Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Antibiotic stewardship in hospital outpatient departments: a qualitative study of alignment with existing guidance.","authors":"Salome O Chitavi, Whitney R Buckel, Michael Kohut, Barbara Braun, Rachel Zetts, David Hyun","doi":"10.1017/ash.2026.10417","DOIUrl":"10.1017/ash.2026.10417","url":null,"abstract":"<p><strong>Objective: </strong>This study examined antibiotic stewardship in hospital outpatient departments (HOPDs) and alignment with CDC Core Elements for outpatient settings. It also explored challenges that The Joint Commission accredited hospitals face when implementing hospital-based interventions in outpatient settings.</p><p><strong>Design: </strong>Qualitative study using in-depth interviews.</p><p><strong>Setting: </strong>HOPDs included hospital-affiliated primary care, urgent care, emergency departments, specialty care, surgical centers, wound care, and dental clinics.</p><p><strong>Participants: </strong>Respondents included Antibiotic Stewardship Program (ASP) lead pharmacists and physicians with and without infectious disease specialization, clinical pharmacists, and accreditation coordinators.</p><p><strong>Methods: </strong>We conducted in-depth interviews with ASP leaders from a cross-section of hospitals of varied size and system membership. We used MAXQDA 2022 (VERBI Software, 2021) and the Framework Method to organize and analyze interview transcripts.</p><p><strong>Results: </strong>We interviewed 42 ASP leaders from 28 hospitals. Findings show that ASPs encountered financial constraints in expanding stewardship into HOPDs. Few hospitals had dedicated leaders or extra staffing for outpatient stewardship. Many hospitals did not have outpatient clinics represented on their ASP committee. Although most hospitals had treatment guidelines, tracked antibiotic use, and provided education for HOPDs, these often focused on inpatient priorities. Challenges in implementing hospital-based interventions in HOPDs included staffing limitations, clinical and operational differences between settings, interpreting requirements, and electronic health record and information technology limitations.</p><p><strong>Conclusion: </strong>Our research suggests that improving antibiotic stewardship within HOPDs necessitates recognizing the unique attributes of these settings, identification of specific resource requirements, and development of tailored strategies, rather than employing inpatient approaches.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e167"},"PeriodicalIF":0.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201321","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 potential effectiveness of far-UVC (222 nm) in preventing infections in long-term care facilities: a six-month nonrandomized controlled phase II trial.","authors":"Mette Assenholm Kristensen, Emilie Hage Mogensen, Stine Yde Nielsen, Christian Kanstrup Holm","doi":"10.1017/ash.2026.10425","DOIUrl":"10.1017/ash.2026.10425","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this study were to assess the potential effectiveness of far-UVC (222 nm) in reducing hospital-treated infections, antibiotic prescriptions, and mortality in long-term care facilities (LTCFs), as well as to evaluate the rationale for a future randomized controlled trial (RCT).</p><p><strong>Design: </strong>A six-month, nonrandomized, controlled, three-arm Phase II trial was conducted in LTCFs in Denmark. Facilities were allocated in a 10:1:1 ratio to usual care, far-UVC in common rooms, and far-UVC in common and residents' rooms. The trial was conducted between November 2024 and April 2025. The primary outcome was LTCF-acquired infections treated in hospitals.</p><p><strong>Results: </strong>The study included 12 LTCFs with a total of 635 residents. In the usual care group (n = 470), 600 hospital-treated infections were identified with a incidence rate (IR) of 86.2 per 10,000 resident-days. In the common rooms group (n = 76), 12 infections were identified with a IR of 10.4 per 10,000 resident-days and an adjusted incidence rate ratio (aIRR) of 0.12 (95% CI: 0.04-0.34). In the common and residents' rooms group (n = 89), 78 infections were identified with a IR of 59.1 per 10,000 resident-days and an aIRR of 0.69 (95% CI: 0.23-2.07). The aIRR for total antibiotic prescriptions was 0.52 (95% CI: 0.29-0.96) in the group with lamps in common rooms and 0.83 (95% CI: 0.50-1.37) in the group with lamps in common and residents' rooms.</p><p><strong>Conclusions: </strong>Far-UVC potentially reduces hospital-treated infections and antibiotic prescriptions in LTCFs, but these results should be considered preliminary until confirmed by an RCT.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e165"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201173","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":"Exploring opportunities to improve health equity with machine learning and artificial intelligence in healthcare epidemiology.","authors":"Umang Joshi, Cristina Lanzas","doi":"10.1017/ash.2026.10747","DOIUrl":"10.1017/ash.2026.10747","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) have the potential to improve diagnostic accuracy, infection control protocols, and health outcomes at the population level. AI/ML also has the potential to exacerbate existing health disparities, underscoring the necessity of developing, testing, and evaluating models with equity-centered frameworks. In this review, we highlight current work and future directions in implementing AI/ML to improve health equity in healthcare epidemiology. AI/ML models can improve the quality of data collected in electronic health records, especially with regard to race and ethnicity, aid in identifying vulnerable populations via classification modeling, and help guide equitable intervention protocols by identifying disparities through predictive modeling. However, data-, algorithm-, and deployment-centric biases must be considered at every step of model synthesis, utilizing fairness metrics to assess the presence of bias and employing ideal mitigation strategies to create equitable AI/ML models for healthcare epidemiology.