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OBJECTIVE: There is widespread overuse of antibiotics in neonatal intensive care units (NICUs). The objective of this study was to safely reduce antibiotic use in participating NICUs by targeting early-onset sepsis (EOS) management. STUDY DESIGN: Twenty-eight NICUs participated in this statewide multicenter antibiotic stewardship quality improvement collaborative. The primary aim was to reduce the total monthly mean antibiotic utilization rate (AUR) by 25% in participant NICUs. RESULT: Aggregate AUR was reduced by 15.3% (p

ImportanceUrinary tract infection (UTI) is the second most common infection leading to hospitalization and is often associated with gram-negative multidrug-resistant organisms (MDROs). Clinicians overuse extended-spectrum antibiotics although most patients are at low risk for MDRO infection. Safe strategies to limit overuse of empiric antibiotics are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates could reduce use of empiric extended-spectrum antibiotics for treatment of UTI.Design, setting, and participantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time and risk-based CPOE prompts; 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in noncritically ill adults (≥18 years) hospitalized with UTI with an 18-month baseline (April 1, 2017-September 30, 2018) and 15-month intervention period (April 1, 2019-June 30, 2020).InterventionsCPOE prompts recommending empiric standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics who have low estimated absolute risk (

ImportancePneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia.Design, setting, and participantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.InterventionCPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (

Purpose Penicillin allergy documentation in the electronic health record (EHR) lacks detail with regard to type of reaction, history of reaction, and other tolerated β-lactams. Because of concern for penicillin allergy cross-reactivity with cefazolin, patients with a reported penicillin allergy are frequently prescribed suboptimal preoperative antibiotics, which have been associated with negative patient outcomes, including increased risk of surgical site infection. The purpose of this study was to increase preoperative use of cefazolin via improvement to the documentation of penicillin allergies in the EHR. Methods This single-center, quasi-experimental quality improvement study compared patients with a self-reported penicillin allergy admitted for select elective surgeries before and after implementation of a penicillin allergy questionnaire. The primary outcome was receipt of cefazolin for surgical prophylaxis. Secondary outcomes were the proportion of patients with detailed penicillin allergy documentation, the proportion of patients with surgical site infections occurring within 30 days of surgery, and the proportion of patients who received the full antibiotic dose before the first surgical incision. Results A total of 100 patients were included in the preintervention group, while 85 patients were included in the postintervention group. Cefazolin use was higher in the postintervention group (13.0% vs 41.2%; P < 0.001). The postintervention group also had a larger proportion of patients with detailed allergy documentation (2.0% vs 50.6%; P < 0.001) and who received the full preoperative antibiotic dose before the first incision (25.0% vs 48.2%; P = 0.001). There was no statistical difference between the groups in the incidence of surgical site infection at 30 days after surgery (3.0% vs 1.2%; P = 0.63). Conclusion Preoperative cefazolin use was higher in patients with a reported penicillin allergy after implementation of a penicillin allergy questionnaire and EHR documentation tool. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Selective treatment of clinical mastitis (STCM) potentially reduces antimicrobial use without negative implications on cow's milk production or health. However, this approach comes with additional costs. The aim of this study was to evaluate the net cash impact (NCI) of implementing STCM compared with blanket treatment of clinical mastitis (BTCM) under different diagnostic test turnaround times (24 h, 14 h, and 8 h) using a stochastic partial budget analysis with Monte Carlo simulation. The target population was European commercial dairy herds; therefore, the model inputs were primarily from European sources. Additionally, variables associated with dairy management programs were obtained from USDA sources, worldwide multisite clinical trials, and expert opinion. The output was calculated by subtracting the cost of STCM from the cost of BTCM, and it represented the expected NCI if a herd switched from BTCM to STCM. Depending on the time-to-treatment efficiency and diagnostic test turnaround time, the expected mean NCI, assuming that STCM has no impact on the cow's future health or production, ranged from +€8.7 to +€12.4 per case with 72.4% to 84.8% of the iterations being ≥€0. Moreover, using the numerically favorable health and production effects of STCM reported in the literature, the expected mean NCI ranged from +€44.5 to +€48.1 per case with 93.6% to 95.4% of the iterations being ≥€0. The variables with the greatest contribution to NCI variance were the proportion of gram-positive cases (39.2% of the variance) and days out of the tank for treated cows (22.0%). However, if cows' future health and production were accounted for, culling risk (24.6%), recurrence risk (19.4%), and milk yield (10.6%) would have the greatest contribution to NCI. The sensitivity analysis indicated that farms with high clinical mastitis incidence, low proportion of gram-positive cases, large number of days out of the tank for treated cows, higher milking frequency or using automatic milking systems, not using the highest priced diagnostic tests, and having high antimicrobial treatment costs are the best candidates for STCM. Improving time-to-treatment efficiency, for example by using a rapid diagnostic test, leads to a favorable NCI, whereas high daily milk yield and milk price enhances the NCI in already positive scenarios. Finally, the cash flow entirely depends on cows' future health and milk yield. Overall, the results indicate that STCM is a practice that positively affects the NCI of many herds. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective study that compared the effects of three days of treatment with ceftriaxone and longer durations of therapy for uncomplicated cystitis in patients admitted to a community teaching hospital. It describes several clinical dilemmas associated with uncomplicated cystitis in the hospital setting, as well as confounding variables affecting the study design. It explores developments in research on the benefits of a shorter duration of antibiotic use in infections.

Persistent post-operative opioid use is a public health concern contributing to population morbidity and mortality. Opioid stewardship is a strategy adopted to rationalise opioid prescribing and limit harmful use. We describe persistent post-discharge opioid use rates and risk factors in a single-centre cohort and describe the opioid stewardship role of our Acute Pain Service (APS). We conducted a retrospective 4-year cohort study of inpatients referred to the APS and discharged with new strong opioids prescribed. We investigated persistent post-discharge opioid use rates, risk factors and patterns of opioid use after community follow-up by APS. We found that 24% of patients discharged with new strong opioids developed persistent opioid use. Risk factors associated with persistent post-discharge opioid use in our cohort included female sex (Odds Ratios [95% confidence interval], p value, OR: 1.89 [1.11–3.22], p = 0.019), pre-admission mental health history (OR: 2.85 [1.64–4.95], p < 0.001) and pre-admission opioid use (OR: 1.79 [1.03–3.11], p = 0.004). A smaller proportion of patients with APS follow-up in community developed persistent opioid use (22%) compared to those without (32%). We conclude that having opioids prescribed at time of discharge can result in persistent opioid use in up to a quarter of patients. The APS has an important protective role in rationalising opioid use in hospital but also following discharge. Development of further opioid stewardship policies is needed including improvement of patient and staff awareness and pre-operative assessment of patients with recognised risk factors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the available literature on ureteric stent‐related infections, the use of antibiotics and bacterial colonisation to identify the current incidence of stent‐related infections, unveil knowledge gaps and generate potential hypotheses for future research. Methods: A literature review was conducted using PubMed, Cochrane and urological association websites identifying relevant English literature published between 1983 and January 2024. Results: There is a worldwide lack of guidelines for antibiotic prophylaxis for stent placement, exchange or extraction. In patients with a negative preoperative urine culture undergoing ureteroscopy and stent placement, it may be considered to only provide prophylaxis in presence of risk factors. However, in pre‐stented patients a preoperative urine culture is important to guide prophylaxis during endourological surgery. During stent indwell time, antibiotic prophylaxis does not show any advantage in preventing urinary tract infections (UTIs). There is no strong evidence to support the use of antibiotics at time of stent removal. In the absence of any clear evidence, management strategies for treating UTIs in patients with ureteric stents vary widely. Stent exchange could be considered to remove the biofilm as a potential source of bacteria. Stent culture can help to guide treatment during infection as urine culture and stent culture can differ. Conclusion: In terms of good antibiotic stewardship, urologists should be aware that unnecessary use of antibiotics provokes bacterial resistance. There is a great need for further research in the field of antibiotic prophylaxis and stent‐related infections to develop evidence that can help shape clear guidelines for this very common urological practice. [ABSTRACT FROM AUTHOR]

