To evaluate the quality of systemic antifungal prescribing in Australian hospitals using point-prevalence survey data from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS).

Data were extracted from the Hospital NAPS dataset from January 2014 to December 2024. Systemic antifungal prescriptions were analyzed for antifungal use, guideline compliance, appropriateness, and reasons for inappropriateness according to the Hospital NAPS methodology. Demographic factors, hospital classifications, antifungals, and antifungal indication were compared.

A total of 7,830 systemic antifungal prescriptions from 372 healthcare facilities across all Australian states and territories were included. Overall 88.4% were guideline compliant and 92.3% of prescriptions were deemed appropriate. Fluconazole was the most commonly prescribed antifungal but had one of the lowest percentage appropriateness (88.4%). In contrast, mold-active azoles, echinocandins, and amphotericin B demonstrated appropriateness rates exceeding 90%. Prescriptions with approval through local antimicrobial stewardship (AMS) processes had significantly higher appropriateness than those without (95.9% vs. 82.9%, p < 0.001). Specialized facilities managing immunocompromised populations showed both higher antifungal use and higher prescribing quality compared to general acute public hospitals.

This national evaluation highlights the overall high quality of systemic antifungal prescribing in Australian hospitals, reflecting the strength of AMS programs. However, variation across hospital types, specialties, and antifungal agents—particularly fluconazole—indicates opportunities for targeted stewardship interventions to further optimize antifungal use.

To evaluate the effectiveness of postcaesarean infection surveillance using the Power Business Intelligence (BI) program, focusing on antibiotic prescriptions. Second, to compare the workload between the traditional and new approaches.

A diagnostic accuracy and workload evaluation.

A tertiary care university hospital in metropolitan Bangkok, Thailand.

All patients who underwent cesarean section between January 1, 2019, and September 30, 2020.

ICD-10 diagnoses, microbiological cultures, and postcesarean section antibiotic prescriptions in 3,243 medical records were captured by the Power BI program to detect surgical site infections (SSIs). All cases underwent conventional surveillance, which independently performed by infection control nurses. All patients were under surveillance until 45 days after surgery to capture delayed SSI diagnosis. SSIs were compared with sensitivity and specificity used to evaluate the new method. The Wilcoxon signed-rank test was employed to compare workload differences between the two methods in a paired-sample design.

The findings demonstrated the high sensitivity (100%) (95% CI: 66.4–100%) and specificity (93%) (95% CI: 90.5–95.4%) of the Power BI method when focusing on antibiotic prescriptions between 8- and 45-days postoperation. Additionally, the Power BI infection monitoring system significantly reduced the number of cases requiring review from 452 to 39 patients (a 91% reduction), indicating a substantial decrease in workload after implementation (P < .001).

This antibiotic prescription-based, semi-automated surveillance program significantly reduced workload, demonstrating its potential to enhance infection monitoring in postcesarean section cases.

To compare demographic patterns, diagnosis distribution, and prescribing trends between urgent care and non-urgent care clinics for infectious disease encounters across age groups.

Retrospective cross-sectional study.

Outpatient encounters from 93 facilities (7 urgent care, 86 non-urgent clinics) in a single Michigan health system, from January 2021 to December 2024.

A total of 161,328 outpatient encounters involving an antibiotic prescription. Data were stratified by age group, sex, race, insurance type, and care setting.

Antibiotic prescription and ICD-10 diagnosis data were extracted from the CHARM database and compared across settings using χ2, Fisher’s exact, and Mann-Whitney tests.

Urgent care encounters involved younger patients (median age 45 vs 55 yr, p < .001), with more visits among children aged 0–5 years (9.0% vs 5.3%, p < .001). Non-urgent care encounters had more patients aged ≥ 60 years (43.8% vs 34.1%, p < .001). Upper respiratory tract infections (URTIs), including acute pharyngitis and otitis media, were more frequent in urgent care (15.0% and 11.9% vs 6.7% and 7.6%, p < .001). Urinary tract infections (UTIs) were more common in non-urgent care (15.2% vs 13.8%, p < .001). Amoxicillin was the most prescribed antibiotic in urgent care (17.4% vs 11.4%, p < .001), while cephalexin led in non-urgent care (13.5% vs 11.5%, p < .001).

Comparatively, a larger proportion of urgent care visits were for patients under the age of 18 and for patients with URTIs. Meanwhile, a greater proportion of non-urgent care encounters were for patients over the age of 60 years old and patients with unspecified UTI.