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e166"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201342","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 changing landscape of outpatient antibiotic prescriptions among advanced practice clinicians in the United States, 2011 and 2022.","authors":"Mohsin Ali, Guillermo V Sanchez, Katryna A Gouin, Emily McDonald, Adam L Hersh, Sarah Kabbani","doi":"10.1017/ash.2026.10346","DOIUrl":"10.1017/ash.2026.10346","url":null,"abstract":"<p><strong>Objective: </strong>Estimate changes in antibiotic prescribing among advanced practice clinicians (APCs)-nurse practitioners (NPs) and physician assistants (PAs)-compared to physicians in 2022 versus 2011 to inform antibiotic stewardship efforts.</p><p><strong>Methods: </strong>Retrospective descriptive analysis of antibiotic prescription rates for 2011 and 2022 using county-level prescription dispensing data by provider type from IQVIA Xponent® (numerator) and population census estimates (denominator). Prescribing rates among physicians and APCs (NPs and PAs) nationally, by state, and by rurality of county are reported.</p><p><strong>Result: </strong>Overall outpatient antibiotic prescribing rates in 2022 declined by 19.2% compared to 2011, from 877 to 709 prescriptions per 1000 population. The physician rate declined by 45% (628 to 345 per 1000 population), whereas the rate for APCs rose by 104% (124 to 253 per 1000 population), particularly for NPs (148% increase from 65 to 161 per 1000 population). The increase in NP prescribing rates was distinctly higher in seven contiguous Southeastern states (163 to 393 per 1000 population from 2011 to 2022, respectively), where rates were higher within rural counties (range, 385 to 651 per 1000 population by state in 2022).</p><p><strong>Conclusion: </strong>APCs accounted for 1 in 3 outpatient antibiotic prescriptions in 2022, more than doubling their rate per capita over the past decade. This increase was especially prominent for NPs, particularly within the Southeast region, likely reflecting their growing role as rural primary care clinicians. Integration of APCs for outpatient antibiotic stewardship efforts is essential.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e162"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159193","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":"Why we do what we do: a survey of ID providers about oral antibiotics.","authors":"Mildred Nelson, Marisa Winkler, Sujit Suchindran, Lucy Sabrin Witt","doi":"10.1017/ash.2026.10421","DOIUrl":"10.1017/ash.2026.10421","url":null,"abstract":"<p><p>We surveyed infectious disease providers to examine beliefs and practices around oral antibiotic use. Provider demographics did not predict beliefs or practices. Certain clinical scenarios were more likely to achieve consensus for oral prescribing. Understanding beliefs and practice patterns can help stewardship teams craft interventions to increase oral antibiotic use.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e159"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159201","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":"Evaluation of antimicrobial orders with expanded indication for use.","authors":"Michael Carlone, Jill Wesolowski, Samantha Loutzenheiser, Chanda Mullen, Steven Gordon, Thomas Fraser, Andrea M Pallotta","doi":"10.1017/ash.2026.10403","DOIUrl":"10.1017/ash.2026.10403","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of requiring infectious source selection on systemic antimicrobial orders for stewardship tracking.</p><p><strong>Design and setting: </strong>Multicenter, health system quality improvement project across 17 hospitals and 21 emergency departments.</p><p><strong>Methods: </strong>All inpatient and ED antimicrobial orders with an indication between September 1 and September 30, 2024 were analyzed. Primary outcome: Prevalence of selected infectious sources. Secondary outcomes: indication frequency, free-text use, and concordance between selected and documented sources in 500 random orders.</p><p><strong>Results: </strong>Among 57,118 orders, empiric indication was most common (71%). Top sources: respiratory (23%), urinary/renal (19%), skin/soft tissue (16%). Concordance was 95%. Free-text entries (2.6%) often matched existing options; dental/oral emerged as a new category.</p><p><strong>Conclusion: </strong>Infectious source selection was evaluated and supports future targeted stewardship interventions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e156"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159255","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":"Stewardship in your pocket: launching Colorado's free antimicrobial mobile application.","authors":"Joana Dimo, Sarah K Parker, Matthew J Weber, Matthew A Miller, Kira E Frappa, Christine E MacBrayne, Katherine C Shihadeh, Margeret M Cooper, Lauren R Biehle, Timothy C Jenkins, Michael J Bozzella, Leigh Anne Bakel","doi":"10.1017/ash.2026.10418","DOIUrl":"10.1017/ash.2026.10418","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to describe the development and implementation of Firstline (www.Firstline.org), a mobile antimicrobial stewardship (ASP) application (app) created to address barriers to robust ASP in Colorado hospitals.