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 ≥

Background: Blood culture contamination leads to unnecessary clinical interventions and increased healthcare costs. Estimations indicate each contamination incurs over $4,500 in avoidable cost. The 2024 IDSA/ASM guideline advises blood culture collection via peripheral venipuncture and cultures from existing vascular catheters should be reserved for suspected Central line associated bloodstream infection (CLABSI) and paired with a peripheral set. It was observed that routine ordering and collection of blood cultures from central venous catheters (CVC) was common practice at our institution and our blood culture contamination rate was above the recommended 1% goal. A multidisciplinary quality improvement plan was implemented to reduce inappropriate catheter blood culture collection. Methods: A pre-post intervention study was conducted at a large quaternary medical center from January 1, 2023 to December 31, 2024 (pre-intervention) and January 1, 2025 to December 31, 2025 (post-intervention). The intervention included simultaneous updates to 1) provider clinical practice guidelines for blood culture indications, 2) nursing policies on culture collection techniques and 3) nutrition policies regarding surveillance cultures from CVCs prior to initiation of total parenteral nutrition. Education was provided and reinforced at multidisciplinary quality rounds as well as various meetings, huddles and lectures. Blood culture contamination was defined using CLSI criteria and rates and collection sites were compared pre and post intervention. CLABSI was determined using National Healthcare Safety Network (NHSN) definitions. CLABSI rates and blood culture collection sites were compared pre and post-intervention. Results: During the study period, 185,030 sets of blood cultures were collected. The number of blood cultures collected from a CVC significantly decreased (Table 1) and the contamination rates of cultures significantly decreased from both peripheral venipuncture and CVC. By reducing collection from lines, 29 estimated contaminations were avoided, with an associated cost savings of $131,602 and a reduction of 203 antimicrobial days. There was a significant decrease in CLABSI rate in the post-intervention period (Figure 1). There were significantly fewer blood cultures drawn from CVCs in patients with NHSN CLABSI in the post-intervention period (70% vs 50%, p = 0.0005). Conclusions: The simultaneous policy change and multifaceted reinforcement with strong senior leadership support resulted in rapid adoption and sustained change in blood culture ordering and collection practices. There was a significant decrease in the proportion of blood cultures drawn from CVCs, blood culture contamination and CLABSI rate in the post-intervention period leading to significant cost savings, fewer antimicrobial days and improved patient outcomes.

Background: Patients in the intensive care unit (ICU) often require two concurrent central venous catheters (CVCs) – a temporary CVC for medication administration and a hemodialysis (HD) catheter (HDC). Having concurrent CVCs increases the risk of central line-associated bloodstream infections (CLABSIs). Triple-lumen HDCs have an additional lumen, which may reduce the need for concurrent CVCs as compared to double-lumen HDCs. We evaluated CVC utilization and prevalence of concurrent CVCs in patients with HDCs in an academic ICU after implementing triple-lumen HDC use. Methods: We analyzed data from patients with newly placed HDCs, admitted to a 20-bed medical ICU in an academic hospital in Atlanta, GA from November 2022-January 2025. Triple-lumen HDCs were introduced February 2024. Data were obtained from the electronic health records. Concurrent CVC was defined as having a newly placed HDC and any other simultaneous CVC for at least one calendar day during the ICU admission. Central line-days were defined as number of CVCs in place per 1000 patient-days and lumen-days were defined as number of lumens in place per 1000 patient-days. We analyzed CVC and lumen utilization and prevalence of concurrent CVCs after the intervention by interrupted time series analysis (ITS). ITS with Poisson regression determined if there was a decrease in lumen-days or admissions with concurrent CVCs in the post-intervention vs. pre-intervention time period. An exploratory analysis compared the number of CLABSIs (as defined by NHSN) pre- and post-intervention. Results: Conclusion: After the introduction of triple-lumen HDCs to an academic medical ICU, the total prevalence of patients on HD requiring concurrent CVCs decreased, however our sample size was too small to demonstrate statistical significance by ITS. Decreasing the need for concurrent CVCs may reduce CLABSIs in this ICU but additional time post-intervention is needed.