Prolonged antibiotic therapy is associated with an increased risk of antimicrobial resistance and adverse events. We evaluated the implementation of a multifaceted antimicrobial stewardship (ASP) initiative aimed at reducing antibiotic duration for respiratory tract infections (RTIs) in outpatient settings.

Quasi-experimental study.

Academic medical center in Riyadh, Saudi Arabia.

Patient with RTIs in outpatient settings

A multifaceted ASP intervention—including a clinical decision support tool and an educational session—was implemented to guide physicians in prescribing the shortest effective duration of oral antibiotics. We compared antibiotic utilization and adherence to evidence-based duration prescribing in a preintervention phase (June 2021–December 2021) and a postintervention phase (January 2022–June 2022) .

We included 2320 patients in our study, of which 1359 were in the preintervention period and 961 in the postintervention period. Following implementation of the multifaceted stewardship initiative, the days of therapy (DOT) per 1,000 outpatient visits decreased from 131 to 50 and the mean duration of antibiotic therapy declined from 6.4 to 6.0 days (p < 0.001). Adherence to the recommended duration improved, with the percentage of prescriptions meeting recommended duration increasing from 49.7% to 56.3% (p = 0.002).

The multifaceted ASP initiative can reduce unnecessary antibiotic exposure and improve the adherence to the recommended duration.

To evaluate the potential sources and current screening strategies for the multidrug-resistant fungal pathogen Candida auris in the US Military Health System (MHS).

Utilizing the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), 6 instances of C. auris colonization or infection were identified within the MHS in 2024. Relevant medical and social history, drug susceptibilities, and next-generation genetic sequencing were obtained from MRSN and the electronic medical record. Hospital screening protocols for C. auris were reviewed in the affected facilities.

One case of C. auris infection and 5 cases of C. auris colonization in 2024 were identified in the MHS. Only 1 case of colonization was likely related to international travel; 5 patients had no recent travel history before infection or colonization. One patient was an active duty service member. Prior hospitalizations and infections were the most common risk factors present in each case. Two isolates had antimicrobial susceptibilities analyzed, both of which suggested resistance to fluconazole. Two of the 3 facilities had C. auris screening protocols in place to screen select individuals with risk factors; however, only 1 of the 6 cases presented was identified through these screening protocols. No cases of nosocomial transmission were found.

C. auris remains a formidable threat to the MHS, with 6 cases identified in 3 treatment facilities, with 2 isolates demonstrating resistance to azoles. Screening protocols should reflect the domestic and international threats of this pathogen.

This paper describes a health-system’s experience incorporating Standardized Antimicrobial Administration Ratio (SAAR) data to optimize the existing antimicrobial use module within the electronic health record. We describe the design and implementation via a standard operating procedure (SOP), which incorporates SAAR and the optimized dashboards into the health-system’s antimicrobial stewardship program.

This is a descriptive study outlining our process of optimizing the electronic health records default antimicrobial use dashboard into a dual-purpose dashboard, SAAR and Antimicrobial Use (AU) dashboard, to be used across a health-system.

10-hospital health-system

For adult and pediatric populations, a pre-populated dashboard was created for each SAAR antimicrobial category using the existing EHR application. For adult, pediatric, and neonatal populations, improvements were made to visualize AU data in the dashboards. We created the framework for a standardized metric for our health-system’s antimicrobial stewardship program (ASP). An SOP was developed to establish an expectation for SAAR data analysis at the site level of our health-system’s ASP. The dashboards and SOP were created to evolve with the AUR protocol and health-system.

Pre-populated dashboards for adult and pediatric SAAR antimicrobial categories are configurable within existing electronic health-records, requiring minimal manipulation from the user to view which antimicrobials are driving a location’s SAAR.

In anticipation of required AUR reporting, other health-systems using the same EHR can utilize this approach to integrate the SAAR into their health-system’s antimicrobial stewardship programs. Collaboration between antimicrobial stewardship clinicians, pharmacist information technology (IT) analysts and infection preventionists are essential to accomplish this endeavor.

Invasive candidiasis including candidemia is a common healthcare-associated infections with significant morbidity and mortality. The USA does not have mandatory national surveillance for mucocutaneous or invasive candidiasis which complicates estimation of epidemiology and outcomes. The aim of this project was to describe the epidemiology, mortality, and Candida-associated hospital readmissions in hospitalized patients with Candida species infections.

This secondary database analysis used clinical microbiology data from adults hospitalized at three large health systems (25-hospitals) in the Greater Houston area totaling over 1.6 million hospitalization days per year from 2018 to 2023. Proportion and rates of Candida cultures per 10,000 hospitalization days were calculated. Risk factors for mortality and Candida-associated readmissions were assessed by multivariable logistic regression.

