Antimicrobial Resistance and Infection Control最新文献

{"title":"Carbapenem-resistant Enterobacterales in Europe: strengthening AMR resilience through coordinated system-level action - lessons from Ukraine.","authors":"Luise Martin, Arina Zanuzdana, Martin Weber, Nataliia Aliieva, Liliia Mykhajliv, Maryana Svirchuk, Mariia Boiko, Artem Horbachevskyi, Hailie Uren, Brar Christian Piening, Beate Kampmann, Tim Eckmanns, Joachim Seybold, Miriam Songa Stegemann","doi":"10.1186/s13756-026-01834-4","DOIUrl":"10.1186/s13756-026-01834-4","url":null,"abstract":"<p><p>Carbapenem-resistant Enterobacterales (CRE) have emerged as one of the most serious antimicrobial resistance (AMR) threats in Europe. Rising incidence, substantial mortality, and marked heterogeneity across the EU/EEA pose a growing challenge. In Ukraine, an already substantial AMR burden and pre-existing limitations in diagnostic and infection prevention capacity, infectious diseases and antimicrobial stewardship (AMS) expertise, workforce resources, and access to effective antimicrobials have been further exacerbated by the war, including through damage to healthcare infrastructure and disruption of supply chains. These conditions facilitate the emergence and spread of CRE. As patient movement across Europe continues, CRE in Ukraine has become a shared European health security challenge. Although numerous national and international initiatives support AMR control in Ukraine, their impact is limited by fragmented implementation, insufficient coordination, and limited visibility across stakeholders. Drawing on hospital partnerships, multidisciplinary expert discussions, and emerging national coordination efforts in Ukraine, we argue that sustainable CRE control requires an integrated, system-level framework combining strengthened microbiological diagnostics and surveillance, infection prevention and control, infectious diseases and AMS expertise, and equitable access to effective antimicrobials. These components should be embedded within a coordinated national framework that aligns international support with national priorities. We describe the recently established, Ukrainian-led Public Health Center of the Ministry of Health of Ukraine (PHC) AMR Coordination Working Group as an emerging example, combining regular technical engagement, structured stakeholder collaboration, and plans to map international AMR-related activities in Ukraine. This approach may inform future European efforts to organise international AMR support in other high-burden and crisis-affected settings.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended spectrum beta-lactamase Klebsiella pneumoniae (ESBL-KP) bloodstream infection outbreak in a Neonatal Intensive Care Unit (NICU) in Bangui, Central African Republic (CAR).","authors":"Agnese Comelli, Maurice Ebode Ela, Innocent Baluhe Muke, Elisée Danwesse, Siridion Manirarora, Synthia Ningatoloum Nazita, Jean Marie Mafuko, Abdon Isango, Gracia Yasselet, Gael Ndrouma, Bienfait Tombola, Baimi Tao Vaizi, Oluwakemi F Ogundipe, Abdoulaye Sepou, Richard Norbert Ngbalé, Fabiola Gordillo Gomez, Chiara Martino, Anna Farra, Mohamad Khalife, Pilar Garcia-Vello","doi":"10.1186/s13756-026-01784-x","DOIUrl":"10.1186/s13756-026-01784-x","url":null,"abstract":"<p><strong>Background: </strong>Multidrug-resistant organism (MDRO) outbreaks in NICUs cause high mortality and strain hospital resources globally, particularly in low-income countries (LICs). In Central African Republic (CAR), limited data on antimicrobial resistance indicate high rates of MDRO. We describe an outbreak of Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae (ESBL-KP) in a Ministry of Health (MoH) hospital NICU in Bangui, supported by Médecins Sans Frontières (MSF).</p><p><strong>Methods: </strong>This retrospective case-control study was conducted at the Centre Hospitalier Universitaire Communautaire-MSF project of Bangui. The study included all neonates admitted to the NICU from 25/10/2023, the admission date of the first confirmed case, to 14/01/2024, the discharge date of the last case. Cases were defined as laboratory-confirmed ESBL-KP bloodstream infections (BSI) with similar resistance profiles, differing by no more than three antibiotic classes based on phenotypic testing. Line lists and routinely encoded data were used, and variables were tested to identify significant exposures. Data on outbreak management, infection prevention and control (IPC) interventions and human resources (HR) management were collected.