Background: Candida auris, an emerging multidrug-resistant yeast, spreads rapidly in healthcare settings and is associated with difficult-to-control outbreaks. Prevalence has risen significantly in the Metro Detroit area, driven by interfacility transfers and inconsistent communication of colonization status. Patients can remain colonized for prolonged periods and shed the organism into the environment, where it persists for months. Active surveillance testing (AST) can support earlier detection and containment. We describe the implementation of a C. auris AST program across a multi-hospital health system. Methods: Screening for C. auris colonization can be either prevention?based or response?based. Response?based strategies, such as point prevalence surveys (PPS), are recommended by the Centers for Disease Control and Prevention when a new case is identified. Prevention?based AST is also recommended to detect cases early among high?risk groups. In April 2025, we launched a C. auris AST program across five hospitals in Southeast Michigan. Composite axilla–groin swabs were tested by real?time polymerase-chain reaction (PCR). High?risk patients were defined as those presenting from long?term acute care hospitals, skilled nursing facilities, subacute rehabilitation facilities, or inpatient rehabilitation centers who required ED admission or transfer from another healthcare facility (including internal transfers) and had one or more of the following: indwelling devices (e.g., endotracheal or tracheostomy tubes), chronic or non?healing wounds, or colonization/infection with multidrug?resistant or carbapenem?resistant organisms. Upon order signing in the electronic health record, an alert prompted providers to order C. auris PCR and initiate contact precautions. Patients were retested upon readmission. PPS were also performed per state health department recommendations following identification of new cases. Results: During the 6?month surveillance period, 2,710 unique patients underwent AST, with 3,044 total tests completed. Of these tests, 969 (31%) were ordered in the emergency department at the time of admission. Overall, 37 patients (1.2%) screened positive for C. auris colonization (Table). During the same period, 1,354 tests were performed through 77 unit?based PPS, yielding 22 positive results (1.6%). Conclusion: Although AST was implemented as a prevention?based strategy, PPS remained necessary for identifying additional cases. Positivity rates were low across both approaches, yet each required substantial coordination, staff time, and laboratory resources. These findings highlight the need to balance the benefits of early detection with operational demands. Alternative approaches beyond widespread screening should be explored to optimize resource utilization while maintaining effective C. auris prevention and control.

Background: Candidozyma auris is an emerging healthcare-associated pathogen that colonizes human skin and survives on healthcare surfaces for up to two weeks. As C. auris re-contaminates the healthcare environment within hours of disinfection, a continuously active disinfectant may provide an advantage over traditional disinfectants in healthcare environments with high rates of C. auris colonization. Water-stable organosilanes (WSOs) have demonstrated continuously active disinfection against bacterial and viral species but have not been studied against C. auris. Goldshield® GS75 (Locust Valley, NY) is a WSO composed of a siloxane bonding agent providing surface coating, a nitrogen molecule for organism attraction, a long carbon chain for cellular penetrance, and a quaternary ammonium compound for disinfection. We tested the efficacy and duration of effect of GS75 on survival of C. auris in vitro. Methods GS75 was applied to C. auris colony forming units (CFUs). After one hour, coupons were swabbed using premoistened sponge-sticks (Neogen Sponge-Stick with proprietary neutralizing buffer active against chlorine and QACs; Neogen, Lansing, MI), processed using the stomacher method and plated quantitatively to Sabouraud Dextrose agar (RemelTM, Lenexa, KS) then incubated for 48 hours at 37°C in ambient air. Duration of GS75 activity was assessed using the same method, with C. auris re-inoculated daily to simulate repeated contamination from a C. auris colonized or infected patient, and recovery attempted at 4 hours, 24 hours, 48 hours, 72 hours, 7 days, 14 days, 21 days, and 28 days after coupon treatment. (Figure). A separate set of coupons was wiped daily with a dry microfiber cloth or a 10% sodium hypochlorite bleach wipe (Sani-Cloth®, PDI, Woodcliff Lake, NJ) before daily re-inoculation to simulate routine environmental cleaning practices that might be necessary even with use of a continuously active disinfectant. Results Mean C. auris CFUs recovered from untreated coupons exceeded 145 at all sampling times, while GS75-treated coupons showed significantly reduced C. auris recovery. The addition of daily bleach or microfiber cloth wiping had minimal effect on GS75 activity (Table). Conclusion One application of GS75 reduced survival of C. auris on a common healthcare facility surface material for up to 28 days, despite repeated C. auris challenge and with minimal reduction in activity after physical or chemical cleaning. These findings support evaluation

