Background: Previously published data demonstrate the need to improve education and training of healthcare workers in antimicrobial stewardship (AMS). The aim of this evaluation was to explore the perceptions of healthcare workers from across the globe concerning various components of AMS training courses including technical content. Methods: This was an electronic cross-sectional survey sent to a convenience sample of 238 healthcare workers with expertise in infectious diseases (ID) and AMS from October to November 2025. Respondent demographic data, assessment of various components of AMS training courses using a 4-point Likert scale (Not Important, Somewhat Important, Important, Very Important), and ranking of AMS course content (1=most important to 9=least important) were collected. Descriptive analyses were used. Results: A total of 57 healthcare workers responded (24% response rate) including 32 physicians (58.2%) and 12 pharmacists (21.8%), mostly working in academic hospitals (73.2%) [Table 1]. The majority of respondents were aged 41-60 years (53.6%), and currently practicing in South America (31.5%), North America (24.5%), and South Asia (12.2%). The AMS course characteristics deemed very important by the majority of respondents included: free/low cost (69.5%), goals and aims described (66.1%), certificate of completion (64.3%), regularly updated materials addressing emerging issues in infectious diseases (63.6%), antimicrobial resistance specific to respondent’s country or community(62.5%), examples of implementation in the respondent’s specific geographical region (60.7%), no expiration on access to course content (58.2%), and appropriate time commitment (53.6%) [Table 2]. The course content topics identified as most important were AMS program fundamentals (45.5%) and application/implementation (34.5%), whereas ID basics (16.4%) was most frequently reported as least important. Conclusion: These data support the need for multi-faceted AMS training courses as most assessed components were identified as “important” or “very important” by this cohort of respondents. It also provides insights on what characteristics of a global AMS training course should be prioritized.

Background: Antibiotics are among the most frequently prescribed medications in skilled nursing facilities (SNFs), yet an estimated 40-75% of these prescriptions may be inappropriate or unnecessary. Vulnerability of SNF residents to antibiotic resistance, C. difficile, and adverse drug events make antibiotic stewardship programs (ASPs) crucial in these settings. Pharmacists are central to the success of ASPs, yet the scope of their responsibilities within Philadelphia SNFs is not known. Our team designed a survey to evaluate how consultant pharmacists are embedded in SNF ASPs, barriers to providing AS services, and interest in receiving further education. Methods: We designed a REDCap survey using the CDC Core Elements for AS in Nursing Homes and the Centers for Medicare & Medicaid Services’ Revised Long-Term Care Surveyor Guidance, which included facility-specific questions for each SNF served, as well as general questions. The survey was disseminated through a multi-modal approach to consultant pharmacists (n=26) identified through previous program activities and all Philadelphia SNFs (n=46) via email, phone, and collaborative meetings. Responses were summarized using descriptive statistics. Results: Fourteen pharmacists completed the survey, covering 23/46 (50%) Philadelphia SNFs. Eight pharmacists (57%) reported providing consulting services to <1 SNF in Philadelphia. Six pharmacists (43%) reported having formal training in AS or infectious diseases, and five (36%) served as the lead or co-lead of ASPs, covering 9/23 SNFs (39%). In 83% of SNFs, pharmacists were contracted to provide AS services for <5 hours per week. Limited contracted hours to perform AS activities was the most common consultant-related barrier to providing AS services, reported by 50% of pharmacists. The most commonly reported facility-related barriers were high rate of staff turnover (36%) and staff time constraints (29%). Pharmacists reported supporting a penicillin allergy delabeling program in 17% of SNFs and reported using antibiotic timeouts to assess antibiotic use in 13% of SNFs. Among the 79% of pharmacists interested in receiving further AS education, priority topics were building engagement and collaboration among staff, residents, and leadership (50%), clinical patient care (43%), and tracking, analyzing, and reporting AS metrics (30%). Conclusion: Health departments have an opportunity to enhance AS services delivered by SNF consultant pharmacists through educational outreach. Our survey identified penicillin allergy delabeling, initiating antibiotic timeouts, and AS metric reporting as priority topics. Systemic barriers, such as limited time for AS activities and staff turnover, were frequently reported. Addressing these barriers will be essential to enable sustained improvements in SNF ASPs.