</p><p><strong>Results: </strong>A total of 242 neonates were admitted during the outbreak period: 44 cases and 153 controls. The incidence rate of ESBL-KP BSI was 29.7 per 1000 patient-days. Mortality among cases was 3.5 times higher (p < 0.0001). Twenty-five cases (56.8%) had early sepsis (sepsis suspected < = 3 days of hospitalisation). Case-control analysis identified maternal risk factors for neonatal infection as the most important independent risk factor. The neonatology unit occupancy rate exceeded 100% in early October, and IPC assessments revealed poor adherence to IPC measures at the beginning of the outbreak. A series of IPC interventions in the first month of the outbreak successfully controlled further spread of the infection, and the outbreak was declared over in approximately two months.</p><p><strong>Conclusion: </strong>The ESBL-KP NICU outbreak reveals gaps in hospital management, with ESBL-KP probably spreading due to high occupancy rate, poor IPC standards, and possibly by multiple simultaneous sources. Access to microbiology and the implementation of IPC practical interventions are critical to identifying and managing outbreaks in LIC.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of antibiotic-resistant bacteria integrating whole genome sequencing and epidemiological information - a global, systematic review, 2012-2023.","authors":"Felix Reichert, Mark Perry, Mirco Sandfort, Sebastian Haller, Dunja Said, Tim Eckmanns, Kevin McDermott, Caro Noake, Robert Wolff, Jörg B Hans","doi":"10.1186/s13756-026-01821-9","DOIUrl":"10.1186/s13756-026-01821-9","url":null,"abstract":"<p><strong>Background: </strong>Epidemiologic surveillance is one pillar in the global efforts to stop the spread of antibiotic-resistant bacteria (ARB) and increasingly includes whole genome sequencing (WGS). However, no review systematically examined the characteristics of such surveillance systems until February 2025. We conducted a systematic review to identify and describe routine surveillance systems of ARB, that integrate WGS and epidemiological information.</p><p><strong>Methods: </strong>A protocol was developed and published on PROSPERO. We searched 8 databases and Google. Included articles needed to report on a national or subnational surveillance system and include epidemiological data as well as WGS of carbapenem-resistant or carbapenemase-producing Enterobacterales (CRE) or Acinetobacter spp., methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococci (VRE). Surveillance system characteristics were analysed narratively.</p><p><strong>Results: </strong>From 13,142 searched articles, 41 were included. The publications were stratified by pathogen. The strata demonstrated similar WGS approaches with a predominance of short-read sequencing platforms. Typing methods mostly included multilocus sequence typing and single nucleotide polymorphism -based analyses for higher discrimination. Reported cluster thresholds showed a wide range of values within and between species. Across strata, there was often a low level of epidemiological data collection, such as exposure of cases, and integration in cluster analyses. WGS surveillance complemented with at least basic epidemiological data has been reported from all six WHO regions for CRE. However, fewer studies and no studies at all for MRSA and VRE were included from the African, Eastern Mediterranean and South-East Asian regions. The national coverage of surveillance ranged from 36% for MRSA to 56% for CRE.</p><p><strong>Conclusion: </strong>WGS-based surveillance on ARB is employed worldwide with predominant use of short-read technology and largely consistent typing methods. Substantial variation in genomic clustering thresholds underscores the need for internationally harmonized standards for data analysis. Insufficient epidemiological information or lacking integration in the analysis of WGS data may reduce the ability to infer transmission pathways and identify outbreaks. To fully exploit the potential of WGS-based surveillance systems in this context for public health and contain current and prevent future outbreaks, we thus call for a routine collection of detailed epidemiological data.