Background: PNGS technology to identify microbial DNA in blood, is used to diagnose infections not identified with standard cultures. The National Healthcare Safety Network (NHSN) defines central line associated bloodstream infection (CLABSI) as an NHSN defined laboratory confirmed bloodstream infection (LCBI) in the presence of an eligible central line. The LCBI definition was updated in 2020, to include pNGS as a non microbiologic test to define CLABSI, not accompanied by a standard blood culture. This study describes the adverse impact of pNGS on CLABSI rates at a pediatric hospital. Methods: CLABSI events attributed to pNGS results, were identified through hospital infection control records from January 2020 through June 2025. Medical charts were reviewed for blood cultures, indications for testing, prior pNGS, and changes in antimicrobial therapy based on pNGS results. CLABSIs associated with mucosal barrier injury (MBI) were not included as these are not part of nationally reported rates. Results: 138 eight CLABSI events were identified during this timeframe, with 21(15.2%) defined by pNGS results. CLABSI rates are shown in the Table. Of pNGS defined CLABSI events, 11 patients had sites of infection other than blood, and 6 had pNGS done only to follow up prior pNGS results. Eight children with organisms identified on pNGS were already being treated and 8 new organisms on pNGS results were considered not clinically significant and not treated. Antimicrobial therapy was given in response to pNGS results for 5 patients: a neonate with candida and ureaplasma on pNGS, a pancreatitis patient with Enterococcus avium and Staphylococcus epidermidis on pNGS, a patient started on ganciclovir due to CMV, and 2 patients treated for organisms on pNGS associated with previously identified non bloodstream infections. Conclusion: Inclusion of pNGS defined CLABSI events increased reported CLABSI rates by a mean 19.2% per year. Most pNGS results were associated with non bloodstream infections. The clinical significance of pNGS results is uncertain and positive results do not correlate with bacterial bloodstream infections. PNGS results should not be considered comparable to traditional blood cultures and should not be used to define CLABSI events.

Background: Central-line-associated bloodstream infections (CLABSI) are a costly yet preventable healthcare-associated infections, contributing to increased morbidity and mortality. We describe the impact of a multidisciplinary multi-faceted approach on CLABSI rates at our institution. Methods: This is a pre—post quasi-experimental retrospective study across an 877-bed, quaternary care academic hospital in Southeast Michigan. The CLABSI rate per 1,000 central-line days, blood culture (BC) order rate per 1,000 patient days, standardized infection ratio (SIR) and standardized utilization ratio (SUR) in the pre-intervention period (1/2023-6/2024) to the post-intervention period (9/2024-8/2025) were compared. CLABSI was determined using National Healthcare Safety Network criteria. The multi-faceted intervention comprised of: (1) implementation of a diagnostic stewardship guideline with an algorithm-based approach to improve appropriate blood-culture ordering; (2) prompt notification of CLABSI-eligible patients to facilitate early evaluation for secondary sources; and (3) use of an electronic central line indications checklist to promote early removal of unnecessary lines, supported by an interprofessional stakeholder meeting in June 2024 that designated unit-level champions for execution and feedback. Results: The CLABSI rate significantly decreased from 1.604 to 1.044, resulting in a 35% reduction (p<0.017) [Table]. The SIR significantly decreased from 1.315 to 0.857, a 35% reduction (p=0.011). The SUR significantly decreased from 0.911 to 0.832, a 9% reduction (p<0.001). The BC order rate per 1,000 patient days decreased from 89.2 in the pre-intervention period to 70.7 post-intervention, a 21% reduction (p<0.001). Discussion: A significant reduction in CLABSI rates, central-line utilization, and blood-culture orders was observed following implementation of a multi-faceted approach supported by multidisciplinary collaboration. These findings demonstrate that a coordinated bundled strategy, executed in close collaboration with primary clinical teams, can significantly reduce CLABSI burden in a large academic medical center.

