Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"A persistent sink reservoir as a potential source of <i>Pseudomonas aeruginosa</i> infections in pediatric oncology patients.","authors":"LaTasha Richards, Craig Gilliam, Jessica Brazelton, Heather L Glasgow, Randall T Hayden, Hana Hakim","doi":"10.1017/ash.2025.54","DOIUrl":"10.1017/ash.2025.54","url":null,"abstract":"<p><strong>Objective: </strong>Outbreaks of <i>Pseudomonas aeruginosa</i> infections have been linked to water-related sources. We describe the investigation of a suspected outbreak of five <i>P. aeruginosa</i> infections in pediatric oncology patients in 2021 that triggered a retrospective review and prospective monitoring of additional cases, environmental sampling, and bacterial genomic analysis.</p><p><strong>Setting and patients: </strong>Pediatric oncology center.</p><p><strong>Methods: </strong>Medical records of patients with <i>P. aeruginosa</i> were reviewed and staff were interviewed to identify common exposures. Environmental samples were cultured for <i>P. aeruginosa.</i> Patient and environmental isolates underwent whole genome sequencing and core genome multi-locus sequence typing (cgMLST) and sequences were added to a previously existing library of <i>P. aeruginosa</i> clinical isolates collected in 2017 and onwards to determine strain relatedness.</p><p><strong>Findings: </strong>During 2019-2022, 82 patients with 110 episodes of <i>P. aeruginosa</i> infections were identified and 132 isolates of <i>P. aeruginosa</i> were sequenced. Twenty-three environmental samples were collected, of which two grew <i>P. aeruginosa</i> in culture. CgMLST demonstrated four multi-patient isolate clusters but no genetic relatedness among the isolates from the patients in the suspected outbreak. Two sink-derived isolates from 2021 were genetically related to patient-derived isolates from 2018 and 2017.</p><p><strong>Conclusions: </strong>Sequencing revealed there is no common source or linkage between the isolates of the suspected <i>P. aeruginosa</i> outbreak in 2021. However, it revealed genetic relatedness of previous patient strains to later strains collected from hospital sinks, suggesting persistent colonization of a reservoir with <i>P. aeruginosa.</i></p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e82"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756167","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":"Three stages of laboratory stewardship in improving appropriate <i>Clostridioides difficile</i> testing in a community-based setting.","authors":"Michael S Wang, Gretchen Zimmerman, Theres Klein, Bethany Stibbe, Monica Rykse, Samuel Ballard, Naveen Vijayam, Joe Brown, Khateeb Raza, Shannon Beckman, Andrew M Skinner","doi":"10.1017/ash.2025.55","DOIUrl":"10.1017/ash.2025.55","url":null,"abstract":"<p><strong>Objective: </strong>Assess the efficacy of staged interventions aimed to reduce inappropriate <i>Clostridioides difficile</i> testing and hospital-onset <i>C. difficile</i> infection (HO-CDI) rates.</p><p><strong>Design: </strong>Interrupted time series.</p><p><strong>Setting: </strong>Community-based.</p><p><strong>Methods/interventions: </strong>National Healthcare Safety Network (NHSN) <i>C. difficile</i> metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.</p><p><strong>Results: </strong>After all interventions, the number of <i>C. difficile</i> tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42-0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01-0.40).</p><p><strong>Conclusions: </strong>Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e81"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665584","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":"Resourcing for hospital antibiotic stewardship programs is associated with higher participation in antimicrobial use tracking: a cross-sectional study.","authors":"Bradley J Langford, Sera Thomas, Kevin Brown, Nick Daneman, Kevin L Schwartz, Valerie Leung","doi":"10.1017/ash.2025.53","DOIUrl":"10.1017/ash.2025.53","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e80"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665567","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":"Protracted cluster of Group A Streptococcal infection among individuals receiving wound care in the community, North East England, 2022: an outbreak report.","authors":"Gayle Dolan, Juliana Coelho, Yan Ryan, Angela Scott, Melanie Milburn, Chris Settle, Theresa Lamagni","doi":"10.1017/ash.2025.44","DOIUrl":"10.1017/ash.2025.44","url":null,"abstract":"<p><strong>Background: </strong>Outbreaks of Group A Streptococcal (GAS) infection are difficult to detect in community healthcare settings and present unique challenges for infection prevention and control (IPC). We describe investigation of a cluster of GAS among individuals receiving wound care from the same community integrated care team (CIT) and associated complexities.</p><p><strong>Methods: </strong>Prospective and retrospective surveillance for cases of invasive and noninvasive GAS infection linked to the CIT was undertaken with the local NHS trust IPC team. Screening samples were requested from staff working in the CIT (n = 191) and from staff and residents (n = 73) in care home A where several cases resided. Clinical isolates were sent to the UKHSA reference laboratory for <i>emm</i> typing and whole genome sequencing (WGS).