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Import of antibiotics by air travellers - an observational study at airports in Sweden and Norway.","authors":"Cecilia Lenander, Amelie Persson, Hajer Al Hassani, Katarina Hedin, Sigurd Høye, Siri Jensen, Pär-Daniel Sundvall, Sofia Sundvall, Anna Moberg","doi":"10.1186/s13756-026-01816-6","DOIUrl":"10.1186/s13756-026-01816-6","url":null,"abstract":"<p><strong>Background: </strong>Overuse and misuse of antibiotics are two of the main drivers of antimicrobial resistance (AMR). In some countries antibiotics can be purchased over the counter, whereas in Scandinavia and most of Europe, antibiotics require a prescription. It is permitted to bring medicines for personal use to Scandinavia. This raises concerns about whether antibiotics are being imported into low-prescribing countries, such as Scandinavia, via international airports. We aimed to investigate the quantity and types of antibiotics imported by air travellers entering Norway and Sweden, based on routine customs inspections at international airports.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted during daytime over five weekdays at three international airports in Sweden and Norway. Anonymous data including the presence, type, and quantity of antibiotics, were registered alongside routine customs inspections. Defined daily doses (DDDs) were calculated for oral antibiotics. Substances were categorised according to the World Health Organization's (WHO) AWaRe classification (Access, Watch and Reserve).</p><p><strong>Results: </strong>Out of around 137,500 travellers arriving from abroad, 406 (0.30%) were inspected at routine customs inspections, of whom 57 (14%) carried antibiotics, corresponding to 643 DDDs. Inspected travellers from outside the EEA more often carried antibiotics than those within EEA (p < 0.001). More than one-third of the antibiotics were classified as 'Watch' according to the AWaRe classification.</p><p><strong>Conclusion: </strong>We found that 14% of inspected international air travellers carried antibiotics. These antibiotics may be used without medical guidance, raising health risks and the risk of AMR. The findings highlight a potential need for public education and/or strengthened regulatory measures.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential of plasma metagenomic next-generation sequencing to guide antibiotic therapy in acute necrotizing pancreatitis with early fever: a prospective multicenter cohort study.","authors":"Xiaoyue Hong, Dingcheng Shen, Chiayen Lin, Xintong Cao, Zefang Sun, Baiqi Liu, Rong Guo, Zhiyong Liu, Tao Luo, Yi Yu, Ming Yang, Bin Feng, Wenqian Zhang, Gengwen Huang","doi":"10.1186/s13756-026-01822-8","DOIUrl":"10.1186/s13756-026-01822-8","url":null,"abstract":"<p><strong>Background: </strong>Indiscriminate antibiotic use remains common in febrile patients with acute necrotizing pancreatitis (ANP), particularly during the early phase. Metagenomic next‑generation sequencing (mNGS) has shown diagnostic utility for infected pancreatic necrosis (IPN) and may offer a means to guide antimicrobial therapy. We aimed to explore whether mNGS could potentially improve the appropriateness of antibiotic use in ANP patients presenting with early fever.</p><p><strong>Methods: </strong>This prospective multicenter cohort study was conducted at five hospitals in China, enrolling ANP patients who developed fever within two weeks of symptom onset. Antibiotic susceptibility was defined per local microbiology laboratory reports. The hypothetical impact of mNGS on reducing inappropriate antibiotic use was evaluated through a retrospective simulation using predefined criteria from the BGI China antimicrobial drug usage card, as mNGS results were not disclosed to the treating teams during the actual clinical course.</p><p><strong>Results: </strong>Between May 2023 and December 2024, 125 ANP patients with early fever were enrolled. Antibiotics were administered to 91.2% (114/125) of patients, whereas only 23.2% (29/125)were eventually confirmed to have IPN, and the rate of appropriate antibiotic use was 14.5% (17/117) based on conventional culture. In our simulated model, if therapy had been guided by plasma mNGS results, the estimated rate of appropriate antibiotic use could have increased to 71.8%.</p><p><strong>Conclusions: </strong>Plasma mNGS facilitates rapid pathogen identification and shows potential for improving antibiotic appropriateness in ANP patients with early fever.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semi-Automated Retrospective Surveillance of Surgical Site Infections (sAReS-SSI) - using hospital routine data for SSI tracking.","authors":"Dominik Sons, Eva Bernauer, Alexander Schmidt, Meike Neuwirth, Robin Otchwemah, Heide Niesalla, Manuel Heurich, Frauke Mattner, Christoph Senges","doi":"10.1186/s13756-026-01818-4","DOIUrl":"10.1186/s13756-026-01818-4","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) place a significant burden on healthcare systems worldwide. Although surveillance is crucial for obtaining accurate data and developing effective prevention strategies, there are still significant gaps due to the frequent reliance on manual and resource-intensive processes. To gain efficient, in-depth insight, we developed an algorithm for semi-Automated Retrospective Surveillance of Surgical Site Infections (sAReS-SSI), which retrospectively identifies SSIs using existing routine hospital data.