Clostridioides difficile (C. difficile) negatively impacts patient care and health care costs. Monitored as a safety metric, hospital onset- C. difficile infections (HO-CDI) occur after day 3 of admission. Standardized Antimicrobial Administration Ratio values for antibacterial agents posing highest risk for C. difficile infection (CDI SAAR) provides national benchmarking and assesses the impact of interventions aimed at improving prescribing practices to reduce C. difficile rates. We implemented several antimicrobial stewardship interventions to evaluate whether these reduced CDI SAAR values and C. difficile rates. Before 2023, C. difficile testing consisted of PCR alone after meeting certain criteria. This changed so that a positive PCR test reflexes to an EIA for toxin B; if negative, CDI is ruled out. Stewardship interventions in 06/2023 provided targeted education and feedback on CDI SAARs to ICU pharmacists to improve antimicrobial use. In 10/2023, a second intervention targeted high SAARs in the medical step-down unit (MSD) through daily patient review for antibiotic optimization. By early 2025, the antimicrobial stewardship pharmacist and physician initiated twice-weekly meetings to assess antimicrobial appropriateness. Patients were identified via chart review or pharmacist referral, and recommendations were communicated to the providers and documented in the chart. HO-CDI decreased both in the ICU and hospital wide after changing to two-step testing, decreasing from 0.55 to 0.25 infections/10,000 patient days (PD) hospital wide (Figure 1) and from 1 to 0.5/10,000PD in ICUs (Figure 3). In 2023, prospective audit and feedback by stewardship pharmacists in MSD patients resulted in a decrease in CDI SAAR from 1.26 to 1.12 (Figure 2). In October 2023, targeted education to ICU pharmacists coincided with reduction of ICU CDI SAAR from 1.57 to 1.43 (Figure 4). After biweekly stewardship rounds were implemented in 2025, HO-CDI decreased from 0.25 to 0.12/10,000PD hospital wide (Figure 1) and from 0.5 to 0.12/10,000PD in our ICUs (Figure 3). Special cause with 5 points at or below the line is noted in our hospital wide SAAR (Figure 2). Also noted special cause with increase in our hospital wide HO-CDI in November 2025 but an investigation did not identify a known cause. Interventions that reduce CDI SAAR values decreased HO-C difficile infections. Targeted interventions like prospective audit and feedback and educating team pharmacists on SAARs improved antibiotic utilization. Handshake stewardship rounding not only reduced SAAR but also decreased HO-CDI in our experience. Antibiotic Stewardship Programs help hospitals improve clinical outcomes and minimize harm by improving antibiotic prescribing.

Background: Staphylococcus aureus is a leading cause of healthcare-associated infections and is associated with high mortality. While decolonization has been effective in reducing methicillin-resistant S. aureus (MRSA) infections in adult and neonatal intensive care units (NICUs), little is known about the impact of decolonization on transmission of S. aureus. Here, we evaluated whether weekly screening and targeted decolonization reduce genomically defined transmission of S. aureus in a NICU. Methods: Infants admitted in 2022-2024 to the NICU at Tisch Hospital received weekly screening cultures of the nares, axilla and groin for MRSA and methicillin-susceptible S. aureus (MSSA). Colonized infants received topical decolonization with chlorhexidine 2% bathing and nasal, buttock, and umbilical mupirocin, with frequency and duration of decolonization based on postmenstrual age (gestational plus chronological age). Genome sequencing was used to identify transmission events, defined as genetically linked S. aureus isolates with <20 single nucleotide variants identified in two infants with overlapping stays. Transmission risk was analyzed using time-to-event (TTE) analyses, and the absolute risk reduction and number needed to treat (NNT) were estimated. Results: Among 1,597 screened infants, 188 (11.8%) were colonized with S. aureus (85.6% MSSA; 14.4% MRSA). Colonized infants had a median NICU length of stay of 96 days, and 39 (20.7%) were involved in at least one transmission event. Of these infants, 84.6% received full decolonization. Across the cohort, 389 conversions from colonization negative to positive were observed, including 97 recolonization events; 55 (56.7%) of these infants became colonized ? 3 times during their stay, indicating sustained exposure and transmission pressure. TTE modeling predicted a 30-day transmission risk of 0.6% if all patients were decolonized, and 8.9% risk if no patients were decolonized. This corresponds to a 30-day absolute risk reduction for transmission of 8.2% and an NNT of 12; decolonizing 12 infants prevented one S. aureus transmission. Conclusions: Genomically informed modeling indicates that weekly screening and targeted decolonization reduce S. aureus transmission in the NICU. Frequent recolonization supports the importance of weekly S. aureus screening and suggests that decolonization prevents infection partly by limiting spread to susceptible hosts, with implications for the spread of resistant strains. Future analyses incorporating time-varying eligibility and exposure will further refine these transmission estimates.