</p><p><strong>Results: </strong>Twenty-two cases were identified over a five-month period. Eighteen had isolates available for typing, 11 of which were <i>emm</i> type 108.1 and 0-2SNPs apart on WGS. Six were different <i>emm</i> types and one <i>emm</i> type 108.1 but 9-13SNPs apart from other isolates and so excluded from the investigation. No staff infected or colonized with <i>emm</i> 108.1 were identified, and no single healthcare worker had attended all cases. GAS was isolated in the room of a case resident in care home A and found to be closely genetically related to clinical isolates.</p><p><strong>Conclusions: </strong>WGS was integral in identifying outbreak cases and a multiagency approach essential to the investigation. Unfortunately, despite this no clear source or route of transmission was identified. Further research is required to determine the most effective IPC strategies for community healthcare.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e79"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665565","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":"Perceptions of sources of transmission among hospital employees infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) in an urban tertiary care hospital: a qualitative study to inform future pandemic management.","authors":"Ziyue Luo, Daniel E Kent, Pooja Shah, Dina Poplausky, MacKenzie Clark MacRae, Cassidy Boomsma, Jacob M Jasper, Alysse G Wurcel, Elena Byhoff, Alice M Tang, Shira Doron, Ramnath Subbaraman","doi":"10.1017/ash.2025.39","DOIUrl":"10.1017/ash.2025.39","url":null,"abstract":"<p><strong>Objective: </strong>Hospital employees are at risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection from patient, coworker, and community interactions. Understanding employees' perspectives on transmission risks may inform hospital pandemic management strategies.</p><p><strong>Design: </strong>Qualitative interviews were conducted with 23 employees to assess factors contributing to perceived transmission risks during patient, coworker, and community interactions and to elicit recommendations. Using a deductive approach, transcripts were coded to identify recurring themes.</p><p><strong>Setting: </strong>Tertiary hospital in Boston, Massachusetts.</p><p><strong>Participants: </strong>Employees with a positive SARS-CoV-2 PCR test between March 2020 and January 2021, a period before widespread vaccine availability.</p><p><strong>Results: </strong>Employees generally reported low concern about transmission risks during patient care. Most patient-related risks, including limited inpatient testing and personal protective equipment availability, were only reported during the early weeks of the pandemic, except for suboptimal masking adherence by patients. Participants reported greater perceived transmission risks from coworkers, due to limited breakroom space, suboptimal coworker masking, and perceptions of inadequate contact tracing. Perceived community risks were related to social gatherings and to household members who also had high SARS-CoV-2 infection risk because they were essential workers. Recommendations included increasing well-ventilated workspaces and breakrooms, increasing support for sick employees, and stronger hospital communication about risks from non-patient-care activities, including the importance of masking adherence with coworkers and in the community.</p><p><strong>Conclusions: </strong>To reduce transmission during future pandemics, hospitals may consider improving communication on risk reduction during coworker and community interactions. Societal investments are needed to improve hospital infrastructure (eg, better ventilation and breakroom space) and increase support for sick employees.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e78"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665562","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 stewardship initiative on prescribing at discharge from a community medical center.","authors":"Gargi Adenkar, Karan Raja, Brandon Chen, Donald Beggs, Christopher Cilderman, Mitesh Patel, Mona Philips","doi":"10.1017/ash.2025.40","DOIUrl":"10.1017/ash.2025.40","url":null,"abstract":"<p><strong>Objective: </strong>Assess the impact of a multifaceted discharge antimicrobial stewardship initiative by comparing proportion of appropriate antimicrobial regimens before and after implementation.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Non-teaching, urban, community medical center.</p><p><strong>Patients: </strong>Adult patients prescribed an oral antimicrobial regimen at discharge were included. Patients were randomized irrespective of encounter type or discharge disposition. Pregnant and post-partum patients were excluded.</p><p><strong>Methods: </strong>A discharge antimicrobial stewardship program was implemented at our facility. Components of the initiative included development of a comprehensive, institution-specific, inpatient and outpatient prescribing guideline, extensive face-to-face clinician education, and real-time, pharmacist prospective audit and feedback at discharge. The validated National Antimicrobial Prescribing Survey tool was used to then categorize one hundred randomized discharge antimicrobial prescriptions as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness.</p><p><strong>Results: </strong>One hundred antimicrobial regimens selected via random sampling were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs 62%, <i>P</i> = .03).</p><p><strong>Conclusions: </strong>Study results highlight the positive impact of a multidisciplinary, multipronged approach in improving discharge antimicrobial prescribing.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e76"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665464","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":"Systematic screening of infection prevention policies for equity impacts.","authors":"Caitlin L McGrath, Yasaman Fatemi, Thérèse Mirisola, Tanya Ferreira, Adrienne D'Alo, Victoria J L Konold, Alicia Tieder, Ashley Stratton, Matthew P Kronman, Danielle M Zerr","doi":"10.1017/ash.2025.16","DOIUrl":"10.1017/ash.2025.16","url":null,"abstract":"<p><p>We reviewed infection prevention policies using an adapted Equity Impact Assessment tool. Thirty-one percent of policies had substantial potential to impact marginalized groups and create or sustain inequities, and most lacked existing equity considerations. Systematic policy review for equity implications can result in actions to improve care and quality.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e77"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665570","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":"Comparative effectiveness of metronidazole and vancomycin for treatment of <i>Clostridioides difficile</i> infection in hospitalized children.","authors":"Thomas J Sandora, Timothy J Savage, Morgan E Ryan, Suzanne E Dahlberg, Kaitlyn Daugherty, Ciarán P Kelly, Nira R Pollock, Larry K Kociolek","doi":"10.1017/ash.2025.51","DOIUrl":"10.1017/ash.2025.51","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of clinical response in children with <i>Clostridioides difficile</i> infection (CDI) treated with metronidazole vs vancomycin.</p><p><strong>Design: </strong>Retrospective cohort study was performed as a secondary analysis of a previously established prospective cohort of hospitalized children with CDI. For 187 participants 2-17 years of age who were treated with metronidazole and/or vancomycin, the primary outcome of clinical response (defined as resolution of diarrhea within 5 days of treatment initiation) was identified retrospectively. Baseline variables associated with the primary outcome were included in a logistic regression propensity score model estimating the likelihood of receiving metronidazole vs vancomycin. Logistic regression using inverse probability of treatment weighting (IPTW) was used to estimate the effect of treatment on clinical response.</p><p><strong>Results: </strong>One hundred seven subjects received metronidazole and 80 subjects received vancomycin as primary treatment. There was no univariable association between treatment group and clinical response; 78.30% (N = 83) of the metronidazole treatment group and 78.75% (N = 63) of the vancomycin group achieved clinical response (<i>P</i> = 0.941). After adjustment using propensity scores with IPTW, the odds of a clinical response for participants who received metronidazole was 0.554 (95% CI: 0.272, 1.131) times the odds of those who received vancomycin (<i>P</i> = 0.105).</p><p><strong>Conclusions: </strong>In this observational cohort study of pediatric inpatients with CDI, the rate of resolution of diarrhea after 5 days of treatment did not differ among children who received metronidazole vs vancomycin.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e74"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665467","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":"Erratum: Investigation of the first cluster of Candida auris cases among pediatric patients in the United States-Nevada, May 2022 - CORRIGENDUM.","authors":"","doi":"10.1017/ash.2025.60","DOIUrl":"https://doi.org/10.1017/ash.2025.60","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1017/ash.2023.400.].</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e75"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665475","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":"Environmental hygiene strategies to combat antimicrobial resistance in healthcare settings.","authors":"Mary Morgan Lee, Caroline A O'Neil, Lucy Vogt, Jennie H Kwon","doi":"10.1017/ash.2025.33","DOIUrl":"10.1017/ash.2025.33","url":null,"abstract":"<p><p>In this manuscript, we highlight current literature on environmental hygiene techniques to combat reservoirs of antibiotic resistant organisms in the healthcare environment. We discuss several topics for each strategy, including mechanism of action, assessment of effectiveness based on studies, cost, and real-world translatability. The techniques and topics summarized here are not inclusive of all available environmental hygiene techniques but highlight some of the more popular and investigated strategies. We focus on the following: Ultraviolet radiation, hydrogen peroxide vapor, copper-coated surfaces, phages, interventions involving sinks, and educational initiatives.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e71"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665470","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}