Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Impact of methicillin-resistant <i>Staphylococcus aureus</i> surveillance and decolonization in the NICU: the Texas children's hospital experience.","authors":"Nahid Hiermandi, Catherine Foster, Judith Campbell, Krystal Purnell, Elizabeth Tocco, Tjin Koy, Kenneth Nobleza, Duc Nguyen, Lucila Marquez","doi":"10.1017/ash.2025.45","DOIUrl":"https://doi.org/10.1017/ash.2025.45","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of screening and decolonization on methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infection in a neonatal intensive care unit.</p><p><strong>Study design: </strong>This is a single-center retrospective cohort study comparing patient characteristics among MRSA-colonized and MRSA-infected infants, rates of MRSA infection before and after screening with targeted decolonization, and MRSA infection among those receiving single or combined decolonization agents.</p><p><strong>Setting: </strong>Texas Children's Hospital Pavilion for Women is a 42-bed level three neonatal intensive care units (NICU) in Houston, TX.</p><p><strong>Patients: </strong>Neonates admitted to the NICU from 2012 to 2022 were included in analysis of MRSA colonization and infection. The gestational age ranged from 22 weeks to 42 weeks.</p><p><strong>Interventions: </strong>The MRSA screening methodology consisted of weekly surveillance PCR or culture on admission until discharge. If positive, infants underwent decolonization consisting of topical intranasal mupirocin, and if meeting the gestational and chronological age-based criteria, topical 2% chlorhexidine wipes and topical intranasal mupirocin.</p><p><strong>Results: </strong>The MRSA colonization rate from 2016 to 2022 was 2.2%. Following the screening and decolonization protocol initiated in 2016, there was a sustained downtrend in the rate of MRSA infection. No MRSA-colonized neonates who received both topical mupirocin and Chlorhexidine gluconate (CHG) developed MRSA infection.</p><p><strong>Conclusions: </strong>We observed a decreased rate of MRSA infection in the NICU following implementation of an MRSA screening and decolonization protocol. While our data suggests that the combination of mupirocin and CHG might prevent infection, further studies are needed due to the low prevalence of MRSA infection in our cohort.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e60"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544656","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":"Penicillin allergy delabeling in long-term care facilities: if not now, then when?","authors":"Kap Sum Foong, Shira Doron, Alysse Wurcel","doi":"10.1017/ash.2025.30","DOIUrl":"https://doi.org/10.1017/ash.2025.30","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e61"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544666","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":"<i>Clostridioides difficile</i> surveillance: 9-year comparison between automated surveillance and conventional surveillance in acute care hospitals.","authors":"Jean Stanciu, Patrick Dolcé, Charles Frenette, Marie-Claude Roy, Lina Kouider, Yves Longtin","doi":"10.1017/ash.2025.5","DOIUrl":"https://doi.org/10.1017/ash.2025.5","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate an automated surveillance system for healthcare-associated <i>Clostridioides difficile</i> infections (HA-CDI).</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Setting: </strong>16 acute care hospitals.</p><p><strong>Patients: </strong>Patients admitted to participating hospitals between 2013 and 2022.</p><p><strong>Methods: </strong>An automated surveillance system was developed with retrospective extraction from admission/discharge/transfer and laboratory databases and compared with conventional surveillance based on clinical definitions collected prospectively by infection control professionals. Comparison of HA-CDI incidence rates calculated by automated vs conventional surveillances were performed with χ², incidence rate ratios, and linear regression. A subset of discordant cases was further investigated by reviewing medical records.</p><p><strong>Results: </strong>Overall, conventional surveillance reported 3,211 cases of HA-CDI for an incidence rate of 4.94 per 10,000 patient-days. Automated surveillance detected 4,708 cases, for an incidence rate of 7.24 per 10,000 patient-days (incidence rate ratio, 1.47; 95% CI, 1.40-1.53). Full concordance between both surveillance methods was observed in 62% of cases, while 34% of cases were detected only by automated surveillance, and 4% were detected by conventional surveillance only. Between 2013 and 2022, an identical declining trend in HA-CDI incidence rates of -0.54 cases per 10,000 patient-days was observed with both surveillance methods. A subset of 49 cases detected only by automated surveillance were reviewed; the main reasons for discrepancy were delayed testing (39%), colonization (24%), misclassifications (14%), and interinstitutional transfers (12%).</p><p><strong>Conclusions: </strong>HA-CDI incidence rates calculated by automated surveillance were higher than those of conventional surveillance, but the overestimation was consistent over time, suggesting that a correction factor could improve precision.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e63"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544719","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":"Women in ASHE.","authors":"Louise-Marie Dembry","doi":"10.1017/ash.2025.34","DOIUrl":"https://doi.org/10.1017/ash.2025.34","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e58"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544828","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":"A review of implementation aspects and sustainability in the prevention of hospital onset bacteremia.","authors":"Robert Garcia, Edward J Septimus, Jack LeDonne, Lisa K Sturm, Nancy Moureau, Michelle DeVries, Barbara DeBaun","doi":"10.1017/ash.2025.1","DOIUrl":"https://doi.org/10.1017/ash.2025.1","url":null,"abstract":"<p><p>The emerging perspectives and implementation aspects presented in this review article outline infection prevention core components supported by recent research relevant to the mitigation of Hospital Onset Bacteremia and Fungemia in a surveillance setting that includes expanded efforts to all vascular access devices.