Objectives: Dental antibiotic stewardship is crucial in low‐ and middle‐income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice. Methods: The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship. Results: Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents. Conclusion: This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra‐indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR. [ABSTRACT FROM AUTHOR]

Aims: Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial‐resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices. Methods and Results: An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open‐ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words 'owner' and 'compliance', 'administration' and 'route', 'cost' and 'culture', and 'patients' and 'acceptance'. Conclusions: The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

In Switzerland and other high-income countries, one out of 3000 to 5000 term and late preterm neonates develops early onset sepsis (EOS) associated with a mortality of around 3%, while incidence and mortality of EOS in very preterm infants are substantially higher. Exposure to antibiotics for suspected EOS is disproportionally high compared to the incidence of EOS with consequences for future health and antimicrobial resistance (AMR). A safe reduction of unnecessary antibiotic treatment has to be a major goal of new management strategies and guidelines. Antibiotics should be administered immediately in situations with clinical signs of septic shock. Group B streptococcus (GBS) and Escherichia coli (E. coli) are the leading pathogens of EOS. Amoxicillin combined with an aminoglycoside remains the first choice for empirical treatment. Serial physical examinations are recommended for all neonates with risk factors for EOS. Neonates without any clinical signs suggestive of EOS should not be treated with antibiotics. In Switzerland, we do not recommend the use of the EOS calculator, a risk stratification tool, due to its unclear impact in a population with an observed antibiotic exposure below 3%. Not all neonates with respiratory distress should be empirically treated with antibiotics. Isolated tachypnea or respiratory distress starting immediately after delivery by elective caesarean section or a clearly assessed alternative explanation than EOS for clinical signs may point towards a low probability of sepsis. On the other hand, unexplained prematurity with risk factors has an inherent higher risk of EOS. Before the start of antibiotic therapy, blood cultures should be drawn with a minimum volume of 1 ml in a single aerobic blood culture bottle. This standard procedure allows antibiotics to be stopped after 24 to 36 h if no pathogen is detected in blood cultures. Current data do not support the use of PCR-based pathogen detection in blood as a standard method. Lumbar puncture is recommended in blood culture–proven EOS, critical illness, or in the presence of neurological symptoms such as seizures or altered consciousness. The accuracy of a single biomarker measurement to distinguish inflammation from infection is low in neonates. Therefore, biomarker guidance is not a standard part of decision-making regarding the start or stop of antibiotic therapy but may be used as part of an algorithm and after appropriate education of health care teams. Every newborn started on antibiotics should be assessed for organ dysfunction with prompt initiation of respiratory and hemodynamic support if needed. An elevated lactate may be a sign of poor perfusion and requires a comprehensive assessment of the clinical condition. Interventions to restore perfusion include fluid boli with crystalloids and catecholamines. Neonates in critical condition should be cared for in a specialized unit. In situations with a low probability of EOS, antibiotics should be stopped as early as possible within the first 24 h after the start of therapy. In cases with microbiologically proven EOS, reassessment and streamlining of antibiotic therapy in neonates is an important step to minimize AMR. Conclusion: This guideline, developed through a critical review of the literature, facilitates a probability-based approach to the management of neonates at risk of early onset sepsis. What is Known: • Neonatal exposure to antibiotics is disproportionally high compared with the incidence of early onset sepsis with implications for future health and antimicrobial resistance. What is New: • A probability-based approach may facilitate a more balanced management of neonatal sepsis and antibiotic stewardship. [ABSTRACT FROM AUTHOR]

There is an urgent need to understand the implementation barriers of antimicrobial stewardship programmes (ASPs) in low- and middle-income countries. We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March–December 2023). We used a self-assessment questionnaire with a scoring system, and multi-level ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGDs) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results. A total of 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 (interquartile range (IQR) 1–5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9–62.5%), classifying 41 (8.0%) hospitals as inadequate (0–25%), 237 (45.9%) as basic (26–50%), 179 (34.7%) as intermediate (51–75%) and 59 (11.4%) as advanced (76–100%). Scores were highest for hospital leadership support (83.4% (IQR 66.7–100%)), followed by ASP team and infectious disease training (66.7% (IQR 55.6–77.8%)); education (50% (IQR 0.0–75.0%)); ASP interventions (43.8% (IQR 18.7–68.7%)); hospital infrastructure (42.9% (IQR 14.3–71.4%)); and monitoring, reporting and feedback (40.9% (IQR 27.3–54.5%)). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level Public Health Development Index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioural skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation. Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs. [ABSTRACT FROM AUTHOR]

Complexity theory has been used previously as a conceptual lens in human healthcare research. Antimicrobial stewardship (AMS) is an inherently complex healthcare intervention; however, the extent to which complexity has been operationalized in AMS is currently unclear. To investigate if, and how, complexity theory has been used to inform AMS in human health care. Scoping review methodology. Empirical research or policies specifically referencing complexity in relation to AMS were considered in any human healthcare setting and geographical location. Databases searched were Cinahl, Cochrane Library, Embase, Medline, National Institute for Health and Care Excellence, PsycInfo, Scopus and Web of Science from inception to June 2020. Grey literature and other databases searched were EVIPNet, Google, Mednar, Proquest Theses and the World Health Organization Library of National Antimicrobial Resistance Action Plans. Non-English language articles were excluded. Of 612 records retrieved, eight articles were included in this review. Heterogeneity in study design and geographical location were noted. Three interventional studies evaluated AMS in hospital (N =2) and long-term care (N =1) settings. The remaining studies were non-interventional and proposed AMS strategies conceptualized through complexity theory. The importance of close engagement between researchers or policy administrators and the target population was emphasized in all studies as a means of ensuring AMS relevance and success. There is a paucity of AMS research informed by complexity theory, and no policy documents could be located using complexity as a guiding theory. Mixed methods, informed by complexity theory, is a potentially suitable strategy to develop, implement and evaluate AMS as a complex intervention. [ABSTRACT FROM AUTHOR]