</p><p><strong>Methods: </strong>sAReS-SSI adopts a patient-centric approach to data analysis, using an ICD-10 and OPS catalogue to detect in-house SSIs through temporal linkage to prior in-house surgeries, refining the NWIF algorithm of the German Institute for Quality and Transparency in Healthcare. sAReS-SSI was evaluated against SSIs that were validated through bedside surveillance in three orthopaedic and trauma surgery wards, as published in the HygArzt study. Its performance was also evaluated in comparison with a reconstructed NWIF algorithm, and contextualised using OP-KISS surveillance reports from the German National Reference Center.</p><p><strong>Results: </strong>sAReS-SSI correctly identified 61 of 65 in-house SSIs published in the HygArzt study. Re-analysis of initially false-positive cases revealed 10 additional true in-house SSIs not captured in HygArzt, yielding a sensitivity of 94.7%, specificity of 94.3%, positive predictive value of 35.9%, and negative predictive value of 99.8%. sAReS-SSI accurately captured infection dynamics in pre- and post-intervention periods of the HygArzt study, correctly identified problematic surgery types, and demonstrated that relying solely on NWIF or OP-KISS might miss a portion of potential SSI events.</p><p><strong>Conclusions: </strong>Automating the analysis of routine information for the detection of SSIs offers opportunities to save resources and enables efficient, large-scale analysis. By narrowing down potential SSI cases, this approach reduces the workload for manual surveillance by hygiene experts. In our cohort sAReS-SSI flagged potential cases and highlighted how routine-data-based case finding may extend OP-KISS surveillance by including additional non-indicator-surgeries.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilient surgical instrument reprocessing during healthcare disasters and outbreaks: a systematic review of barriers, preparedness gaps and policy strategies.","authors":"Mohammad Sadegh Nematollahi, Iman Farahi-Ashtiani, Lida Shams","doi":"10.1186/s13756-026-01820-w","DOIUrl":"10.1186/s13756-026-01820-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical instrument reprocessing is essential for infection prevention and continuity of surgical care. However, evidence on barriers and adaptive strategies for maintaining reprocessing capacity during healthcare disruptions remains fragmented. This systematic review synthesized evidence on reprocessing vulnerabilities, barriers, and adaptive strategies across infectious outbreaks, emergency preparedness contexts, infrastructure disruptions, and resource-constrained settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Scopus, Web of Science, and Google Scholar were searched through February 2026 in accordance with PRISMA 2020 guidelines. Eligible studies evaluated reusable surgical instrument reprocessing during infectious outbreaks, infrastructure disruptions, emergency preparedness contexts, or other healthcare disruption settings. Two reviewers independently performed study screening and quality appraisal, with data extraction conducted by one reviewer and independently checked by a second reviewer, using Joanna Briggs Institute (JBI) appraisal tools appropriate to study design. Given substantial methodological and contextual heterogeneity, findings were synthesized narratively. The review protocol was prospectively registered in PROSPERO (CRD420261324153).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven studies from nine countries were included, comprising outbreak investigations, preparedness surveys, cohort and case-control studies, case series, and quasi-experimental or implementation-oriented studies. Most studies focused on infectious outbreaks associated with failures in reprocessing complex reusable devices. Recurrent barriers included incomplete cleaning workflows, inadequate lumen decontamination, equipment malfunction or contamination, contaminated water or rinsing systems, limited emergency preparedness, workforce gaps, and incomplete instrument-tracking systems. Infrastructure disruptions and limited sterilization capacity were associated with delays or interruptions