</p><p><strong>Design: </strong>A mixed-methods pragmatic implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from October 2023-December 2025.</p><p><strong>Methods: </strong>ASP teams at Children's Hospital Colorado and Denver Health partnered with Firstline to develop the app using locally curated content. The app launched in October 2023 with a multifaceted dissemination campaign. Reach was assessed using geocoded user data. Effectiveness and adoption were evaluated using cross-sectional surveys at two time points. Implementation was characterized by analyzing utilization patterns. Maintenance was assessed by tracking monthly active users over two years.</p><p><strong>Results: </strong>Within the first year, 4,409 unique Colorado users downloaded the app, representing 15% of state clinicians (19% in Denver Metro; 5-17% in rural regions). Survey respondents (n = 215) reported high satisfaction: 63.9% and 72.9% found the app very easy to use, 71.3% and 83.2% reported enhanced antibiotic selection knowledge, and 100% advocated for ongoing support. Among respondents, 10% reported their facilities had formally adopted Firstline guidelines. The most frequently accessed content included common, high-impact infections. Monthly active users remained stable (average 871) over two years.</p><p><strong>Conclusions: </strong>We demonstrated use of Firstline across Colorado, with increasing engagement in rural areas. High user satisfaction, sustained engagement, and emerging institutional adoption suggest this \"stewardship in your pocket\" model offers a unique, scalable approach to extending ASP support beyond academic medical centers.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e158"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159265","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":"Azithromycin and doxycycline intravenous and oral administrations before and after prescriber-facing alert for intravenous fluid conservation.","authors":"Jennifer Dela-Pena, Jill Wesolowski, Gretchen Sacha, Andrea M Pallotta","doi":"10.1017/ash.2026.10411","DOIUrl":"10.1017/ash.2026.10411","url":null,"abstract":"<p><strong>Objective: </strong>Intravenous (IV) to oral (PO) antimicrobial stewardship initiatives can be implemented by various healthcare providers in conjunction with clinical decision support tools. Our study evaluated the impact of a prescriber-facing IV to PO alert on azithromycin and doxycycline prescribing, acquisition cost, and waste generated.</p><p><strong>Methods: </strong>Our institution implemented an IV to PO alert at order entry for IV azithromycin and IV doxycycline with alternative dosage forms included. All emergency department and inpatient IV and PO azithromycin and doxycycline administrations were included during May 12, 2024 - September 28, 2024 (pre-group) and October 13, 2024 - March 1, 2025 (postgroup). The primary outcome was the change in PO azithromycin and doxycycline administrations over time. Secondary outcomes included cost savings and waste generated.</p><p><strong>Results: </strong>A total of 25,529 azithromycin (56% IV, 43% PO) and 40,584 doxycycline (27% IV, 73% PO) administrations were included in the pre-group. The postgroup included 32,505 azithromycin (22% IV, 78% PO) and 44,601 doxycycline (12% IV, 88% PO) administrations. An increase of almost 38.9% (95% CI 34.9 to 43.0%) in the proportion of PO azithromycin and 17% (95% CI 14.4 to 19.6%) in the proportion of PO doxycycline was observed immediately after alert implementation. Azithromycin and doxycycline total waste decreased by 270.3 and 230.6 kg, respectively. Monthly savings of USD 28,739.48 were calculated for azithromycin and USD 46,637.87 for doxycycline.</p><p><strong>Conclusion: </strong>A prescriber-facing IV to PO alert led to increase PO administrations of azithromycin and doxycycline with reduction in cost and waste generated.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e163"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159257","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":"Diagnosis of histoplasmosis by next-generation sequencing of microbial cell-free DNA in Texas.","authors":"Fernando H Centeno, Todd Lasco, Mayar Al Mohajer","doi":"10.1017/ash.2026.10429","DOIUrl":"10.1017/ash.2026.10429","url":null,"abstract":"<p><p>We examine the impact of microbial cell-free DNA (mcfDNA) NGS for the diagnosis of Histoplasma capsulatuim in a quaternary referral center in Texas. Of eight included patients, five had a change in their antifungal coverage after mcfDNA NGS results with faster turnaround times than antigen testing and cultures.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e164"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159186","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 microbial cell-free DNA sequencing in the diagnosis of mycobacterial infections in a quaternary care center by Centeno et al.","authors":"Frederick S Nolte","doi":"10.1017/ash.2025.10209","DOIUrl":"10.1017/ash.2025.10209","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e161"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159198","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}