Background: Carbapenem-resistant Acinetobacter baumannii Complex (CRAB) is associated with severe infections and high death rates. The 2024 bacterial priority pathogens list (BPPL) published by World Health Organization indicates CRAB to be a critical priority. This study attempts to describe the 30-day and 90-day mortality following date of specimen collection, and factors associated with higher death rate related to CRAB infections. Method A case was defined as a patient with Acinetobacter baumannii complex isolated from normally sterile sites, urine, lower respiratory tract specimens or wound specimen resistant to meropenem, imipenem or doripenem from the surveillance area. The surveillance area included Davidson and seven other surrounding counties in Tennessee. Epidemiologic and clinical data were collected through the Multi-site Gram-Negative Surveillance Initiative’s (MuGSI) from 2014–2024. Chi-square test was used comparing categorical variables, and logistic regression was used to calculate adjusted odds ratios of variables considered to be associated with mortality. Data analysis was done using SAS 9.4. Result Of 249 cases of CRAB, 151(60.64%) were male; mean age was 60.9 years. There were 167 (67.1%) white, 77 (30.9%) African American and 5 (2.0%) other races. 211(84.74%) cases had isolates from urine whereas 38 (15.26%) were from normally sterile sites. Thirty-seven cases (14.9%) and 60 (24.1%) cases died within 30 days and 90 days of specimen collection respectively. A higher proportion of African American persons died within 30 days compared to White persons (21.3% vs. 12.9%; P Conclusion In this study, older patients had a significantly higher risk of dying and African Americans also appeared to have increased risk of dying within 30 days after specimen collection. The risk of dying within 90 days was much higher for invasive infections. Understanding the risk factors associated with higher mortality is important to improve clinical outcome among patients infected with CRAB.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical multidrug-resistant pathogen. The Emergency Intensive Care Unit (EICU) is particularly vulnerable to transmission due to the high-pressure environment and need for immediate clinical decisions, often made with incomplete microbiological data. While patient-related factors are traditionally prioritized, the relative contribution of invasive procedures and environmental colonization pressure in this specialized setting remains under-quantified. This study aimed to identify the determinants of CRAB acquisition through a comprehensive, hierarchical analysis of patient, treatment, and environmental factors. Methods: A retrospective case–control study was conducted at a tertiary hospital from April 2020 to December 2023. Monthly indicators of CRAB acquisition were examined in relation to environmental characteristics using Spearman correlation. A four-block multivariable hierarchical logistic regression analysis, consisting of patient demographics, clinical characteristics, treatment factors, and environmental characteristics, was performed (48 cases, 144 controls) to identify independent risk factors for CRAB acquisition and to evaluate the model’s explanatory power. Result: During the study period, the monthly CRAB acquisition rate showed a median of 1.69 (range, 0.00–14.59) per 1,000 patient-days. This rate correlated positively with colonization pressure (daily mean number of CRAB-positive inpatients; r = .399, p = .007). Although hand hygiene compliance was high (median 93.8%; range 70.0–100.0%), it showed no correlation with CRAB acquisition rate (p = .753). In the hierarchical analysis, the model’s explanatory power improved significantly as treatment and environmental blocks were added (Nagelkerke R from .043 to .609). In the final model, carbapenem use was the strongest independent predictor (OR 8.58; 95% CI, 2.62–28.09; p p = .004), enteral nutrition (OR 6.36; p = .002), and mechanical ventilation (OR 4.79; p = .037). Colonization pressure also remained a significant independent risk factor (OR 3.56; p Conclusion: CRAB acquisition in the EICU is primarily driven by carbapenem-associated selection pressure, invasive procedures involving fluid exposure, and colonization pressure. Notably, the lack of correlation between high hand hygiene compliance and acquisition rates suggests that individual-level efforts alone are insufficient to mitigate risk in high-pressure environments. Consequently, effective prevention requires a paradigm shift from individual compliance toward organizational strategies. This includes strengthening treatment-related infection prevention bundles for high-risk invasive procedures and implementing dynamic environmental controls based on real-time colonization pressure.

Background: Antimicrobial resistance (AMR) is a major global threat to patient safety and healthcare systems, largely driven by inappropriate antimicrobial use. Antimicrobial Stewardship Programs (ASPs) are recommended to optimize prescribing practices and mitigate resistance; however, data on their impact in private hospitals, particularly in middle-income countries, remain limited. The objective of this study is to describe the implementation of an Antimicrobial Stewardship Program and evaluate its clinical, microbiological, and economic impact in a private hospital. Methods: We conducted a retrospective observational before–after study in a private hospital, comparing a pre-intervention period (January–December 2022) with a post-intervention period (January 2023–December 2025). The ASP was implemented by a multidisciplinary team and included development of institutional antimicrobial treatment and surgical prophylaxis guidelines, prospective audit with feedback, restriction and pre-authorization of selected broad-spectrum antimicrobials, and integration among clinical pharmacy, infectious diseases, microbiology, and infection prevention services. Outcomes included antimicrobial prescribing conformity, antimicrobial consumption, incidence of multidrug-resistant organisms (MDROs), and direct antimicrobial acquisition costs. Results: Antimicrobial prescribing conformity increased from 86% in the pre-intervention period to consistently above 95% during the post-intervention years. Analysis of 720 clinical cultures identified 62 MDRO cases (8.7%) in the baseline period. Following ASP implementation, gram-positive multidrug-resistant organisms declined progressively, with no cases detected after 2024, while resistance among gram-negative organisms showed variable trends over time. An initial reduction in the use of broad-spectrum antimicrobials, particularly carbapenems, was observed after program implementation. Annual antimicrobial costs decreased from R$ 842,903.75 (≈ US$ 155,797) in 2022 to R$ 568,570.77 (≈ US$ 105,210) in 2023, followed by R$ 842,903.75 (≈ US$ 155,797) in 2022 to R$ 568,570.77 (≈ US$ 105,210) in 2023, followed by increases in 2024 – R$ 996,912.08 (≈ US$ 184,445) and 2025 – R$ 1,070,034.74 (≈ US$ 197,856), coinciding with a substantial increase in the number of patients receiving antimicrobials (from 9,704 in 2022 to 15,018 in 2025).increases in 2024 – R$ 996,912.08 (≈ US$ 184,445) and 2025 – R$ 1,070,034.74 (≈ US$ 197,856), coinciding with a substantial increase in the number of patients receiving antimicrobials (from 9,704 in 2022 to 15,018 in 2025). Conclusions: Implementation of a structured ASP in a private hospital was associated with improved prescribing quality, reduced initial use of broad-spectrum antimicrobials, favorable trends in gram-positive resistance, and mitigation of cost escalation despite increased patient volume. These findings highlight antimicrobial stewardship as a scalable and effective strategy to improve patient safety and contain antimicrobial resistance in private healthcare settings.