in surgical services. Reported adaptive strategies included standardized multistep cleaning protocols, environmental monitoring, workforce training and simulation, instrument traceability systems, mobile or container-based sterilization capacity, and contingency reprocessing approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Current evidence suggests that challenges in surgical instrument reprocessing across healthcare disruption contexts are associated with interacting operational, infrastructural, technological, and organizational factors rather than isolated technical failures alone. Strengthening routine reprocessing reliability, workforce preparedness, environmental monitoring, infrastructure reliability, instrument traceability, and flexible reprocessing capacity may support continuity and safety of surgical services during healthcare disruptions. However, the evidence base remains small and heterogeneous and is weighted toward infectious outbre","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship in practice: determinants of prescription behaviour and developing interventions to improve surgical prophylaxis in a Rwandan tertiary hospital-a mixed methods study using the behaviour change wheel.","authors":"Caroline Theunissen, Marie Fidèle Muremba, Leopold Bitunguhari, Sibyl Anthierens, Acsa Igizeneza, Ralph Huits, Emmanuel Bottieau, Gloria Cristina Cordoba, Félix De Bièvre, Innocent Hahirwa, Florence Masaisa, Edmond Ntaganda, Jean Claude Semuto Ngabonziza, Jeroen Schouten","doi":"10.1186/s13756-026-01771-2","DOIUrl":"10.1186/s13756-026-01771-2","url":null,"abstract":"<p><strong>Background: </strong>Behavioural sciences should be used to design and improve antimicrobial stewardship (AMS) interventions aiming surgical prophylaxis (SP).</p><p><strong>Methods: </strong>A mixed-methods study at the University Teaching Hospital of Kigali, Rwanda. The study included an audit on SP practices and the development of SP interventions based on determinants of prescription behaviour yielded by 2 group discussions and by applying the Capability, Opportunity Motivation Behaviour (COM-B) model and the Behaviour Change Wheel (BCW) framework.</p><p><strong>Results: </strong>The audit included 190 patients: SP prescription was inappropriate regarding determinable duration in 37% (51/139); dosage in 19% (32/167); choice in 77% (136/177) and adequate coverage of expected micro-organisms in 20% (34/175). In 31 patients (16%), SP was appropriate for all four determinants. Barriers of prescription behaviour change pertained to knowledge of guidelines, hierarchical dynamics, access to antimicrobials, inter-professional communication, entrenched routines, documentation issues and lacking surveillance of surgical site infections and antimicrobial resistance. Facilitators of prescription change were the development of a local guideline and audit and feedback processes after implementing change. Subsequent policies and interventions were developed, focusing on (1) developing a local SP guideline, (2) education and training, (3) strengthening drug availability and (4) monitoring and feedback on SP practices before and after implementing change.</p><p><strong>Conclusions: </strong>This mixed methods study showed suboptimal SP practices regarding to duration, dosage, choice and adequate coverage. Barriers and facilitators of prescription behaviour change touched on all COM-B categories and informed the development of tailored AMS interventions, focusing on the intervention functions \"education\", \"training\", \"environmental restructuring\" and \"enablement\".</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"15 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of national antimicrobial resistance policies on antibiotic prescribing rates in South Korea: an interrupted time series analysis.","authors":"Jin Suk Kim, Seog-Kyun Mun","doi":"10.1186/s13756-026-01793-w","DOIUrl":"10.1186/s13756-026-01793-w","url":null,"abstract":"<p><strong>Background: </strong>Despite the antimicrobial resistance (AMR) policies implemented in Korea, outpatient antibiotic consumption remains high. Evidence on the effects of these policies is limited. We assessed the effects of Korea's AMR control policies on antibiotic prescription rates by examining short- and long-term impacts across healthcare institution types and policy intervention periods.