Background: Candida kefyr, a non-albicans-yeast species, is recognized as a potential emerging pathogen among immunocompromised patients. Previous epidemiological studies have indicated that hematologic malignancy is a key risk factor for invasive infection among patients with cancer and those with neutropenia; however, the clinical impact is not well defined. Methods: As part of a clinical inquiry, we conducted a retrospective review of laboratory-confirmed cases of C. kefyr to understand its occurrence and distribution at an NCI-designated comprehensive cancer center from January 2024 through September 2025. Demographic, laboratory, and clinical outcome data were extracted from the electronic medical record. Epidemiologic data were reviewed to evaluate for potential trends or characteristics of patients with C. kefyr infection or colonization Results: Overall, 24 isolates were identified from 21 distinct patients. The majority were from urinary sources (71.4%). The majority of cases were considered colonizers (61.9%), but eight (38.1%) patients had clinical infections, including two (25%) bloodstream infections. The majority of patients were female (15, 71.4%) with a median age of 70 years old and an Eastern Cooperative Oncology Group (ECOG) score of 3 or greater (13, 62%). In contrast to published literature, a majority (17, 81.0%) of patients had solid tumors, and hematologic malignancy was less common, with only one patient having severe neutropenia at the time of culture. The majority (16, 76.2%) of patients had some form of central venous catheter. Only two (9.5%) patients were receiving antifungal therapy at the time of culture, with one additional patient having received antifungal therapy within the preceding 90 days. Overall, the 90-day mortality in patients with C. kefyr isolated was high (14/21; 66.7%), though not necessarily related to the organism. Conclusions: C. kefyr is a potential emerging pathogen, and patients with colonization or infection were noted to have substantial 90-day mortality. In contrast to prior studies, we observed several cases in non-neutropenic patients with solid tumors. Additional comparative studies with other organisms or Candida species are needed to better characterize risk factors, clinical impact, and the role of this organism in cancer patients.

Background: Identified risk factors for Candida auris infection are generally markers of disease severity and/or medical vulnerability. A regional C. auris outbreak in 2022 led to extensive admission and point-prevalence testing in tertiary care hospital. We retrospectively reviewed charts to identify novel risk factors for progression from colonization to infection in a universally medically complex population. Methods: A case-control study was performed to compare patients developing invasive infection (cases) from those remaining colonization. Inclusion criteria were patients newly identified to be colonized with C. auris during a hospital admission from 1/2023 through 5/2025. Patients diagnosed with clinical infection as their first evidence of colonization were excluded. Risk factor variables included ICU status, other drug resistant organisms (MDROs), length of stay (LOS), time to colonization (days from admission to identification of C. auris), antimicrobial coverage with broadly acting agents, operative and other procedures, type/number of devices. Factors were compared between cases and controls using Fisher’s Exact Tests for categorical variables and Mann-Whitney U Tests for continuous variables using SAS 9.4. Results: During the study, 74 patients became colonized and 17 went on to develop invasive infection. The following were associated with infection: colonization with other MDROs, tracheostomy, liver failure, dialysis (though not renal failure), transplant w/in last year (driven by liver, N=7), number of drains at colonization (table 1). Several factors associated with severity of illness (ICU status, antibiotic pressure) were not associated with progression to infection in this cohort. Discussion: In a medically complex population, several risk factors associated with illness severity were not associated with progression from C. auris colonization to infection, whereas liver disease and transplantation, along with other MDROs, tracheostomy, and number of drains were. Targeted interventions attempting to decolonize tracheostomy or drain sites, and/or liver disease patients in general may help prioritize infection prevention where it is most needed.

Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.