Aged care staff and doctors frequently highlight consumers' role in antibiotic treatment decisions. However, few studies include consumers. This study aimed to investigate consumer perspectives on antibiotic use in residential aged care. A search across 6 online databases yielded 3,373 studies, with 5 meeting inclusion criteria. Participant quotes, themes, statistical analyses, and authors' interpretive summaries in the included studies were inductively coded and refined to generate themes. Three themes emerged: perception of benefits and risks of antibiotics, perceived role in antibiotic treatment decision-making, and information-communication needs. Consumers held positive attitudes toward antibiotics, did not associate antibiotics with the exclusive treatment of bacterial infections, and had limited awareness of potential risks, such as antibiotic resistance. Studies showed diverse perceptions regarding residents' and their families' involvement in antibiotic treatment decision-making with some residents actively seeking antibiotics and others trusting doctors to decide. Studies also described consumer need for effective provider-consumer communication and information sharing that was affected by contextual barriers such as motivation, preferences, available information resources, and provider attitudes. Limited literature is available on consumer perspectives on antibiotic use in aged care. The review highlights that consumer needs are more complex than simply wanting an antibiotic. Antimicrobial stewardship programs should target consumer awareness, beliefs, and provider-consumer communication to enhance antibiotic use in aged care. • Consumer perspectives on antibiotic use in aged care are underexplored. • Limited consumer knowledge of antibiotics and antibiotic resistance is a concern. • Consumers generally trust health care providers in antibiotic treatment decisions. • Effective provider-consumer communication is crucial for better antibiotic use in aged care. [ABSTRACT FROM AUTHOR]

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Burkholderia cepacia complex (Bcc) is a bacterial group with 'natural' multi-antimicrobial resistance. This complex has generated epidemic outbreaks across the world. In people with cystic fibrosis (CF), Bcc can cause severe lung infections that lead to accelerated lung damage, which can be complicated by necrotizing pneumonia accompanied by high fevers, leucocytosis, and bacteraemia, which commonly causes fatal outcomes. Specifically, infection by Burkholderia cenocepacia is considered an exclusion criterion for lung transplantation. The species of Bcc exhibit both genetic and phenotypic hypervariability that complicate their accurate microbiological identification. Automated methods such as MALDI-TOF can err in the determination of species. Their slow growth even in selective agars and the absence of international consensuses on the optimal conditions for their isolation make early diagnosis a difficult challenge to overcome. The absence of correlations between antibiograms and clinical results has resulted in the absence of standardized cut-off values of antimicrobial susceptibility, a fact that brings a latent risk since incorrect antibiotic therapy can induce the selection of more aggressive variants that worsen the clinical picture of the host, added to the absence of a clear therapeutic guide for the eradication of pulmonary infections by Bcc in patients with CF, resulting in frequently ineffective treatments. There is an urgent need to standardize methods and diagnostic tools that would allow an early and accurate diagnosis, as well as to perform clinical studies of the effectiveness of available antibiotics to eradicate Bcc infections, which would allow us to establish standardized therapeutic schemes for Bcc-infected patients. [ABSTRACT FROM AUTHOR]

Background: Following the Chinese guidelines' recommendation to completely cancel routine cephalosporin skin tests, the choice of cephalosporin as surgical prophylactic medication was affected. This was due to the limited cognition of the predictive value of cephalosporin skin test or the desire to avoid medical disputes. The aim of this retrospective study was to evaluate whether the pharmacist-led perioperative antibiotic prophylaxis model could improve clinicians' medical behavior in choosing cephalosporin antibiotics for surgical prophylaxis. Methods: From July 2021 to May 2022, a retrospective analysis was conducted on the selection of surgical preventive medication, skin test, postoperative infection and adverse drug reactions in foot and ankle surgery. The study was divided into three period: the rountine cephalosporin skin test period (Period I: Skin Test), the period when the routine cephalosporin skin test was cancelled but the pharmacist did not intervene (Period II: Cancel Skin Test), and the period when the pharmacist-led perioperative antibiotic prophylaxis was implemented after the cancellation of the cephalosporin skin test (Period III: Pharmacist Intervention). Results: A total of 1,583 patients were enrolled in this study. There was no significant difference in the utilization rate of cefuroxime between the routine skin test stage and the skin test cancelled stage [74.92% (Period I) vs. 74.54% (Period II), P > 0.05]. However, in the pharmacist intervention stage, the usage rate of cefuroxime significantly increased compared to the initial stage when the skin test was cancelled [87.07% (Period III) vs. 74.54% (Period II), P < 0.05]. The use of cephalosporins also increased in patients with self-reported beta-lactam allergies between these stages [41.94% (Period III) vs. 3.22% (Period II), P < 0.05)]. There was no significant difference in the incidence of postoperative infection and adverse drug reactions among the three periods. Conclusion: The pharmacist-led perioperative antibiotic prophylaxis model can significantly improve the medical behavior of clinicians in choosing cephalosporin antibiotics as surgical prophylactic medication and optimize the perioperative medication plan. [ABSTRACT FROM AUTHOR]

Background: Aminoglycosides are crucial for treating multidrug-resistant gram-negative infections and endocarditis. However, aminoglycosides are associated with significant risks of nephrotoxicity, necessitating careful dose selection and therapeutic drug monitoring. Therapeutic drug monitoring is essential for minimizing risk; however, few institutions routinely perform it. This study aimed to assess the impact of a pharmacist-driven therapeutic drug monitoring intervention on aminoglycoside usage trends and clinical outcomes. Methods: This retrospective cohort study included 263 patients treated with aminoglycosides between 2014 and 2023. A pharmacist-led therapeutic drug monitoring intervention began in 2017, focusing on monitoring renal function, documenting patient weight, and closely managing aminoglycoside concentrations. Trends in aminoglycoside use and renal outcomes were analyzed. Results: Over the study period, appropriate use of aminoglycosides at the time of initial prescription increased from 49 to 82% (P < 0.01). Pharmacist dosing design at initial prescription increased significantly from 21% pre-intervention to 60% post-intervention (P < 0.01). The proportion of pharmacist intervention in initial dosing design increased over time. The proportion of patients with measured aminoglycoside blood concentrations significantly increased from 53% pre-intervention to 72% post-intervention (P < 0.01). The proportion of patients who were able to manage target blood concentrations from the initial aminoglycoside dose without dose adjustments increased from 31% pre-intervention to 42% post-intervention, although the results were not significantly different (P = 0.07). The incidence rate of renal impairment remained similar (11% vs. 12%; P = 0.85), although the annual average number of cases decreased from 4.3 before the intervention to 2.5 after. Similarly, there were no significant differences in clinical efficacy before and after the intervention (65% vs. 71%; P = 0.35). Furthermore, aminoglycoside stewardship led to a 56% cost saving. Conclusions: Pharmacist-led aminoglycoside stewardship significantly improved the appropriate use of aminoglycosides and decreased the associated costs. Thus, pharmacist involvement is essential for the proper use of aminoglycosides. However, many patients required aminoglycoside dose reductions despite the pharmacist's guideline-based dosing design. Therefore, further accumulation of information on the management of aminoglycoside blood concentration may be necessary for the revision of these guidelines. [ABSTRACT FROM AUTHOR]

ABSTRACT Solid organ transplant and hematopoietic cell transplant patients face an increased risk of infectious diseases, greater exposure to antibiotics, and heightened risk of multidrug‐resistant organisms (MDROs) due to their immunosuppressed state. Antimicrobial stewardship programs (ASP) are essential in reducing the incidence of MDRO by conserving antimicrobial use, minimizing treatment durations, and improving the appropriate use of diagnostic testing. However, the role of ASP in transplant infectious diseases (TID) is still evolving, necessitating greater collaboration between ASP and transplant programs. This collaboration will mitigate infection risks, reduce infection‐associated costs, and improve outcomes. This article reviews the key components for implementing ASP in TID, especially for those that are establishing or growing their ASP to include TID, including specific goals, structure and funding, ASP initiatives (including antibiotic allergy delabeling, diagnostic stewardship, and antiviral/antifungal stewardship), metrics, and educational opportunities. [ABSTRACT FROM AUTHOR]