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e62"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544722","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":"Examining the impact of treatment guidelines on outpatient antibiotic prescription trends at a cancer center in Pakistan.","authors":"Salma Abbas, Seemal Aslam, Sara Batool, Mahnoor Zafar, Sadia Khaliq, Momal Fatima, Iraj Shehzad, Muhammad Arslan, Iqra Attiq, Muhammad Shehbaz, Anum Khan, Muhammad Ali Raza, Hamza Zulfiqar, Ahsan Mahmood, Faisal Sultan","doi":"10.1017/ash.2025.2","DOIUrl":"https://doi.org/10.1017/ash.2025.2","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of treatment guidelines on the trends of outpatient antibiotic prescription among pediatric and adult patients at a cancer center in Pakistan.</p><p><strong>Design: </strong>Retrospective observational study conducted between July 1^st 2018 and July 31^st 2023.</p><p><strong>Methods: </strong>We determined the indication for antibiotics and the frequency of guideline-discordant prescriptions for upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), urinary tract infection (UTI), and diarrhea. The χ² test was used to assess the impact of treatment guidelines on antibiotics prescribed for these indications.</p><p><strong>Results: </strong>The top indications for antibiotic prescription were skin and skin structure infection (SSSI) (n = 5159; 21.5%), URTI (n = 2760; 11.5%) and UTI (n = 2686; 11.2%). Amoxicillin-clavulanate (n = 7964; 33.3%), was the most frequently prescribed antibiotic. A large proportion of antibiotic prescriptions for URTI, diarrhea, UTI, and LRTI were either inappropriate (n = 6695; 86.5%) or unnecessary (n = 5534; 71.5%). Results revealed a statistically significant decline in the proportion of inappropriate antibiotics for UTI (91.3% vs 84.0%; <i>P</i> ≤ .001) and diarrhea (92.6% vs 87.0%; <i>P</i> = .031) and unnecessary antibiotics for diarrhea (90.2% vs 83.2%; <i>P</i> = .016) with the introduction of treatment guidelines. We noted a higher proportion of unnecessary prescriptions for LRTI (41.7% vs 31.7%; <i>P</i> = .003) and inappropriate antibiotics for UTI (95.1% vs 87.4%; <i>P</i> = .011) for pediatric patients.</p><p><strong>Conclusion: </strong>Misuse of outpatient antibiotics is common. Diarrhea, URTI, UTI, and LRTI are high-priority conditions for outpatient oncology-focused prescriber education and stewardship interventions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e51"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544739","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":"An inpatient antimicrobial stewardship team driven penicillin allergy delabeling protocol for minimal and low-risk penicillin allergic patients.","authors":"Shivanjali Shankaran, Emily Adochio, Robert Petrak, Benjamin Goldenberg, Fischer Herald, Christy Lunn, Hayley Hodgson, Sarah Won","doi":"10.1017/ash.2025.7","DOIUrl":"https://doi.org/10.1017/ash.2025.7","url":null,"abstract":"<p><p>Inappropriate penicillin allergy labeling results in suboptimal or excessive broad spectrum antibiotic use. In this multidisciplinary project, the antimicrobial stewardship team safely delabeled 71.4% of hospitalized patients approached. Similar programs may also be able to delabel minimal or low-risk penicillin allergic patients without formal allergy consultation.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e54"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544725","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":"Stewarding the inappropriate diagnosis and treatment of urinary tract infection: leveraging the urinalysis to understand true antibiotic overuse.","authors":"Whitney Hartlage, Alyssa Y Castillo, Zahra Kassamali Escobar, Maria Bajenov, Natalia Martinez-Paz, John B Lynch, Chloe Bryson-Cahn, Jeannie D Chan","doi":"10.1017/ash.2025.26","DOIUrl":"https://doi.org/10.1017/ash.2025.26","url":null,"abstract":"<p><p>We evaluated 249 asymptomatic patients receiving antibiotics for urinary infection: 222 had asymptomatic pyuria and/or nitrituria (ASPN) and 133 had asymptomatic bacteriuria (ASB, growth ≥10⁵ colony forming units/ml). ASPN identified 40% more cases of unnecessary antibiotics compared to ASB and may be a more comprehensive measure of unnecessary antibiotic use.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e49"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544718","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":"Stewarding beyond the 9-5: Implementation of overnight review of rapid blood culture identification panel results by intensive care unit pharmacists.","authors":"Sarah M Arduser Sindelar, Jonathan H Ryder, Jeremy Tigh, Theodore Blum, Jessica Prucha, Paul Fey, Scott J Bergman, Trevor C Van Schooneveld, Shawnalyn W Sunagawa","doi":"10.1017/ash.2025.28","DOIUrl":"https://doi.org/10.1017/ash.2025.28","url":null,"abstract":"<p><p>Rapid blood culture identification is most effective with antimicrobial stewardship feedback, which is limited during non-business hours. We implemented overnight review of Blood Culture Identification 2 panel results by intensive care unit pharmacists and demonstrated reduced time to evaluation (3.6 vs 9.3 hours, <i>P</i> < .01).</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e52"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544716","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":"Curbing inappropriate <i>C. difficile</i> treatment in patients receiving concomitant laxatives.","authors":"Paige Fields, Christopher David, Anish Choksi, Natasha N Pettit, Alison K Lew, Jennifer Pisano, Cynthia T Nguyen","doi":"10.1017/ash.2025.25","DOIUrl":"https://doi.org/10.1017/ash.2025.25","url":null,"abstract":"<p><p>In the setting of universal <i>Clostridioides difficile</i> screening, we implemented an alert that triggered when <i>C. difficile</i> treatment was ordered in patients who recently received laxatives. This resulted in <i>C. difficile</i> treatment avoidance in 37% of patients and was associated with drug cost savings of $143,905 over a 10-month period.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e50"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544732","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}