Background: A foundational daily activity for infection preventionists (IP) is reconciling nursing isolation documentation to surveillance system current and historical isolation markers. Inefficiencies and isolation delays occur when: (i) electronic healthcare records [EHR] and IP surveillance tools are separate applications requiring manual person dependent resolution; (ii) EHR has logic limited isolation alerts or lack patient isolation history markers to activate on readmission; and (iii) IP staffing when limited to weekdays. Outcomes result in potential communicable disease exposures and added resources for bed reassignment and room cleaning of semi-private rooms. Surveys identified up to 25% of patients require a change in patient isolation status in an average 250-300 bed acute care hospital. Methods: EHR nursing isolation was aggregated to isolation alerts from IP third party surveillance software into a technology enabling advanced analytics platform in use for daily device rounds. Real time data overlays updated for admitted patients including pending ER hold admissions. Nursing and IP developed rules defining match agreement and review isolation conditions, visual displays and patient specific information. A pilot proof of concept was tested in 11 acute care hospitals ranging in size from 100 to 740 beds displaying both full facility and unit specific views. High performing nursing units operationalized the tool at the beginning of each shift during daily patient safety rounds including weekends and holidays. Results: Tool visuals displayed a patient list to prioritize review of isolation status (Figure 1), patient specific details of mismatch (Figure 2) and reconciled isolation (Figure 3). The average resolution within 24h was 86% (range 79-95%). Charge nurse adoption improved time to isolation, reduced reliance on IP manual processes, improved first time bed assignments and guided nursing patient care assignments. The tool solved for lab “new results” alert gaps to caregivers for MRSA, Candida auris, etc. and provided timely information to care team members unable to access EHR isolation status. Feedback was overwhelmingly positive from users. Short term limitations to reconciliation occurred for patients with clinical conditions warranting isolation pending diagnostic test results (i.e. C. difficile). Conclusion: The technology enabler tool brings together various data streams into a single view for patient care teams and leadership to prioritize activities. The tool enabled shared responsibility between nursing and IP for reconciling isolation status, improved communications, driving operational efficiencies and improving safety.

Background: Measles cases increased significantly in the Americas in 2025; the region lost its measles-free status due to the return of endemic transmission in Canada, Mexico, and the U.S., primarily driven by low vaccination rates among unvaccinated or under-vaccinated populations. In August 2025, Mexico City experienced a surge in measles cases, prompting an urgent call to boost immunization coverage among targeted groups through mass vaccination of children, adolescents, healthcare workers (HCWs), and adults under 50. We report post-vaccination mumps cases among HCWs from six hospitals. Methods: A retrospective study of individuals vaccinated with the Serum Institute of India measles, mumps, and rubella (MMR) vaccine, which contains the Leningrad-Zagreb (L-Z) strain, was conducted at six national referral tertiary care hospitals affiliated with the Mexican Ministry of Health. We included all individuals under 50 years who, 10-30 days after vaccination, developed salivary gland swelling with or without malaise, headache, lymphadenopathy, or fever. We performed a descriptive analysis and calculated the incidence rate of vaccine-related mumps per 1000 doses of the MMR vaccine. Results: Between 08/21/2025 and 11/30/2025, 10,590 HCWs received the Serum Institute of India MMR vaccine; 27 (2.5 X MMR 1000 vaccines) developed parotid swelling (7 bilateral, 20 unilateral), with concomitant fever in 7 (25.9%); lymphadenopathy, 10 (37%); pharyngitis, 11 (40.7%); arthralgias, 8 (29.6%); and headache, 11 (40.7%). One person developed a rash and malaise. The median time from vaccination to mumps was 16.8 days. No cases of meningitis or other complications were reported. The average duration of symptoms was 8.2 days. No secondary mumps cases were detected. Discussion: Post-vaccination mumps and aseptic meningitis after MMR vaccination are rare and infrequently reported, though prevalence varies by strain. Despite similar efficacy among MMR vaccines, the Serum Institute of India vaccine includes the L-Z strain, which carries a higher risk of mumps (approximately 4.4%) than the Jeryl-Lynn strain used in the MMR-II® (0.5-1.6%), which is primarily used in high-income countries. In our cohort, the prevalence of post-vaccine mumps with the Serum Institute of India MMR, a lower-cost vaccine, was low and consistent with other reports. No cases of aseptic meningitis were reported. With the rising number of measles cases worldwide and the need to increase vaccination coverage against measles in under-vaccinated populations, reinforcing the similar efficacy and safety of different vaccines is crucial. All HCWs must be protected.

