Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Erratum: Three stages of laboratory stewardship in improving appropriate <i>Clostridioides difficile</i> testing in a community-based setting-CORRIGENDUM.","authors":"Michael S Wang, Gretchen Zimmerman, Theresa Klein, Bethany Stibbe, Monica Rykse, Samuel Ballard, Naveen Vijayam, Joe Brown, Khateeb Raza, Shannon Beckman, Andrew M Skinner","doi":"10.1017/ash.2025.10098","DOIUrl":"10.1017/ash.2025.10098","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1017/ash.2025.55.].</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e170"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849937","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":"Longitudinal surveillance and transmission of <i>Acinetobacter baumannii</i> using whole genome sequencing-a tale of two hospitals.","authors":"Chetan Jinadatha, Hosoon Choi, Sorabh Dhar, Keith S Kaye, Munok Hwang, Jing Xu, Thanuri Navarathna, John David Coppin, Piyali Chatterjee","doi":"10.1017/ash.2025.10092","DOIUrl":"10.1017/ash.2025.10092","url":null,"abstract":"<p><strong>Objective: </strong><i>Acinetobacter baumannii</i> is known to cause global outbreaks and routine surveillance to prevent nosocomial transmission has historically been limited. A longitudinal surveillance study of <i>Acinetobacter</i> isolates using whole genome sequencing (WGS) and whole genome multilocus sequence typing (wgMLST) was performed to map the distribution of sequence types (STs) and intrahospital transmission.</p><p><strong>Methods: </strong>All <i>Acinetobacter</i> clinical isolates were collected in two hospitals (H1, H2) from fifteen units between 2017 and 2021 in Southeast Michigan and analyzed. The isolates were subjected to WGS using the NextSeq instrument (Illumina). The contigs were <i>de novo</i> assembled using SPAdes (v3.7.1) and wgMLST analysis was performed using BioNumerics software v7.6. Minimum spanning tree (MST) and dendrograms were created to map distribution of STs and putative transmissions.</p><p><strong>Results: </strong>ST2^Pas was the most prevalent in both hospitals (H1:47.2% and H2:59.7%), followed by ST406^Pas (H1:11.1%, H2:8%). ST15^Pas (H1:9.7%) was only found in H1. Transmission was mapped for ST2^Pas, ST406^Pas (H1, H2), and ST15^Pas for H1 and mainly located in the ICU settings.</p><p><strong>Conclusions: </strong>Presence of several STs (ST2^Pas, ST406^Pas, and ST15^Pas) prevalent from both hospitals suggest that these are common circulating strains in the area. Sporadic transmission events mainly in the ICU settings in both hospitals (H1 and H2) were noted indicating attention to enhanced infection prevention and control measures. Given that <i>Acinetobacte</i>r infections are predominantly hospital acquired, an effective surveillance plan incorporating WGS and wgMLST may improve the ability to identify and track trends rapidly, implement effective infection control intervention, and reduce healthcare-associated infections (HAIs).</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e173"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849941","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":"Proportion of carbapenem-resistant Enterobacterales with readily detectable beta-lactam resistance.","authors":"Eli Wilber, Gillian Smith, Jesse T Jacob, Paulina A Rebolledo","doi":"10.1017/ash.2025.10072","DOIUrl":"10.1017/ash.2025.10072","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e179"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849945","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":"ASHE careers-Dr. David J. Weber.","authors":"David J Weber","doi":"10.1017/ash.2025.10046","DOIUrl":"https://doi.org/10.1017/ash.2025.10046","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e171"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849936","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":"Fournier gangrene is associated with increased length of stay and higher healthcare costs compared to non-perineal necrotizing soft tissue infections: a retrospective analysis of the National Inpatient Sample (2016-2020).","authors":"Hayato Mitaka, Kristen McQuerry, Kelsey Karnik, Alexandre R Marra, Toshio Naito, Patrick Ten Eyck, Paul G Auwaerter, Yuji Yamada, Takaaki Kobayashi","doi":"10.1017/ash.2025.10084","DOIUrl":"10.1017/ash.2025.10084","url":null,"abstract":"<p><strong>Background: </strong>Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) of the perineum. Recent retrospective studies from quaternary centers suggest improved outcomes and a potentially less aggressive clinical course for FG than non-perineal NSTIs. However, comprehensive nationwide data remain limited.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed the National Inpatient Sample (2016-2020) to compare outcomes between FG and non-perineal NSTIs. Adult patients undergoing surgical debridement with a diagnosis of FG or NSTI were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), hospital costs, and home discharge rates. Multivariable regression analyses adjusted for patient demographics, comorbidities, and hospital characteristics.