Within the study period, 7514 hospitalized patients aged 64 ± 16 years (mean± standard deviation (SD)) with 10,183 unique Candida cultures were identified. Majority of Candida cultures were nosocomial (59%) with wide variability in mean time to positive culture (9 ± 44 days) after admission. Candida specimens were from blood (32%), abdomen (29%), or mucocutaneous (24%) cultures and most commonly C. albicans (44%) or C. glabrata (21%). C. auris increased significantly from 2% of cultures from 2018–20 to 5% in 2021–23 (p < 0.0001). Length of hospital stay was 21 ± 34 days and inpatient mortality was 17%. Multivariable analyses identified hospitalization variables and Candida species predictive of inpatient all-cause mortality and Candida-associated readmissions after initial hospitalization.

These analyses highlight the significant burden of candidiasis and the emergence of new strains, including C. auris. Ongoing surveillance can refine burden estimates and assess the impact of stewardship and infection control interventions.

To describe the screening practice of nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) among nine health organizations in Kentucky.

The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited its Advisory Board members to share their nasal MRSA PCR protocols and guidelines. The documents were examined to highlight institutional similarities and differences.

Nine health systems, including both community hospitals and academic medical centers, responded to the KASIC request. Most systems with nasal MRSA PCR testing capacity had established protocols or guidelines to support its appropriate use. All institutions recommended nasal MRSA PCR for pneumonia indications while three organizations also used it for non-pneumonia indications. None of these institutions permitted pharmacists to discontinue anti-MRSA antibiotics per protocol.

This study provides the first statewide overview of nasal MRSA PCR screening practices, offering stewardship programs a framework to customize their own protocols and guidelines.

Burn injuries result in loss of skin barrier and altered immune responses that in turn make patients especially vulnerable to healthcare-associated infections. Despite prolonged exposures of these patients to hospital environments, burn-specific infection prevention strategies are understudied. We present a research agenda identifying key research gaps and organizing them into priority areas to guide future investigations in this high-risk population.

Members of the Society for Healthcare Epidemiology of America (SHEA) Burn Infection Prevention and Control Special Interest Group and the American Burn Association (ABA) collaborated to develop this research agenda, combining expertise in infection prevention, antimicrobial stewardship, and burn care.

We identified five priority areas: (1) improving surveillance and epidemiologic data on burn infections; (2) better understanding of microbiology, including biofilms and the microbiome; (3) evaluating wound healing strategies; (4) refining infection prevention and control practices unique to burn units; and (5) building burn patient specific risk assessment and predictive models. The agenda highlights the need for standardized definitions and shared data platforms. It calls for evaluation of practical strategies for infection prevention, stewardship, and environmental control.

This research agenda intends to help guide future studies aimed at furthering knowledge and improving outcomes in burn care.

To determine the local applicability of 2021 American Academy for the Study of Liver Diseases spontaneous bacterial peritonitis (SBP) treatment guidelines by evaluating the microbiology and clinical outcomes of SBP cases in an academic health system.

Retrospective cohort study.

Five-hospital academic health system.

Hospitalized adult patients with SBP.

This study involved 2 components. First, patients meeting inclusion criteria with peritoneal fluid cultures positive for a pathogen were included in the culture-positive group. Antibiotic susceptibilities were analyzed for these patients. Second, remaining culture-negative patients were randomly selected and sequentially evaluated until the culture-negative and culture-positive groups were approximately the same size. Clinical data for all patients were evaluated based on empiric antibiotics received.

Forty-nine patients with culture-positive SBP and 48 patients with culture-negative SBP were included. Eight (16%) positive cultures contained TGC-nonsusceptible organisms. Patients receiving empiric third-generation cephalosporin (TGC) monotherapy had similar clinical outcomes as patients receiving empiric broad-spectrum therapy, including similar 30-day mortality (36% vs 38%; P = 1.00), 90-day mortality (55% vs 55%; P = 1.00), and median duration of hospitalization (6.5 d vs 8 d; P = .25). ICU admission, recent hospitalization, and nosocomial infection were not associated with TGC-nonsusceptible pathogen isolation in a univariate logistic regression analysis.

Within our health system, 16% of isolates in culture-positive SBP patients were nonsusceptible to TGCs. No statistically significant difference was detected in clinical outcomes in patients receiving TGC or broader-spectrum antimicrobial therapy.