Background: In response to the 2014 Ebola outbreak, Regional Emerging Special Pathogen Treatment Centers (RESPTCs) were established across the 10 U.S. Health and Human Services regions to maintain a high-level of preparedness to care for patients with high consequence infectious diseases (HCID) in specially designed biocontainment units (BCU). The Johns Hopkins BCU purposefully integrated infection prevention and control principles and practitioners into operational plans as the foundation of healthcare worker safety in the high-level isolation environment. Infection preventionists (IPs) serve as Trained Observers (TOs) who are responsible for oversight of enhanced personal protective equipment (PPE) donning and doffing procedures and overall safety throughout the clinical shift. The TO role is fulfilled exclusively by IPs who are essential to maintaining BCU staff proficiency by facilitating ongoing quarterly training. Methods: A comprehensive training and validation framework was implemented to sustainably embed IPs as TOs into the BCU program. First, a dedicated IP BCU program manager role was established to integrate infection prevention into ongoing protocol development and operational decision-making. Next, TO candidates underwent a standardized competency-based process that required demonstration of proficiency in leading enhanced PPE ensemble donning and doffing procedures. Additionally, TO candidates were expected to confidently demonstrate effective use of structured checklists and standard operating procedures, navigate BCU workflow and infrastructure, and be familiar with Category A waste management protocols. Risk identification and mitigation skills were reinforced through peer coaching and drilled over the course of multiple practice and training sessions. TO validation required independent confirmation of candidate proficiency by two validated TOs to ensure inter-rater consistency. Results: Over 11 years, 23 IPs achieved TO validation and continued to revalidate and maintain their skill set throughout their IP tenure during BCU quarterly training. Currently, 8 of 17 IPs are active TOs. IP integration into BCU training and operations fosters increased trust and a heightened sense of safety across the team. Dedicated TOs with the sole responsibility to ensure healthcare worker safety allows for deeper specialization and improved adherence to safety standards, unburdening other clinicians from balancing multiple roles between bedside and operational safety. Conclusion: Embedding IPs as TOs within RESPTC preparedness plans and BCU response operations—beyond their traditional role in developing standard operating procedures, processes, and protocols—is a best practice to promote a culture of safety and an innovative approach to support operational efficiency for patient care in high-level isolation environments.

Background: Blood culture (BCx) algorithms can safely and effectively reduce unnecessary BCxs. We compared the effect of implementing a BCx algorithm across multiple inpatient units within our hospital system, focusing on blood culture event (BCE) rates and secondary adverse events. Method: The same BCx algorithm (Figure 1) was implemented in multiple inpatient units across three hospitals in our health system (Figure 2). BCE rates were compared between pre- and post-intervention periods with interrupted time series (ITS) analyses. Differences in secondary outcomes, including incidence of central line-associated bloodstream infections (CLABSI) and Clostridioides difficile infection (CDI), were compared using χ tests. Result: The rate of BCE decreased after implementation of the BCx algorithm across all units (Figure 3). An immediate decrease in BCE rate was noted in most units upon implementation of the algorithm, except in the cardiac ICU, cardiac floors and neurocritical care unit. No unit demonstrated a significant post-intervention decrease in the BCE rate, with the surgical ICU demonstrating a significant regression to the mean with time. Antibiotic use decreased across all analyzed units (Figure 4). Readmission rates decreased significantly on the cardiac floor, neurocritical care unit and cardiothoracic ICU in hospital 1 and also in the critical care unit in hospital 2, while it increased significantly in the cardiothoracic stepdown unit. CLABSI rates decreased significantly in the cardiac ICU and the solid oncology floor, while CDI rates decreased significantly in the neurocritical care unit. No significant increase was seen in CLABSI and CDI rates or antibiotic use. Conclusion: This study demonstrated that the BCx algorithm was effective in decreasing BCEs across all units and hospitals without any clear harms. However, the effect of BCx algorithms is partially dependent on the nature of the unit where it is implemented. The decrease in BCEs was limited to the time period directly after implementation of the algorithm. No units demonstrated ongoing decreases in BCE rates, with the surgical ICU in particular demonstrating a steady increase of BCE rates as time progressed, although rates of BCE remained below pre-intervention levels. Consistent decreases were seen in antibiotic use post-implementation, although causality between the two cannot be determined. Further research is warranted on how to implement a more durable change and on the use of such algorithms in more specific populations, including immunocompromised hosts.