</p><p><strong>Results: </strong>A total of 5,007 FG and 24,782 non-perineal NSTI patients were identified. Crude in-hospital mortality rates were 5.8% for FG and 5.4% for non-perineal NSTIs, with stable trends observed over five years. After adjustment, no significant difference in mortality was observed (adjusted odds ratio [aOR]: 1.04; 95% CI: 0.90-1.20). However, FG was associated with longer LOS (adjusted mean difference: 1.99 days; 95% CI: 1.53-2.46) and higher hospital costs ($37,809 higher; 95% CI: $29,540-$46,077). Home discharge rates were similar between groups (aOR: 0.97; 95% CI: 0.89-1.05).</p><p><strong>Discussion: </strong>Despite similar mortality rates, FG hospitalizations were associated with increased LOS and higher costs compared to non-perineal NSTIs. These findings may suggest potential nationwide disparities in FG care quality, particularly outside specialized referral centers. Further research is needed to understand if standardized care pathways tailored to FG may optimize management and reduce resource utilization.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e178"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849940","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":"Methicillin-resistant <i>Staphylococcus</i> aureus nasal swabs: trends in use and association with outcomes.","authors":"Hayley B Gershengorn, Hannah Wunsch, Bhavarth Shukla","doi":"10.1017/ash.2025.10093","DOIUrl":"10.1017/ash.2025.10093","url":null,"abstract":"<p><strong>Objective: </strong>To investigate patterns of early methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>PINC-A1 Healthcare Database (2008-2021).</p><p><strong>Participants: </strong>Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.</p><p><strong>Methods: </strong>We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.</p><p><strong>Results: </strong>We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0-37.6%; full range: 0%-98.0%]; median odds ratio [95% CI]: 84.7 [63.3-115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%-0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04-1.31], <i>P</i> = .007).</p><p><strong>Conclusions: </strong>Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e177"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849942","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":"Precaution or barrier? Reconsidering contact and isolation measures in palliative care: a systematic scoping review.","authors":"Henry T He, Shannon Bunn, Brittany Rance","doi":"10.1017/ash.2025.10096","DOIUrl":"10.1017/ash.2025.10096","url":null,"abstract":"<p><strong>Objective: </strong>Infection control measures like contact precautions may conflict with patient-centered palliative care principles, but their efficacy and harms in this context remain understudied. This review evaluates how contact precautions affect quality of life, social connectedness, and infection control efficacy in palliative care.</p><p><strong>Design: </strong>Systematic scoping review.</p><p><strong>Setting: </strong>Palliative care settings (eg, palliative care units and hospices).</p><p><strong>Participants: </strong>Adults and children receiving palliative care, with no restrictions on age or comorbidity.</p><p><strong>Methods: </strong>English-language studies on contact precautions in palliative care were included. Ovid MEDLINE and Ovid Embase were searched from inception to December 20, 2024, using terms related to antimicrobial resistance, contact precautions, and palliative care. No publication type or status restrictions were applied. The protocol was registered on the Open Science Framework and followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.</p><p><strong>Results: </strong>Fifteen studies were included, primarily from Germany (73%) and using qualitative methods (80%). Most focused on patients in palliative care units or hospices, though geographic and methodological limitations restrict generalizability. Common challenges included fear, loneliness, disrupted intimacy, and inconsistent protocols. Contact precautions were often bundled with other infection prevention interventions, limiting the ability to assess their specific impact. Terminology varied widely. No study directly evaluated the efficacy of contact precautions in reducing antimicrobial-resistant organism (ARO) transmission, though one pediatric study reported liberal protocols and no nosocomial ARO infections.</p><p><strong>Conclusions: </strong>A case-by-case approach is needed to balance infection control with patient dignity and quality of life. Consistent terminology and more robust, mixed-methods research are essential to inform evidence-based protocols in diverse settings.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e174"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849944","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":"Title: race and ethnicity and the risk of community-acquired third-generation cephalosporin-resistant uropathogens: a systematic review and meta-analysis.","authors":"Sweta Balaji, Sarah Blackmon, Esther E Avendano, Samson Alemu Argaw, Rebecca A Morin, Nanguneri Nirmala, Shira Doron, Maya L Nadimpalli","doi":"10.1017/ash.2025.10097","DOIUrl":"10.1017/ash.2025.10097","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this systematic review and meta-analysis (SRMA) was to synthesize literature on the differences in risk of community-acquired third-generation cephalosporin resistant (3GC-R) uropathogens across racial and ethnic groups.