, while other tested virulence genes ( <i><b>fimH, ramA, traT, K3,</b></i> and <i><b>K5</b></i> ) were not detected. Significant associations were identified between resistance patterns and demographic factors, including age and sex, highlighting potential vulnerabilities in specific populations.</p><p><strong>Conclusions: </strong>This study underscores the alarming prevalence of MDR <i>K. pneumoniae</i> and aligns with global trends of rising AMR. Addressing these challenges requires targeted antimicrobial stewardship programs, infection control measures, public education, and enhanced surveillance systems. Incorporating molecular resistance testing and novel therapeutic agents in future research is crucial to developing effective containment strategies and preserving antibiotic efficacy.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e64"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544728","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":"Patterns of antimicrobial use among hospitalized Veterans with and without a penicillin-class allergy.","authors":"Funnce Liu, Hang Hoang-Nguyen, Erin Ham, McKenna C Eastment, Luis G Tulloch-Palomino","doi":"10.1017/ash.2025.11","DOIUrl":"https://doi.org/10.1017/ash.2025.11","url":null,"abstract":"<p><strong>Objective: </strong>To explore the progress that the Veterans Health Administration has made to minimize the impact of the penicillin (PCN) allergy label, we determined the proportion of Veterans who reported a PCN-class allergy at the time of hospitalization and described antibiotic use in hospitalizations with and without a PCN-class allergy.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Participants: </strong>National sample of 6,541,299 acute care admissions between 2011 and 2022.</p><p><strong>Methods: </strong>We calculated the prevalence of PCN-class allergies on admission and used Poisson regression to compare patterns of antibiotic use between hospitalizations with and without a PCN-class allergy.</p><p><strong>Results: </strong>The prevalence of PCN-class allergies on admission decreased from 12.99% to 11.20%. Use of cefazolin and non-pseudomonal third-generation cephalosporins increased regardless of PCN-class allergy status (\"PCN-class allergy only\" +11.46%, \"No antibiotic allergy\" +4.92%). The prevalence ratio (PR) for antibiotic use in hospitalizations with a PCN-class allergy compared to hospitalizations without antibiotic allergies, decreased for anti-Methicillin Resistant <i>Staphylococcus aureus</i> agents (1.26 [1.25, 1.28] to 1.15 [1.13, 1.17]), carbapenems (1.59 [1.54, 1.65] to 1.47 [1.41, 1.53]), and aztreonam (23.89 [22.45, 25.43] to 17.57 [15.90, 19.42]); and increased for fluoroquinolones (1.58 [1.56, 1.60] to 2.15 [2.09, 2.20]).</p><p><strong>Conclusions: </strong>Prevalence of PCN-class allergies is declining and narrow-spectrum βL use is rising among hospitalized Veterans. Prescribing differences are decreasing between hospitalizations with and without a reported PCN-class allergy, except for aminoglycosides, clindamycin, and fluoroquinolones. These findings can serve to identify areas of focus for future analyses or interventions related to the impact of the PCN allergy label on antibiotic selection.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e57"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544664","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":"Strategies, personnel, and diversity of pediatric antimicrobial stewardship programs in the United States: Strategies and composition of US pediatric ASPs.","authors":"Christina S Manice, Alexander S Plattner, Edan Leshem, Jason G Newland, Mari M Nakamura","doi":"10.1017/ash.2025.18","DOIUrl":"10.1017/ash.2025.18","url":null,"abstract":"<p><strong>Objective: </strong>We sought to characterize US pediatric antimicrobial stewardship programs (ASPs), including their hospital demographics, staffing, funded full-time equivalents (FTEs) by hospital size, and relative emphasis on recommended stewardship strategies. We examined the self-reported characteristics of ASP personnel with regard to discipline, race, ethnicity, gender identity, and years of experience in antimicrobial stewardship.</p><p><strong>Design: </strong>Descriptive two-part survey.</p><p><strong>Setting: </strong>Pediatric ASPs at hospitals participating in Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), a pediatric quality improvement collaborative of >70 children's hospitals.</p><p><strong>Participants: </strong>Survey distributed to 82 US pediatric ASPs, excluding hospitals without pediatric ASPs. Part I completed by ASP leader (physician or pharmacist). Part II distributed to ASP team members.</p><p><strong>Methods: </strong>Part I addressed hospital demographics, ASP funding, and program choices related to the CDC's 2019 Core Elements of Hospital Antibiotic Stewardship Programs. Part II requested that participants anonymously self-identify race, ethnicity, gender identity, training, and duration of ASP experience. Descriptive statistics performed.</p><p><strong>Results: </strong>Sixty-two ASPs responded: 61 (98%) with formal ASP, 40 (65%) from freestanding children's hospitals. 40 (65%) co-led by an ASP physician and pharmacist. 60 (97%) reported dedicated inpatient physician FTE, 57 (92%) dedicated inpatient pharmacist FTE. Most programs (35 [58%]) reported inadequate staffing support. The 125 ASP professionals who completed Part II predominantly self-reported as White (89 [71%]), with fewer self-reporting as Asian (9 [15%]) or Black (4 [3%]).</p><p><strong>Conclusion: </strong>US pediatric ASPs have achieved substantial progress in meeting the CDC Core Elements, but many report insufficient resources. We identified underrepresentation in the ASP workforce.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e59"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544820","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":"Characteristics and framework analysis of Department of Defense hospital Antibiotic Stewardship Programs guided by the Centers for Disease Control and Prevention Core Elements.","authors":"LeeAnne C Lynch, Katrin Mende, Rana F Hamdy, Cara H Olsen, Paige E Waterman, David R Tribble","doi":"10.1017/ash.2025.14","DOIUrl":"https://doi.org/10.1017/ash.2025.14","url":null,"abstract":"<p><strong>Objective: </strong>Characterization and assessment of Department of Defense's (DoD's) Antibiotic Stewardship Programs (ASPs) to determine adherence to Centers for Disease Control and Prevention (CDC) Core Elements and compare to national adherence.</p><p><strong>Design: </strong>Retrospective, observational with supplemental survey.</p><p><strong>Methods: </strong>Facility characteristics and CDC Core Elements (CE) adherence data for 2017-2021 were retrieved from the National Healthcare Safety Network's (NHSN) annual hospital survey with DoD data from the Defense Health Agency and national data from the Antibiotic Resistance and Patient Safety Portal. An online supplemental survey was administered to DoD hospitals. Descriptive statistics and bivariate analyses were completed for facility characteristics and supplemental survey questions to determine correlations between variables. A framework analysis compared DoD ASPs to CEs and Priority Elements.</p><p><strong>Results: </strong>Supplemental surveys were completed for 85.1% of DoD's hospitals. DoD's hospitals were smaller on average than national hospitals. ASP leaders were assigned more often than volunteer and typically served in the role for less than four years. Staffing mix differed, with more equivalent proportions of civilian/contractor to military at larger hospitals in the U.S. Most DoD ASPs consisted of ≤ 25% pharmacists. ASP leaders were largely available on a daily basis; pharmacist leaders spent more time on ASP activities than physicians. CE adherence was high, but in 2021 DoD lagged national adherence in the structural CEs of Leadership, Accountability, and Pharmacy Expertise.</p><p><strong>Conclusions: </strong>DoD hospitals lagged in national adherence to the structural CEs, presenting opportunities for ASP improvement. Refinement of CE adherence measurements, coupled with impact on health outcomes, could aid in better-identifying areas for improvement.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e56"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544730","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}