Background: Antimicrobial resistance (AMR) is increasingly concentrated in hospital settings, where severe infections, older patients and extensive antibiotic exposure converge. While antimicrobial stewardship programs (ASPs) are central to mitigation, long-term global evidence linking resistance patterns to actionable stewardship priorities (and especially for Gram-negative pathogens) has been limited. We assessed three decades (1990–2021) of global AMR trends to identify stewardship-relevant signals for hospital epidemiology and policy, and also developed forecasts scenarios to 2050. Methods: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations and 11 infectious syndromes across 204 countries from 1990–2021, using the Global Burden of Diseases 2021 framework. Analyses integrated 520 million microbiology, hospital discharge, mortality, pharmaceutical sales and antibiotic use records. AMR burden was quantified under two counterfactuals: replacement of resistant infections with drug-susceptible infections (attributable burden) and replacement with no infection (associated burden). Forecasts to 2050 evaluated a reference scenario, a Gram-negative drug development scenario, and a better-care scenario reflecting improved infection management and access to appropriate antibiotics. Results: In 2021, an estimated 4.71 million deaths (95% UI 4.23–5.19) were associated with bacterial AMR, including 1.14 million deaths (1.00–1.28) directly attributable to resistance. Hospital-relevant trends were dominated by Gram-negative resistance: carbapenem-resistant infections showed the largest absolute increase in burden, with associated deaths rising from 0.62 million in 1990 to 1.03 million in 2021. In contrast to declines exceeding 50% among children younger than 5 years, AMR mortality increased by over 80% among adults aged 70 years and older – a population disproportionately affected by bloodstream, respiratory and intra-abdominal infections managed in acute-care settings. By 2050, attributable AMR deaths are projected to reach 1.91 million globally under the reference scenario. Importantly, the better-care scenario (reflecting strengthened stewardship, timely appropriate therapy and improved quality of care) could avert an estimated 92.0 million cumulative deaths between 2025 and 2050, compared with 11.1 million deaths averted under a Gram-negative drug development scenario alone. Conclusion: The global AMR burden is increasingly driven by carbapenem-resistant Gram-negative infections in older, hospitalized populations. These findings indicate that antimicrobial stewardship and hospital infection prevention offer substantially greater population-level mortality benefits than reliance on new antibiotic development alone. Policy efforts should prioritize robust ASP implementation, optimization of empiric therapy for severe infections, rapid de-escalation, as well as system-wide improvements in care quality to curb the projected rise in hospital AMR mortality.

Background: In 2025, 50 measles outbreaks drove 87% of confirmed cases reported in the United States. As a highly infectious virus with an estimated R ranging from 12-18, we sought rapidly scalable and implementable measles preparedness measures for our facilities. Methods: The electronic health record (EHR) has flags that can be placed on patient records to denote the presence of, or concern for, active, transmissible infections. These flags are highly visible in the EHR and represent a good usability heuristic as front line providers are already trained to look for this information. Infection Prevention and Control (IPAC) worked with nursing informatics to develop measles-specific flags for suspected, confirmed and exposed patients in the EHR, expanding flagging functionality in preparation for potential measles cases and exposures. The flagging was tied to registry functionality to allow for tracking of exposed and confirmed cases longitudinally for supporting IPAC investigations in addition to clinical operations. Results: Three different flags were developed in the EHR to address measles. Specific criteria were created for each flag, as shown in Table 1. Table 1: Attached as Image Conclusion: As a highly contagious virus, measles presents unique challenges to healthcare facilities managing both cases and exposures. Measles flags within the EHR can be leveraged to assist facilities with case tracking, exposure management, and infection prevention and control.

Background: Isolation gowns are one of the most used personal protective equipment worn by healthcare workers to prevent healthcare associated infections (HAIs) that can spread via direct- or indirect contact of contaminated objects. Isolation gowns are available as either reusable or disposable; however, urgent data are needed to determine whether these two gown types are associated with differences in HAI rates. Objective: To assess if respiratory and gastrointestinal viral HAI rates differ by using disposable versus reusable gowns. Methods/design: A retrospective observational analysis compared HAI rates per 1000 patient-days before and after phased implementation of reusable gowns across inpatient units from July 2020 through November 2025. to examine the significance of differences in HAI rates. Results/discussion: The analysis identified 513 HAIs, including 314 respiratory and 169 gastrointestinal viral infections. Statistically significant lower HAI rates were observed with reusable gowns compared with disposable gowns for all HAIs combined (0.75 vs. 1.07, p=0.002) and gastrointestinal HAIs (0.26 vs. 0.35, p=0.009). Lower but statistically insignificant rates were observed for respiratory viral HAIs (0.49 vs. 0.72, p=0.07). Rates were comparable or lower with reusable gown use for norovirus (0.16 vs. 0.16, p=0.98), respiratory syncytial virus (0.03 vs. 0.04, p=0.67), and influenza (0.03 vs. 0.02, p=0.72). Implementation of reusable gowns was not associated with increased respiratory HAI rates and was associated with lower overall HAI incidence. These findings suggest that reusable gowns provide effective protection against respiratory pathogen transmission while supporting sustainability initiatives. Reusable gowns may represent a viable strategy to balance infection prevention, environmental impact, and resource utilization in healthcare settings.