</p><p><strong>Methods: </strong>We conducted an interrupted time series analysis using an ARIMAX (1,0,0) model with nationwide quarterly data from tertiary hospitals, general hospitals, hospitals, and clinics from the first quarter of 2000 to the fourth quarter of 2023. Four policy interventions were modeled as level and slope changes to estimate short-term effects immediately after each intervention and long-term effects eight quarters later.</p><p><strong>Results: </strong>The 2001 policy was associated with short-term reductions in antibiotic prescription rates across all institution types, decreasing by 2.21% points (pp) in tertiary hospitals, 3.65 pp in general hospitals, 1.60 pp in hospitals, and 3.21 pp in clinics. Long term, reductions were observed only in general hospitals (- 2.95 pp), while increases occurred in other settings. Following the 2006 policy, short-term prescription rates increased across all institutions but declined in the long term in tertiary (- 2.94 pp) and general hospitals (- 2.61 pp), with increases persisting in hospitals and clinics. After the 2013 policy, short-and long-term prescription rates increased across all institution types. The 2017 policy was associated with short-term increases across all settings, long-term decline was observed only in clinics (- 0.94 pp).</p><p><strong>Conclusion: </strong>The effects of Korea's AMR policies varied according to policy type, implementation period, and healthcare institution type, with substantial differences between short-term and long-term outcomes. Although several policies were associated with reductions in antibiotic prescribing, these effects were often not sustained over time. These findings suggest that regulation, public reporting, and financial incentives alone are insufficient to achieve lasting changes in prescribing behavior. Sustainable AMR control will require institution-specific and multifaceted strategies that integrate antimicrobial stewardship, continuous monitoring and feedback, patient engagement, and One Health approaches.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional assessment of hand hygiene compliance and its association with healthcare-associated infection incidence in intensive care units.","authors":"Ágnes Csörnyei-Kelemen, Zoltan Csörnyei, Zoltán Balogh","doi":"10.1186/s13756-026-01794-9","DOIUrl":"10.1186/s13756-026-01794-9","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have reported heterogeneous associations between average hand hygiene (HH) compliance and healthcare-associated infection (HAI) incidence, suggesting that monthly mean compliance alone may not fully characterize clinically relevant patterns of HH performance. We aimed to evaluate whether complementary metrics derived from the same HH dataset could provide additional contextual information on the relationship between HH performance and HAI incidence.</p><p><strong>Methods: </strong>We conducted a prospective observational study using HH audit data collected across three intensive care units with differing operational and staffing profiles. Monthly HAI incidence data were obtained from a parallel prospective surveillance program conducted by the same infection prevention team. Monthly HH performance was characterized using predefined metrics representing overall compliance level, day-to-day variability, critical low-compliance episodes, and lower-tail performance. These included weighted monthly HH compliance, coefficient of variation, the proportion of critical HH days defined as observed days with daily compliance below 40%, and the 25th percentile of daily compliance values. Associations with HAI incidence were explored using correlation analyses.</p><p><strong>Results: </strong>Weighted monthly HH compliance demonstrated the strongest pooled inverse association with HAI incidence. Complementary metrics reflecting day-to-day variability, critical low-compliance days, and lower-tail performance were also associated with HAI incidence, although their relative informativeness differed across units. These findings suggest that average compliance remains an important surveillance metric, while additional metrics may help characterize operational instability and episodes of distinctly poor HH performance.</p><p><strong>Conclusions: </strong>Average HH compliance remains an informative surveillance metric and should not be replaced by complementary indicators. However, measures reflecting day-to-day variability, critical low-compliance days, and lower-tail performance may provide additional operational context for interpreting HH surveillance data. Incorporating multiple HH performance dimensions may support more targeted infection prevention and workforce-management strategies.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}