Despite infection and sepsis being a major public health challenge, early detection and timely management are often hindered by several factors. These includes the similarity of clinical presentations between infectious and non-infectious conditisons, as well as limitations of current diagnostic methods such as lengthy turnaround times and low sensitivity. Consequently, there is increasing interest in identifying biomarkers that can quickly and accurately differentiate bacterial sepsis from other inflammatory processes, whether infectious or non-infectious. Procalcitonin has emerged as one of the most extensively studied and utilized biomarkers in managing infection and sepsis, especially within the framework of antibiotic stewardship. This review aims to examine the role of Procalcitonin in guiding antibiotic stewardship. It explores the production and release of procalcitonin and its relevance in the context of infection and sepsis. The discussion focus on the clinical and economic impacts of using procalcitonin to guide the initiation and discontinuation of antibiotics in managing these conditions. [ABSTRACT FROM AUTHOR]

Pharyngitis is an inflammatory condition of the pharynx and/or tonsils commonly seen in both children and adults. Viruses and bacteria represent the most common encountered etiologic agents—yeast/fungi and parasites are infrequently implicated. Some of these are predominantly observed in unique populations (eg, immunocompromised or unvaccinated individuals). This manuscript (part 3 of 3) summarizes the current state of biomarker diagnostic testing and highlights the expanding role they will likely play in the expedited diagnosis and management of patients with acute pharyngitis. Biomarkers, in conjunction with rapid antigen and/or nucleic acid amplification testing, will likely become the standard of care to accurately diagnose the etiologic agent(s) of pharyngitis. This novel testing paradigm has the potential to guide appropriate patient management and antibiotic stewardship by accurately determining if the cause of pharyngitis is due to a viral or bacterial etiology. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) are common however the widespread use of antibiotics has led to a rise in antimicrobial resistance (AMR) amongst uropathogens, rendering a significant proportion of infections resistant to first line treatment. AMR in UTIs may differentially affect men and women, younger and older patients. The purpose of this study was to investigate MDR (multi-drug resistance) and AMR in males and females in an Australian health district. Methods: There were 85,844 E. coli urinary isolates (2007–2020) analysed from adult patients. An E. coli isolate with MDR was defined as resistant to at least 1 agent in ≥ 3 antimicrobial classes. Chi-square tests and relative risk were calculated by comparing resistance in males and females and by age for antibiotics commonly used to treat UTIs in hospital and community collected samples. Results: There was a higher proportion of MDR E. coli in males compared to females in both the community (6.4% vs. 5.2%, P < 0.001) and hospital datasets (16.5% vs. 12.8%, P < 0.001). The proportions of MDR for both males and females were significantly higher in the hospital setting. Resistance rates were higher in males compared to females for amoxicillin, amoxicillin/clavulanate, cephalexin and norfloxacin (p < 0.005), though not for trimethoprim. Antibiotic resistance was seen to increase over time. Conclusions: A higher proportion of MDR E. coli were noted in urine samples from males compared with females, possibly due to the increased likelihood of prior treatment for UTIs in men. Antimicrobial stewardship interventions could be targeted towards this cohort to address increasing rates of AMR. [ABSTRACT FROM AUTHOR]

Background The 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) community-acquired pneumonia (CAP) guidelines recommend that clinicians prescribe empiric antibiotics for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa only if locally validated risk factors (or 2 generic risk factors if local validation is not feasible) are present. Methods In this cross-sectional study that included adults hospitalized for CAP across 50 hospitals in the Premier Healthcare Database from 2010 to 2015, we sought to describe how the use of extended-spectrum antibiotics (ESAs) and the coverage for patients with CAP due to restraint organisms would change under the 2 approaches described in the 2019 ATS/IDSA guidelines. The proportion of ESA use in patients with CAP and the proportion of ESA coverage among patients with infections resistant to recommended CAP therapy were measured. Results In the 50 hospitals, 19%–75% of patients received ESAs, and 42%–100% of patients with resistant organisms received ESAs. The median number of risk factors identified per hospital was 9 (interquartile range, 6–12). Overall, treatment according to local risk factors reduced the number of patients receiving ESAs by 38.8 percentage points and by 47.5 percentage points when using generic risk factors. However, the effect varied by hospital. The use of generic risk factors always resulted in less ESA use and less coverage for resistant organisms. Using locally validated risk factors resulted in a similar outcome in all but 1 hospital. Conclusions Future guidelines should explicitly define the optimal trade-off between adequate coverage for resistant organisms and ESA use. [ABSTRACT FROM AUTHOR]

Background Antibiotics are a strong risk factor for Clostridioides difficile infection (CDI), and CDI incidence is often measured as an important outcome metric for antimicrobial stewardship interventions aiming to reduce antibiotic use. However, risk of CDI from antibiotics varies by agent and dependent on the intensity (ie, spectrum and duration) of antibiotic therapy. Thus, the impact of stewardship interventions on CDI incidence is variable, and understanding this risk requires a more granular measure of intensity of therapy than traditionally used measures like days of therapy (DOT). Methods We performed a retrospective cohort study to measure the independent association between intensity of antibiotic therapy, as measured by the antibiotic spectrum index (ASI), and hospital-associated CDI (HA-CDI) at a large academic medical center between January 2018 and March 2020. We constructed a marginal Poisson regression model to generate adjusted relative risks for a unit increase in ASI per antibiotic day. Results We included 35 457 inpatient encounters in our cohort. Sixty-eight percent of patients received at least 1 antibiotic. We identified 128 HA-CDI cases, which corresponds to an incidence rate of 4.1 cases per 10 000 patient-days. After adjusting for known confounders, each additional unit increase in ASI per antibiotic day was associated with 1.09 times the risk of HA-CDI (relative risk = 1.09; 95% CI: 1.06–1.13). Conclusions The ASI was strongly associated with HA-CDI and could be a useful tool in evaluating the impact of antibiotic stewardship on HA-CDI rates, providing more granular information than the more commonly used DOT. [ABSTRACT FROM AUTHOR]

There is growing excitement about the clinical use of artificial intelligence and machine learning (ML) technologies. Advancements in computing and the accessibility of ML frameworks enable researchers to easily train predictive models using electronic health record data. However, several practical factors must be considered when employing ML on electronic health record data. We provide a primer on ML and approaches commonly taken to address these challenges. To illustrate how these approaches have been applied to address antimicrobial resistance, we review the use of electronic health record data to construct ML models for predicting pathogen carriage or infection, optimizing empiric therapy, and aiding antimicrobial stewardship tasks. ML shows promise in promoting the appropriate use of antimicrobials, although clinical deployment is limited. We conclude by describing the potential dangers of, and barriers to, implementation of ML models in the clinic. [ABSTRACT FROM AUTHOR]