Background: Optimizing antimicrobial use is essential to reducing antimicrobial resistance and healthcare-associated infections. The Standardized Antimicrobial Administration Ratio (SAAR), reported through the National Healthcare Safety Network (NHSN), provides a risk-adjusted benchmark for antimicrobial utilization, yet its use as a structured feedback tool across multiple hospitals remains limited. In June 2025, a jurisdiction-led antimicrobial stewardship intervention was implemented to provide standardized, data-driven feedback to acute care hospitals. This analysis evaluates early changes in facility-level SAARs following implementation. Methods Five acute care hospitals participated in a monthly feedback intervention adapted from a previously piloted quarterly model. Public health analysts generated standardized written reports using routinely submitted NHSN SAAR data for adult inpatient antimicrobial use. Reports included facility-level SAAR benchmarking, peer comparisons across participating hospitals, and qualitative assessment of prescribing patterns, including empiric therapy selection, de-escalation opportunities, and duration of therapy. Facility-level SAAR trends from January 2024 through December 2025 were examined using descriptive time-series review. Percent change relative to the June 2025 baseline was calculated for July–December 2025. Year-over-year comparisons to the same months in 2024 were used to account for seasonality. Results Pre-intervention SAARs varied across hospitals, with several facilities demonstrating upward trajectories. Following implementation, three of five hospitals demonstrated relative declines in overall SAARs, while two hospitals showed stabilization after previously increasing trends. Percent-change analyses for July–December 2025 showed reductions of approximately 0.5% to 7% compared with the June 2025 baseline, with three hospitals achieving declines of 5–7%. Year-over-year comparisons indicated reductions of approximately 3–10% in three hospitals, with the remaining facilities showing stable use (≤2% change). Conclusions Early findings suggest that a jurisdiction-led, SAAR-based feedback model may support measurable improvements or stabilization in antimicrobial use across diverse acute care hospitals. Leveraging routinely available NHSN data to provide consistent, structured feedback represents a feasible, low-burden approach to strengthening antimicrobial stewardship efforts. Ongoing analyses will evaluate unit-specific and antimicrobial-specific SAAR categories to further characterize the intervention’s impact.

Background: Active surveillance for carbapenem-resistant Acinetobacter baumannii (CRAB) is essential for infection prevention in endemic settings. Skin screening using pre-moistened sponges with enrichment has demonstrated the highest sensitivity for CRAB detection and is considered the reference standard. However, sponge-based sampling is labor-intensive and less feasible for routine use. Prior studies reported limited sensitivity of swab-based screening. We evaluated whether an optimized swab-based protocol, incorporating expanded skin sampling sites, could improve sensitivity compared with sponge sampling among known CRAB carriers. Methods: This paired-method study included hospitalized patients with documented prior CRAB carriage withing prior 3 months. On the day of screening, skin samples were collected before bathing simultaneously using Polywipe sponges and dry E-Swabs (Copan Italia S.P.A., Brescia, Italy), from opposite sides of the body. Swabs were used to sample multiple skin sites, including palm, interdigital spaces, antecubital fossa, axilla, groin, knee crease, sole of the foot, and toe webs, encompassing moist skin folds known to favor Acinetobacter colonization. Skin samples were collected from patients’ arms and legs (groin and downward), Sponge samples were incubated overnight in brain–heart infusion (BHI) broth at 37 °C, vortexed, and plated onto CHROMagar MDR Acinetobacter. Swabs were broken directly into 3 mL BHI broth, incubated overnight, vortexed, and plated identically. Sponge sampling was defined as the gold standard. Sensitivity of swab screening was calculated among sponge-positive samples. Results: Among 134 paired screening samples from known CRAB carriers, 95 (70.9%) were positive by sponge sampling. Of these, 78 were also positive by swab screening, yielding a swab sensitivity of 82.1% (95% CI, 73.2–88.5). Thirty-nine patients (29.1% of the cohort) screened negative by both methods on the day of sampling, despite prior documented carriage. Discordant results were predominantly sponge-positive/swab-negative. Conclusions: Among patients with known CRAB carriage, an optimized swab-based skin screening protocol achieved substantially higher sensitivity than previously reported swab methods, though sensitivity remained lower than sponge-based screening. The inclusion of moist skin folds (such as the knee creases and toe webs), which are known to harbor Acinetobacter spp. but are not routinely sampled in previous studies, may explain the improved detection observed. The high proportion of negative screeing among known carriers highlights the dynamic and intermittent nature of CRAB skin colonization and the limitations of single time-point screening.

Infectious diseases fellowship programs for physicians seek to train the next generation of leaders in antimicrobial stewardship, but few published resources are available to guide educational experiences. As an adaptable tool for training programs, we created a list of entrustable professional activities and suggested tasks to achieve competency during fellowship.