</p><p><strong>Methods: </strong>This SRMA builds on a completed scoping review of the association between race, ethnicity, and risk of colonization or community-acquired infection with ESKAPE pathogens. A literature search was conducted for the earlier scoping review in January 2022 and updated in March 2024. Following PRISMA guidelines, titles and abstracts were screened before advancing to full-text review and data extraction. A customized extraction form in Covidence captured relevant information from each study. For this SRMA, studies identified in the scoping review that reported case counts or effect measures related to colonization or community-acquired infection with 3GC-R uropathogens across distinct identities were included. Separate random effects meta-analyses assessed differences in risk of 3GC-R uropathogens between each minority racial/ethnic group and White/Caucasian persons.</p><p><strong>Results: </strong>Five studies comprising 13,527 subjects were included in the SRMA, among which there was generally a higher risk of 3GC-R uropathogens among Hispanic/Latinx and Asian persons compared to White persons. Only the meta-analysis of Hispanic/Latinx versus White/Caucasian persons yielded a statistically significant pooled risk ratio; specifically, Hispanic/Latinx persons had a 27% higher risk of harboring 3GC-R uropathogens (95% CI: 1.04, 1.55).</p><p><strong>Conclusions: </strong>As antibiotic resistance rises in community settings, our findings support the need to understand the structural issues that underpin differential risk of 3GC-R uropathogens across race and ethnicity.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e172"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849947","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":"Statewide analysis of NHSN antimicrobial use rate and standardized antimicrobial administration ratio (SAAR) 2017-2023, Tennessee.","authors":"Glodi Mutamba, Callyn Wren, Dipen Patel, Melphine Harriott, Christopher Evans","doi":"10.1017/ash.2025.10083","DOIUrl":"10.1017/ash.2025.10083","url":null,"abstract":"<p><strong>Objective: </strong>To describe antimicrobial use in Tennessee from 2017 to 2023.</p><p><strong>Design: </strong>Retrospective analysis of antimicrobial use using data from the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option.</p><p><strong>Setting: </strong>Acute care and critical access facilities in Tennessee.</p><p><strong>Results: </strong>From 2017 to 2023, 97 facilities in Tennessee submitted data to the NHSN AU Option. The number of reporting facilities increased from 25 to 95. During this time, the statewide average antimicrobial use significantly rose from 593 days of therapy (DOT)/1000 days present (DP) to 621 DOT/1000 DP (<i>P</i> = .0478). The All-Antibacterial Standardized Antimicrobial Administration Ratio (SAAR) values remained near 1.0, indicating overall use was as predicted. However, the All-Antibacterial SAAR values, particularly in small facilities, revealed that they utilized antibiotic agents more than predicted during the study period. Additionally, the SAAR trends varied by patient care locations, with the oncology unit (ONC) experiencing a significant increase from 0.73 to 1.12 (<i>P</i>-value<.0001). West Tennessee had the highest antimicrobial use rate at 736 DOT per 1000 DP, and an All-Antibacterial SAAR of 1.21. The top antimicrobial agents-vancomycin, ceftriaxone, piperacillin/tazobactam, cefepime, and cefazolin-accounted for 54% of the total antimicrobial use.</p><p><strong>Conclusions: </strong>This statewide analysis of AU and SAAR trends identifies areas where additional antimicrobial stewardship efforts may be targeted to improve antimicrobial use. Facilities of different sizes and geographic locations have unique demographics that can affect antimicrobial use, requiring specialized antimicrobial stewardship techniques.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e181"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849946","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":"Weighing options: empiric antibiotic use and stewardship opportunities in critically ill patients with community-acquired pneumonia.","authors":"Nalea Trujillo, Calvin Diep, David Ha, Ariadna Garcia, Marisa Holubar","doi":"10.1017/ash.2025.10082","DOIUrl":"10.1017/ash.2025.10082","url":null,"abstract":"<p><p>In this retrospective study, critically ill patients with community-acquired pneumonia frequently received empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) and antipseudomonal antibiotics despite having few or no guidelines-endorsed risk factors. De-escalation of anti-MRSA therapy was quicker, likely aided by MRSA polymerase chain reaction assays.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e180"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849948","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}