Quality is central to value-based care, and measurement is essential for assessing performance and understanding improvement over time. Both value-based care and methods for quality measurement are evolving. Infectious diseases (ID) has been less engaged than other specialties in quality measure development, and ID providers must seize the opportunity to engage with quality measure development and research. Antimicrobial stewardship programs are an ideal starting point for ID-related quality measure development; antimicrobial stewardship program interventions and best practices are ID specific, measurable, and effective, yet they are grossly undercompensated. Herein, we provide a scheme for prioritizing research focused on development of ID-specific quality measures. Maturation of quality measurement research in ID, beginning with an initial focus on stewardship-related conditions and then expanding to non-stewardship topics, will allow ID to take control of its future in value-based care and promote the growth of ID through greater recognition of its value. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods and Results Conclusions Companion animals, like household dogs, are an overlooked transmission point for zoonotic pathogens such as nontyphoidal Salmonella (NTS). Given the proximity of dogs to humans and the use of critically important antibiotics in companion animal medicine, household dogs represent a risk for the spread of antimicrobial‐resistant (AMR) Salmonella.To this end, we aimed to leverage existing biosurveillance infrastructure to investigate AMR and the zoonotic potential of NTS isolated from dogs and humans. We identified all NTS strains isolated from domestic dogs via the Veterinary Laboratory Investigation and Response Network between May 2017 and March 2023 (N = 87), and spatiotemporally matched strains isolated from humans in the NCBI Pathogen Isolate Browser (N = 77). These 164 strains, collected from 17 states in the United States, formed the basis of our analysis. Strains isolated from dogs comprised diverse serovars, with most being clinically relevant to human health. All strains possessed AMR determinants for drug classes deemed critically or highly important by the World Health Organization. We identified sixteen NTS isolates from humans closely related to ≥1 of six dog‐associated strains.Collectively, our data emphasize the importance of antimicrobial stewardship and sustained biosurveillance beyond human‐ and agriculture‐associated veterinary medicine, using a One‐Health framework that accounts for all transmission points including companion animals. [ABSTRACT FROM AUTHOR]

Background: The emergence and spread of carbapenem resistance among Enterobacteriaceae, particularly Klebsiella pneumoniae, constitute a serious threat to public health, since carbapenems are the last line of defense in the treatment of life-threatening infections caused by drug-resistant Enterobacteriaceae. The current study investigated the co-existence of different virulence factors and carbapenemases in carbapenem-resistant Klebsiella pneumoniae clinical isolates from Alexandria, Egypt. Results: Phenotypic characterization of virulence factors indicated that 41.5% of the isolates were strong biofilm producers, while hypermucoviscosity was detected in 14.9% of the isolates. All isolates harbored five or more virulence factor encoding genes. entB, ycfM, mrkD and fimH were detected in all isolates, while only one isolate was negative for ybtS. uge, iutA, rmpA and kpn were detected in 61 (64.8%), 55 (58.5%), 41 (43.6%) and 27 (28.7%) isolates, respectively, while all isolates lacked magA and k2A. Phenotypic detection of carbapenemases was explored by performing CarbaNP and mCIM/eCIM. CarbaNP test showed positive results in 98.9% of the isolates and positive mCIM tests were observed in all isolates, while 68 (72.3%) isolates showed positive eCIM tests. blaNDM was the most prevalent carbapenemase encoding gene (92.5%) followed by the blaOXA−48 (51.1%), while blaKPC was detected in only one (1.06%) isolate. blaVIM, blaIMP and blaGES were not detected in any of the tested isolates. Conclusions: The widespread of carbapenem-resistant Klebsiella pneumoniae represents a major problem in health care settings. A significant association between certain virulence factors and carbapenemase-encoding genes was observed. Antibiotic stewardship programs and infection control policies should be effectively implemented especially in hospitals to limit the spread of such highly virulent pathogens. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programs (ASPs) refer to a set of coordinated actions that improve the quality of care and combat antimicrobial resistance. Currently, information regarding the status of ASPs in Mexico is scarce. We aimed to describe the status of ASPs in 12 hospitals from Christus Muguerza Healthcare System. Methods: A cross-sectional study was conducted in 12 hospitals, with a previously developed self-assessment tool to calculate each hospital's ASP development score. The self-assessment tool includes 7 standards with 23 items. Score categories were defined as; high, medium, low, or none. The overall ASP development score was calculated using the proportional weight of each standard. Participating hospitals were divided into 2 groups according to their bed count. Statistical analysis was conducted in Excel program (Microsoft, Redmont, Washington). Results: 12 hospitals completed the self-assessment survey. The median overall ASP development score was 32.3%. The highest overall development scores were observed for hospitals with > 40 beds. The core elements with the lowest development scores were Education and training, and Reporting and feedback. Unlike hospitals with over 40 beds, those with 40 beds or less had a low development score for Hospital leadership support. The core element with the highest development score was Infection prevention and control. Conclusions: This is the first multicenter assessment of ASPs in Mexico, revealing a high proportion of low-score hospitals. National implementation of ASPs is required to combat antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) remains a significant public health challenge in Low- and Middle-Income Countries (LMIC). Inappropriate use of Anti-Tubercular Treatment (ATT) undermines treatment efficacy and could contribute to drug resistance. While antimicrobial stewardship programs (AMSP) are well established, anti-tubercular treatment stewardship programs (ATTSP) in private hospitals do not have an established model. An AMSP model in a private tertiary care hospital in South India was repurposed to monitor the prescription appropriateness of ATT. A multidisciplinary team evaluated the ATT prescription appropriateness among inpatients over a one-year period with the 4R's criteria: Right Indication, Right Drug, Right Dose, and Right Frequency. The ATTSP team filed recommendations for inappropriate prescriptions to the primary clinical care team, and compliance to the recommendations was documented within 48 hours. During the study period, 172 ATT prescriptions were evaluated. Inappropriate dose and drug prescriptions were found in 16% and 7%, respectively. The primary clinical care teams complied with 83% of the recommendations within 48 hours. The potential impact of implementing the ATTSP model nationwide was assessed using published data, suggesting that the opportunities to correct inappropriate prescriptions could reach a quarter million. The study provides a proof of concept that an ATTSP can be successfully implemented in a TB endemic, resource-constrained setting. Extrapolation for implementing ATTSP across the country has the potential for huge public health benefits. [ABSTRACT FROM AUTHOR]