This article seeks to develop a critical theory of political resentment that can account for the role of toxic sentiments of hatred and spite in contemporary processes of democratic backsliding by analyzing the Brazilian case. After reviewing debates about the concept of political resentment in modern and contemporary social theory, the article advances the concept of toxic resentment and outlines its three main constitutive elements. The article then presents the foundations for a critical theory of toxic resentment that focuses on two contextual factors: economic transformation or decline and actual or perceived status losses. The final sections discuss how such a theory can advance our understanding of the recent rise of conservative movements and the resulting crises of democratic politics. By highlighting the intersections between gender hierarchies, economic transformation, and support for the far right in Brazil and elsewhere, the conclusions define toxic resentment as a type of social and political bond that agglutinates different types of anxieties and hostile responses.

Background: Electronic surveillance for hospital-onset sepsis using CDC’s Adult Sepsis Event definition could provide an efficient and objective method to identify a broad array of serious healthcare-associated infections, many of which are missed through current reporting processes. We developed risk adjustment models of varying complexity to support facility-level comparison of hospital-onset sepsis rates, evaluated trade-offs between model performance and feasibility, and quantified residual inter-facility variation that may reflect gaps in care. Methods: We conducted a retrospective study of adults hospitalized for <3 days within 113 community hospitals between 2022-2023. Hospital-onset Adult Sepsis Events (HO-ASEs) occurring on day 4 or later were identified using updated CDC surveillance criteria. We used logistic regression to develop three risk adjustment models of increasing complexity using covariates from administrative and electronic health record data: basic model (hospital and aggregate patient descriptors), intermediate model (replacing aggregate patient descriptors with patient-level descriptors), and maximal model (adding detailed physiologic and clinical data from hospital days 1-3; Figure 1). We evaluated model performance using Area Under Receiver Operating Curve (AUROC), calculated hospital-level Standardized Infection Ratios (SIRs) for each model and assessed concordance in hospital rankings using Kendall’s tau coefficient (τ). Results: The cohort included 1,557,252 hospitalizations of <3 days, of which 24,169 (1.6%) met HO-ASE criteria and 8,500 (35.2%) died in-hospital. The basic model had limited discrimination (AUROC 0.589, 95% CI, 0.585-0.593). Adding patient-level characteristics to form the intermediate model markedly improved performance (AUROC 0.839, 95% CI 0.836-0.841), with further inclusion of detailed clinical data in the maximal model yielding modest additional improvement (AUROC 0.850, 95% CI 0.848-0.853). Concordance between hospital rankings derived from the crude or basic risk-adjusted HO-ASE rates versus rankings derived from the intermediate or maximal models was moderate (τ 0.40-0.51) whereas concordance between rankings derived from the intermediate vs. maximal models was high (τ 0.86). There was a wide distribution of HO-ASE SIRs across facilities even after risk adjustment using the maximal model (Figure 2), with high signal-to-noise ratios and good calibration. Conclusions: Risk adjustment models incorporating hospital characteristics and patient-level data perform well and might explain substantial variability in HO-ASE rates between facilities. The persistence of residual variability after highly detailed adjustment may reflect differences in care processes, suggesting that risk-adjusted HO-ASE comparisons can help identify gaps and opportunities in the prevention of severe healthcare-associated infections. Our findings support the use of HO-ASE as an electronic, scalable, risk-adjusted metric for facility-level benchmarking to inform quality improvement initiatives.

Background: NYC Health + Hospitals (H+H) provides care to large communities experiencing social vulnerability. During the 2022 mpox outbreak, H+H implemented a large-scale, targeted mpox vaccination campaign using electronic health record (EHR) reminders among groups with greatest risk of mpox infection. When demand was high, 25% of available vaccine appointments were reserved for established H+H patients. This study aims to describe patterns of mpox vaccination amongst eligible H+H patient groups. Methods: H+H started vaccinating with JYNNEOS in May 2022 and used EHR reminders to encourage vaccination amongst those eligible, including: (1) Patients with an HIV diagnosis AND who had a sexually transmitted infection in the past year; OR (2) Patients who received at least one mpox vaccine and was due for the second; OR (3) Patients with a sexual orientation in the EHR as Gay, Bisexual, Lesbian, Something else, or Choose not to disclose; OR (4) Patients with a gender identity in the EHR as Transgender Female, Transgender Male, Gender Non-binary/Nonconforming, Other, or Choose not to disclose. We extracted data from the NYC Citywide Immunization Registry through April 30, 2025, into our EHR. We calculated a Pearson correlation coefficient between the 2022 Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) and percentage who received at least one mpox vaccination by zip code with significance set at a p-value <0.05. Results: Figure 1 summarizes key events along the H+H mpox vaccination timeline. There were 112,680 H+H patients eligible for mpox vaccination, of which 25.7% received at least one dose by April 2025, compared to 51.5% amongst patients with HIV (Table). White patients had the highest proportion vaccinated (31.1%), and Hispanic/Latinx patients had the lowest (22.0%). Figure 2 indicates the percentage vaccinated by neighborhood at three time points (September 2022, April 2023, April 2025). As of April 2025, the percentage of eligible individuals vaccinated by zip code was negatively correlated with SVI of the zip code (r= -0.0529; p<0.01) (Figure 3). Conclusion: Amongst eligible H+H patients, we identified disparities in mpox vaccination rates by race/ethnicity, neighborhood, and the zip code SVI. The use of EHR reminders may have helped us achieve a higher vaccination rate amongst eligible patients with HIV, compared to the overall cohort. A limitation may be misclassification of eligible individuals, which relies on structured social history and gender identity data accurately documented in the EHR. Our findings identify areas for quality improvement to optimize vaccine equity.