AbstractThe purpose of this narrative review is to analyze the most recent studies about the role of C-reactive protein (CRP) and procalcitonin (PCT), two of the main biomarkers of infection, in distinguishing viral from bacterial etiology, in predicting the severity of infection and in guiding antibiotic stewardship in children with community-acquired pneumonia (CAP). The studies examined reveal that both CRP and PCT play a valuable role in diagnosing pediatric CAP, though each has limitations. CRP has moderate accuracy in distinguishing bacterial from viral infections, but its elevated levels are not exclusive to bacterial infections; PCT, however, shows higher specificity for bacterial CAP, with studies confirming its ability to differentiate bacterial causes, especially in severe cases. When integrated with clinical findings, CRP and PCT improve the sensitivity of pneumonia diagnoses and help in predicting severe outcomes such as sepsis and empyema; furthermore, both biomarkers prove useful in guiding antibiotic therapy, with PCT showing a more dynamic response to treatment. However, even though CRP and PCT offer valuable insights into the diagnosis and management of pediatric CAP, their application should be always integrated with clinical assessment rather than used in isolation. More studies are needed to define standardized thresholds and decision algorithms that incorporate these biomarkers. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide. Understanding the bacterial profiles and antibiotic susceptibility patterns causing neonatal sepsis is crucial for guiding appropriate treatment, improving patient outcomes, and combating the emergence of antibiotic resistance. Despite its importance, data regarding neonatal sepsis in the study area is limited. Therefore, this study aimed to characterize the bacterial pathogens and identify associated factors among neonates with suspected sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. Methods: A cross-sectional study was conducted by reviewing laboratory records of neonates admitted for suspected sepsis from January 2019 to December 2021. Data were checked for completeness and encoded in a spreadsheet program. Then, data were exported to STATA version 17 for analysis. Descriptive statistics such as frequency and percentage were computed. The association between neonatal sepsis and potential risk factors was assessed using Pearson's chi-square test. A p-value of < 0.05, was considered statistically significant. Results: A total of 1,236 neonates were included. Of these, 96.2% (1,190/1,236) had a fever before admission. The prevalence of culture-confirmed sepsis was 25.4% (314/1,236). Bacterial pathogens accounted for 23% (284/1,236) of these isolates, with Gram-negative bacteria being more prevalent at 75.3% (214/284) than Gram-positive bacteria at 24.7% (70/284). The most frequently isolated bacterial pathogens were K. pneumoniae 38.7% (110/284) and S. aureus 13% (37/284). The isolates demonstrated a high resistance level to commonly used antibiotics, with 61.6% exhibiting multidrug resistance. K. pneumoniae showed the highest rate of multidrug resistance (90.9%). Neonatal sepsis was associated with several factors, including fever before and after admission, hypothermia, increased respiration, suspected pneumonia, and suspected meningitis. Conclusion: This study identified a high prevalence of culture-confirmed sepsis in neonates at UoGCSH, with Gram-negative bacteria, especially K. pneumoniae, dominating the isolated pathogens. The isolated bacteria exhibited alarming resistance to commonly used antibiotics, with a high proportion demonstrating multidrug resistance. Implementing effective antibiotic stewardship programs is crucial to optimize antibiotic use, reduce unnecessary prescriptions, and curb the spread of resistant strains. [ABSTRACT FROM AUTHOR]

Gelling-fibre dressings have been found to be a rapid and effective tool for exudate management. Suprasorb Liquacel Pro is a soft, conformable non-woven dressing made from sodium carboxymethyl cellulose and strengthening cellulose fibres. When it comes into contact with wound exudate or blood, the absorbent dressing forms a gel, creating a moist wound environment. Cell debris and bacteria in the exudate are retained inside the fibre dressing and removed during the dressing change. The high vertical absorption of exudate into the fibre dressing protects the wound environment and the wound edge, thus supporting the healing process. Suprasorb Liquacel Ag has additional antimicrobial abilities with the inclusion of nanosilver technology, shown to be effective in killing bacteria and managing bioburden. [ABSTRACT FROM AUTHOR]

Pediatric hospitals are uniquely positioned to be impacted by antimicrobial waste. To explore this issue, we reviewed the current literature to identify the reasons, costs, and potential solutions to waste. Identified reasons for waste included weight-based dosing, medication order changes due to changing patient status, loss or expiration of doses, and medication errors. The cost of waste included financial costs, promotion of antimicrobial resistance, and generation of greenhouse gases. Proposed interventions to reduce waste included an early switch from intravenous to oral administration, required stop dates, standardized dosing times, and optimization of the pharmacy batching process. However, additional studies are needed to assess the potential correlation between these proposed interventions and waste reduction. Antimicrobial stewardship programs have been identified as a group that can play a crucial role in partnering to implement these interventions to potentially reduce antimicrobial waste and promote better healthcare sustainability. [ABSTRACT FROM AUTHOR]

The article focuses on the American Veterinary Medical Association's (AVMA) efforts to promote antimicrobial stewardship in veterinary practice. Topics include the creation of the Committee on Antimicrobials, development of core principles for antimicrobial stewardship, and the implementation of strategies to reduce antimicrobial use through education and prevention.

Small animal antimicrobial stewardship (AS) is emerging as a priority area in the global battle against antimicrobial resistance. Veterinary practices have limited support for implementation of AS programs, and even within veterinary schools, efforts are largely siloed and often limited in scope. Increased collaboration is needed to support and unify AS and infection prevention and control efforts, and to identify priorities for continued research. To address this, a 2-day in-person small animal AS workshop was held in August 2023. Delegates representing 23 US veterinary schools and 4 corporations/government agencies gathered for a series of lightning talks and focused group discussions in 3 domains: implementation of clinical AS programs, research opportunities and needs, and education. The workshop's goal was to identify and propose solutions for AS challenges. Meeting discussion identified a lack of resources and training as the greatest barriers to hospital AS program advancement and suggested creating standards for AS programs and a road map to support program development. Assessing antimicrobial treatment effects and performing studies to establish necessary treatment durations were considered the highest research priorities. Integrated educational practices were recommended to support unified messaging of AS concepts between preclinical and clinical training. The development of strategies to implement these suggestions was delegated to working groups with a goal to continue meeting biennially as a large group. Sharing news of these efforts is considered integral to heightening awareness and promoting implementation of AS practices moving forward in academic, specialty, and primary care settings. [ABSTRACT FROM AUTHOR]

OBJECTIVE To understand antimicrobial stewardship (AS) and infection prevention and control (IPC) activities in veterinary schools. METHODS An online survey was completed by representatives from American Association of Veterinary Medical Colleges-accredited veterinary schools in the US and Caribbean prior to attending the Inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools. Responses were examined to identify patterns among AS and IPC activities and adherence to the AVMA core principles. RESULTS Half (12 of 24) of the surveyed schools had an AS committee and most (79% [19 of 24]) had an IPC committee. Lack of dedicated staff time was a common barrier to AS (88% [21 of 24]) and IPC (75% [18 of 24]) reported by schools both with and without AS and IPC committees. Eleven of 24 schools (46%) reported performing at least 1 activity focused on each of the AVMA's 5 core principles of AS. Although 79% (19 of 24) of schools incorporate AS into preclinical curricula, training of clinical faculty (17% [4 of 24]), veterinary technicians and support staff (21% [5 of 24]), and house officers (42% [10 of 24]) is less common, despite these individuals engaging in teaching clinical-year veterinary students. CONCLUSIONS Veterinary schools varied in established AS education and AS and IPC practices, though financial and human resources were a common barrier. CLINICAL RELEVANCE A collaborative and cohesive approach to AS and IPC among schools to create sustainable frameworks for practice improvement will help combat the global threat of antimicrobial resistance. This is a critical action for settings where future veterinarians are trained. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a main contributor to calf mortality, but diagnosis is difficult. Objectives: Develop and validate a predictive model for bacteremia in critically ill calves (CIC). Animals: A total of 334 CIC, sampled for blood culture. Methods: Cross‐sectional study. Multivariable logistic regression and classification tree analysis on clinical, ultrasonographic, and laboratory variables were performed on a dataset including all animals. Model validation was done on 30% of the dataset. Similar statistics (except validation) were performed on a subset of the database (n = 143), in which presumed contaminants were excluded. Results: The best performing model to predict bacteremia, taking all detected bacteria into account, included tachypnea, tachycardia, acidemia, hypoglycemia, venous hypoxemia, and hypoproteinemia. Sensitivity and specificity of this model were 70.6% and 98.0%, respectively, but decreased to 61.5% and 91.7% during model validation. The best‐performing model, excluding presumed contaminants, included abnormal temperature, heart rate, absence of enteritis, hypocalcemia, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity of this model were 71.4% and 93.9%, respectively. Both classification trees performed less well in comparison to logistic regression. The classification tree excluding presumed contaminants, featured hypoglycemia, absence of diarrhea, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity were 39.4% and 92.7%, respectively. Conclusions and Clinical Importance: Hypoglycemia, hyperlactatemia, and hypoproteinemia seem relevant in assessing bacteremia in CIC. The performance of these models based on basic clinical and blood variables remains insufficient to predict bacteremia. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic skin disorder characterized by painful inflammatory nodules and abscesses, significantly impacting patients' quality of life. Current treatment strategies, including topical antibiotics, often yield limited efficacy and pose risks of antibiotic resistance. Photodynamic therapy has emerged as a potential option, with RLP068/Cl (ELKOFAST®, non-sterile formulation) showing promising efficacy due to its broad-spectrum bactericidal activity. We conducted a pilot study assessing the therapeutic response to photodynamic therapy with RLP068/Cl versus topical clindamycin gel in patients affected by hidradenitis suppurativa of Hurley score I, II, and III. Results revealed higher efficacy of photodynamic therapy in combination with RLP068/Cl, particularly in mild cases. Its efficacy remains reliable even in more severe cases when combined with adalimumab. The observed faster lesion improvement and pain relief were ascribed to the bactericidal effects of RLP068/Cl against Gram+ and Gram− bacteria. Furthermore, photoactivated RLP068/Cl was well tolerated with no adverse events reported. Therefore, photodynamic therapy following RLP068/Cl application represents a novel therapeutic option for hidradenitis suppurativa with potential implications for antibiotic stewardship in dermatology. [ABSTRACT FROM AUTHOR]

Objective: To isolate Pseudomonas aeruginosa from different clinical samples and determine the antimicrobial activity of Ceftazidime/avibactam against these isolates. Study Design: Prospective Cross-sectional study. Setting: Pathology Laboratory of Lahore General Hospital, Lahore. Period: July 2023 to June 2024. Methods: One hundred thirteen Pseudomonas aeruginosa were identified from different samples Bacterial identification was done by gram staining, bench tests, and API20NE. The antimicrobial sensitivity testing of the causative bacteria was conducted, using commercially available discs, by Kirby Bauer disc diffusion assay and reported in accordance with Clinical & Laboratory Standards Institute (CLSI) 2022. Results: Out of 113 resistant strains of Pseudomonas aeruginosa obtained from different clinical samples Ceftazidime/avibactam was only sensitive to 43.4% of strains and resistant to 56.6% of them. Conclusion: According to the findings of this study, Pseudomonas aeruginosa, a nosocomial organism is isolated from many different clinical samples. The findings of this study also indicate that even a new combination antibiotic fails to show sensitivity in more than half of the isolates. This is a frightening situation that places stress on avoiding the misuse of antibiotics and following anti-microbial stewardship. [ABSTRACT FROM AUTHOR]

Diagnosis of urinary tract infections (UTI) is a routine part of medical work and yet is well recognised to be an area of high clinical uncertainty. Meanwhile, diagnosis of UTI is becoming increasingly important to policymakers globally due to concerns about antibiotic over‐prescription. Drawing on Mol's concept of ontological multiplicity in clinical work, I explore how diagnostic uncertainty is co‐ordinated into certainty by a UK national diagnostic algorithm for UTI. The diagnosis of UTI is produced or withheld as a post hoc rationalisation of a prior decision whether to prescribe antibiotics or not. Work in the sociology of diagnosis has already noted that diagnostic steps are often re‐ordered by health‐care professionals taking diverse actions in the best interest of their patients. This article contributes an argument that ordering diagnostic work around antimicrobial stewardship agendas has the effect of narrowing possible actions. Exploring the consequences and effects of doing diagnosis in this way for different groups, I argue that a greater creativity about what could be done to care for painful bladders could be found in a return to more clinical ways of working. [ABSTRACT FROM AUTHOR]

Canine urinary excretion of chloramphenicol was evaluated to optimize a dosing protocol for treating urinary tract infections. Seven healthy male intact purpose‐bred Beagles and six healthy client‐owned dogs of various breeds each received a single oral 50 mg/kg dose of chloramphenicol. Urine was collected at baseline, and 6, 8, 12, and 24 h after chloramphenicol. Chloramphenicol urine concentrations were measured and compared to the epidemiological cutoff value for E. coli (16 mcg/mL). At 8 h, mean chloramphenicol concentration from all dogs was 266.9 mcg/mL (90% CI 136.2–397.7 mcg/mL) but was lower in Beagles than client‐owned dogs. At 12 h, mean chloramphenicol concentration from all dogs was 111.0 mcg/mL (90% CI 36.9–185.0 mcg/mL) and was lower in Beagles (10.6 mcg/mL, 90% CI 1.4–19.8 mcg/mL) than client‐owned dogs (228.0 mcg/mL, 90% CI 103.0–353.1 mcg/mL). Urine half‐life was similar for all dogs (1.8–3.8 h). This justifies dosing chloramphenicol 50 mg/kg PO q 8 h. All client‐owned dogs additionally maintained concentrations well above 16 mcg/mL, for 12 h, suggesting that q 12‐h dosing might be appropriate for non‐Beagle dogs with susceptible lower urinary tract infections. A clinical trial in dogs with urinary tract infections is needed as well as further investigation into potential breed differences. [ABSTRACT FROM AUTHOR]

The rise of antibiotic-resistant bacteria in clinical settings has become a significant global concern. Among these bacteria, Acinetobacter baumannii stands out due to its remarkable ability to acquire resistance genes and persist in hospital environments, leading to some of the most challenging infections. Horizontal gene transfer (HGT) plays a crucial role in the evolution of this pathogen. The A. baumannii AMA205 strain, belonging to sequence type ST79, was isolated from a COVID-19 patient in Argentina in 2021. This strain's antimicrobial resistance profile is notable as it harbors multiple resistance genes, some of which had not been previously described in this species. The AmpC family β-lactamase blaCMY-6, commonly found in Enterobacterales, had never been detected in A. baumannii before. Furthermore, this is the first ST79 strain known to carry the carbapenemase blaNDM-1 gene. Other acquired resistance genes include the carbapenemase blaOXA-23, further complicating treatment. Susceptibility testing revealed high resistance to most antibiotic families, including cefiderocol, with significant contributions from blaCMY-6 and blaNDM-1 genes to the cephalosporin and carbapenem resistance profiles. The A. baumannii AMA205 genome also contains genetic traits coding for 111 potential virulence factors, such as the iron-uptake system and biofilm-associated proteins. This study underscores A. baumannii's ability to acquire multiple resistance genes and highlights the need for alternative therapies and effective antimicrobial stewardship to control the spread of these highly resistant strains. [ABSTRACT FROM AUTHOR]

Objective: To develop a theory-informed behaviour change intervention to promote appropriate hospital antibiotic use, guided by the Medical Research Council's complex interventions framework. Methods: A phased approach was used, including triangulation of data from meta-ethnography and two qualitative studies. Central to intervention design was the generation of a robust theoretical basis using the Behaviour Change Wheel to identify relevant determinants of behaviour change and intervention components. Intervention content was guided by APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria and coded using a Behaviour Change Technique Taxonomy. Stakeholders were involved throughout. Results: From numerous modifiable prescribing behaviours identified, active 'antibiotic time-out' was selected as the target behaviour to help clinicians safely initiate antibiotic reassessment. Prescribers' capability, opportunity, and motivation were potential drivers for changing this behaviour. The design process resulted in the selection of 25 behaviour change techniques subsequently translated into intervention content. Integral to this work was the development and refinement of a Digital Antibiotic Review Tracking Toolkit. Conclusion: This novel work demonstrates how the Behaviour Change Wheel can be used with the Medical Research Council framework to develop a theory-based behaviour change intervention targeting barriers to timely hospital antibiotic reassessment. Future research will evaluate the Antibiotic Toolkit's feasibility and effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population. [ABSTRACT FROM AUTHOR]