Background: Healthcare-associated bloodstream infections (HABSIs) are major cause of morbidity and mortality in intensive care units (ICUs), particularly in low - and middle-income countries (LMICs). However, ICU-level surveillance data describing the epidemiology and antimicrobial resistance pattern of bloodstream infections in Vietnam remain limited. Methods: We conducted a restrospective descriptive study using routine infection prevention and control (IPC) surveillance data from an adult ICU at a tertiary infection diseases hospital in Hanoi, Vietnam. All laboratory-confirmed HABSI episodes recorded between October 2023 and December 2025 were included. Cases were identified using standardized national IPC surveillance definitions aligned with CDC/NHSN principles. Demographic characteristics, exposure to invasive devices, microbiological profiles and antimicrobial resistance patterns were analyzed. Results: A total of 134 HABSI episodes were identified. Male patients accounted for 73.9% (99/134) of cases. Most infections occurred among critically ill ICU patients with prolonged ICU stays and exposure to invasive devices. Central venous catheters were present in the majority of HABSI episodes 84.3% (113/134), suggesting a high level of exposure to intravascular devices. Gram-negative organisms predominated (82 episodes) with Acinetobacter baumannii was the most frequently identified pathogen (20.9%), followed by Klebsiella pneumoniae (15.7%) being the most frequently isolated pathogens. A high proportion of isolates demonstrated multidrug resistance, with 67.1% (55/82) of gram -negative isolates exhibiting carbapenem resistance, predominantly a mong A.baumanii and K.pneumoniae . In addition, fungal bloodstream infections due to Candida species accounted for 30 episodes (22.4%). Conclusion: HABSI in this adult ICU were associated with frequent central venous catheter use and a high burden of antimicrobial resistance, particularly carbapenem-resistant gram-negative bacteria dominated by Acinetobacter baumanii. The substantial proportion of candidemia further highlights the complexity of bloodstream infections in critically ill patients. These findings underscore the importance of strengthening facility-based IPC surveillance, optimizing central line care practices, and integrating stewardship interventions in high-risk ICU settings in Vietnam.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections present treatment challenges due to host-related factors, infection source, and complex resistance mechanisms. Attribution of poor clinical outcomes to suboptimal therapy versus underlying host factors remains unclear. Evidence supporting an optimal treatment strategy is limited. Current Infectious Diseases Society of America (IDSA) guidance recommends high-dose ampicillin-sulbactam in combination with an additional agent, including minocycline, as a treatment option. In 2025, the Clinical & Laboratory Standards Institute (CLSI) lowered the A. baumannii minocycline susceptibility breakpoint from ?4 to ?1 mcg/mL. Despite this change, our health system’s standard practice includes high-dose ampicillin-sulbactam plus minocycline for invasive CRAB infections. Given the updated CLSI breakpoint, this study evaluated clinical outcomes among patients with CRAB infections treated with minocycline. Methods: This was a retrospective cohort study of hospitalized adult patients with CRAB isolates who received minocycline within a large integrated health system from June 1, 2024, to June 1, 2025. Patients were excluded if isolates were deemed colonization by provider documentation or cultures were obtained in the outpatient setting. The primary outcome was clinical failure defined as need for antibiotic escalation, lack of microbiologic cure, 90-day readmission requiring retreatment, or 90-day all-cause mortality. Result: We identified 137 CRAB isolates from 128 patients; majority were male (84, 61.3%) with a mean age of 63 ± 14.5 years. ICU admission occurred in 57 patients (39.4%) and the mean Charlson Comorbidity Index was 6.1 ± 2.5. The most common infection sources were respiratory (75, 54.7%), skin and soft tissue/osteomyelitis (34, 24.8%), and bloodstream (19, 13.9%). Most infections were polymicrobial (95, 69.3%). Combination therapy was used in 102 cases (74.5%). Based on updated CLSI breakpoints, only 35% of isolates were minocycline susceptible versus 84% susceptibility to previous breakpoints. Clinical failure was similar regardless of minocycline susceptibility (52.1% with MIC ?1 mcg/mL vs 51.7% with MIC <1 mcg/mL, p=0.964). In contrast, clinical failure was more frequent among patients with CRAB bacteremia (14/19, 73.7%; p=0.04), 18 of which had isolates with a minocycline MIC Conclusion: Following the 2025 CLSI breakpoint revision, most CRAB isolates were identified as minocycline resistant. Clinical outcomes did not differ between groups based on minocycline susceptibility. Outcomes were poor however for sterile-site infections despite documented in-vitro susceptibility. These findings highlight the need for careful differentiation between colonization and true infection at non-sterile sites and emphasize the limitation of MIC-based susceptibility in predicting clinical outcomes of CRAB infections.