Penicillin allergy is a significant burden on patient, prescribing and hospital outcomes. There has been increasing interest in the incorporation of penicillin allergy testing (i.e. delabelling) into antimicrobial stewardship (AMS) programmes to reduce the burden of penicillin allergy labels and improve prescribing. In particular, there has been a focus on point‐of‐care penicillin allergy assessment and direct oral challenge for low‐risk phenotypes. The National Antibiotic Allergy Network has provided a guide to assist AMS clinicians with the incorporation of penicillin allergy programmes, in particular direct oral challenge, into Australian hospitals. [ABSTRACT FROM AUTHOR]

Purpose: To describe the long-term effects of an ASP among febrile neutropenia (FN) patients. Methods: A quasi-experimental study was conducted between 2015 and 2023 at a tertiary care hospital in Istanbul, Türkiye. The ASP was implemented for FN patients, and the effects were assessed before and after the ASP interventions, which included FN clinical pathways and regular multi-disciplinary meetings with relevant healthcare workers. Results: A total of 489 FN episodes of 290 patients were included, 42% were female, and the mean age was 56 years (SD: 15, range: 18–89 years). After the intervention, the rate of appropriate antimicrobial therapy at the levels of starting (p = 0.005), switching (p < 0.001), and de-escalation/discontinuation, (p < 0.001) significantly increased. Another positive impact of the ASP was a significant reduction in candidemia (from 4.88 to 0.74, p = 0.004), as well as a significant reduction in the 90-day mortality rate (from 19 to 5%, p < 0.001). In multivariate analysis, having a gram-negative bloodstream infection, prolonged days with fever, and a high risk for neutropenia were found to be significant predictors of 90-day mortality, while follow-up with ASP significantly reduced mortality. Conclusion: Implementation of ASP led to reduced candidemia and LOS without increasing mortality, even in a country with a high rate of antimicrobial resistance. Implementation of sustainable ASP for FN patients is critical in combating antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Purpose: Bloodstream infections (BSIs) are associated with significant morbidity, mortality and costs, while prolonged blood culture (BC) diagnosis may delay the initiation of targeted therapy. This study evaluates the impact of an optimized microbiology laboratory process on turnaround times, antibiotic use, clinical outcomes and economics for hospitalized BSI patients. Methods: A pre-post study was conducted in a Chinese hospital in which BSI derived BC results before (Oct. 2020- Sep. 2021) and after (Oct. 2021- Sep. 2022) newly implemented microbiology diagnostics and workflow changes were analyzed. Turnaround times, antibiotic initiation, length of stay and in-hospital costs were compared. Results: From 213 included patients, 134 were pre-optimization (pre-op) and 79 were post-optimization (post-op) cases. The median time from blood sample collection (BSC) to pathogen identification (ID) decreased from 70.12 to 47.43 h post-op (P < 0.001). The median time from BSC to the first ID report related initiation of pathogen-directed antibiotic use decreased from 88.48 to 47.85 h post-op (P < 0.001). The average hospital stay decreased from 19.54 to 16.79 days and 30-day readmissions declined from 18.7 to 13.9%, while the mean total antimicrobial drug usage costs decreased by 3,889 CNY per patient (P = 0.022) after optimization. Conclusions: Implementing new diagnostics technologies and optimizing laboratory workflows significantly reduced antimicrobial drug usage costs, shortened the time to ID results and improved the timeliness of appropriate antibiotic choices to treat BSIs. Investments in faster testing and process improvements were clearly beneficial for patient outcomes and healthcare economics. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionDuring recent years, the world—including Scandinavia—has experienced significant challenges with shortages of antibiotics. In Scandinavia, phenoxymethylpenicillin is recommended as first-line antibiotic treatment for most acute respiratory tract infections (ARTIs). However, the Scandinavian countries each constitute rather small markets for phenoxymethylpenicillin. The aim of this discussion paper is to enlighten the differences in Scandinavian ARTI antibiotic treatment recommendations. This information is fundamental for exploring the potential of harmonizing treatment recommendations in Denmark, Norway and Sweden—to help ensure sufficient future supply of phenoxymethylpenicillin.Information from national ARTI antibiotic treatment recommendations from respectively Denmark, Norway and Sweden has been collated.Several discrepancies exist in recommendations. Adult dosage varies from a minimum of 660 mg x 4 (Denmark) to a maximum of 2000 mg × 3 (Sweden). Within Norway and Sweden, variations in recommended dosage also exist between the different types of ARTIs. A main challenge is that the tablet strengths recommended, and available on the market in the three countries, differs.Also, antibiotic treatment durations vary significantly between countries and infections treated—from five to 10 days of treatment.In the capacity of a well-established network for antibiotic stewardship, we have enlightened the differences in Scandinavian ARTI antibiotic treatment recommendations. This paper is the first step moving forward to scrutinizing the potential for harmonizing recommendations for Denmark, Norway and Sweden—to help ensure continued supply of phenoxymethylpenicillin for use within the Scandinavian countries. [ABSTRACT FROM AUTHOR]

Objectives: To investigate receipt of antibiotics among patients with neuroborreliosis after initial antibiotic treatment, likely attributable to posttreatment symptoms. Methods: We performed a nationwide, matched, population-based cohort study in Denmark (2009-2021). We included all Danish patients with neuroborreliosis, i.e. a positive Borrelia burgdorferi intrathecal antibody index test and a cerebrospinal fluid leukocyte count ≥10 × 106/l, and initially treated with doxycycline. To form a comparison cohort, we randomly extracted individuals from the general population matched 1:10 to patients with neuroborreliosis on date of birth and sex. The main outcome was receipt of doxycycline, and the secondary outcome was receipt of phenoxymethylpenicillin. We calculated short-term (<1 year) and long-term (≥1 year) hazard ratios (HR) with 95% confidence intervals (95%CI). Results: We included 463 patients with neuroborreliosis and 2,315 comparison cohort members. Compared with the comparison cohort members, patients with neuroborreliosis initially treated with doxycycline had increased receipt of additional doxycycline within 1 year (HR: 38.6, 95%CI: 17.5–85.0) and ≥1 years (HR: 3.5, 95%CI: 1.9–6.3). Compared with comparison cohort members, patients with neuroborreliosis had no increased receipt of phenoxymethylpenicillin (<1 year HR 1.0, 95%CI: 0.7–1.3; ≥1 years HR 1.2, 95%CI: 0.9–1.5). Conclusions: After initial antibiotic treatment, patients with neuroborreliosis have increased receipt of doxycycline particularly within one year after initial antibiotic therapy but also subsequently. The lack of increased receipt of phenoxymethylpenicillin suggests that the receipt of doxycycline was not merely due to differences in healthcare-seeking behaviour, increased risk of early Lyme borreliosis due to exposure, or differences in antibacterial usage in general. [ABSTRACT FROM AUTHOR]