Background Inappropriate urine culturing is a driver of unnecessary antibiotic use and treatment of asymptomatic bacteriuria. Diagnostic stewardship interventions, including clinical decision support(CDS), can reduce urine culture utilization; however, their impact on downstream testing patterns and antibiotic prescribing remains limited. In August 2024, Tufts Medical Center implemented an indication-based CDS requiring providers to select a guideline-concordant indication when ordering inpatient urinalysis(UA), UA with reflex to culture(UARC), or urine culture alone(UCx) We evaluated the impact of this intervention on urine testing utilization, ordering appropriateness, and associated antibiotic prescribing. Methods We conducted an interrupted time series analysis of monthly urine testing rates from August 2023 through July 2025, with CDS implementation in August 2024. The primary outcome was utilization of urine testing, measured as rates of UA, UARC, and UCx per 1000 patient days. Segmented regression models with a normal distribution and identity link were used to estimate baseline trends, immediate level changes at implementation, and post-intervention trend differences(ITS). As a secondary outcome, we retrospectively reviewed a random sample of 153 adult patients post-implementation UARC orders to assess urine testing appropriateness and antibiotic prescribing based on clinical documentation and predefined institutional criteria(Image 1). Results During the study, 124,762 urine tests were ordered across 225,614 census days. Prior to CDS implementation, UA, UARC, and UCx rates showed no significant secular trends(Figure 1-3). Following implementation, UARC and UCx rates showed immediate and significant level decrease. UARC utilization increased post-implementation but remained below pre-intervention levels, while UCx rates showed a sustained reduction without significant post-intervention trend change. In contrast, UA rates increased immediately after implementation, followed by a non-significant decline. Table 1 summarizes effect estimates. Of 153 audited UARC orders, 46.4% originated from the emergency department (ED), 41.2% from intensive care unit and 12.4% from inpatient floor units. Urinary signs or symptoms were the most frequently selected indication for UARC, particularly in the ED(95.8%). Documentation supported appropriate UARC testing in only 9.9% of ED orders, 19.2% of floor orders, and 27.8% of ICU orders. Antibiotics were initiated for presumed urinary tract infection(UTI) in 29 patients(19%), of whom 9(5.9%) had documented UTI. Conclusion Indication-based urine testing CDS intervention produced immediate and intended changes in testing utilization (decreased UARC and Ucx, and increased UA), followed by partial attenuation of the UARC effect over time. Post-implementation chart audit demonstrated persistent gaps in documentation-supported appropriateness and antibiotic initiation, underscoring the need for additional targeted stewardship interventions beyond CDS alone.

Background: Nursing homes residents are at high risk of severe COVID-19 infections. Age-related immunosenescence blunts the response to routine vaccinations, such that the estimated vaccine effectiveness for COVID-19 is <33% in nursing home residents. We assessed risk factors associated with breakthrough COVID-19 infections (BT) among previously vaccinated residents of Veterans Affairs (VA) nursing homes, termed Community Living Centers (CLCs). Methods We characterized residents who had received the primary COVID vaccine series and were present in VA CLCs at four census dates: 1/1/21, 7/1/21, 1/1/22, and 7/1/22 which included the Delta (mid-2021), Omicron BA.1 (early 2022) and BA.4/BA.5 (mid-2022) peaks. In each of these census cohorts, we assessed COVID-19 booster vaccines and identified laboratory confirmed COVID cases. We identified time-at-risk for BT starting at 14 days post-primary series vaccination or the beginning of the 6-month interval; and extending until death, BT, 7 days after discharge, or the end of the 6-month interval. For each census date, we characterized risk factors for BT and death following BT using survival and logistic regression models, respectively. Results We identified Table 1). Cases of BT infection increased from 41 pre-Delta to <800 during the Omicron BA.1 and BA.4/BA.5 waves. Survival models indicated an increased risk of BT among residents aged ≥Figure 1). We did not detect significant effects of sex, race and ethnicity, or Charlson Comorbidity Index (CCI). Compared to the primary series alone, a single booster dose had a protective effect against BT infection during the July 2021 and January 2022 eras; we did not detect effects of additional boosters. Mortality models from all census dates included 2011 residents with BT. Age ≥Figure 2). Discussion Among vaccinated nursing home residents, age ≥