We describe the implementation, outcomes, and challenges of a complex outpatient oral antimicrobial therapy program (COpAT) in Canada to provide a framework for those interested in establishing such a program.

Outpatient ambulatory clinic led by infectious diseases physicians, serving patients from a tertiary hospital and a small community hospital.

Retrospective observational study that evaluated the efficacy, safety, and cost savings of patients enrolled in the program from August 2023 to June 2024.

One hundred three patients were included, of which 84.4% achieved successful clinical outcomes. Mean age of the patients was 62 years and 30% had diabetes. The top three sources of infections were bone and joint, intra-abdominal, and skin-and-soft tissue. Mean duration of COpAT was 37 days. Seventy-five percent of patients required only a single agent, and amoxicillin/clavulanic acid was most commonly used. Twenty-two patients developed an adverse reaction, of which three required a change in therapy and one resolved with antibiotic dose reduction. No C. difficile infections or mortality were reported 30-days post COpAT discharge. Twelve patients were re-admitted to the hospital; 50% of the cases were unrelated to infections. Compared to outpatient intravenous therapy, the total cost savings from COpAT were estimated to be $255,000 Canadian dollars (CAD), which translated to an average cost savings of $2500 CAD per patient per year.

We demonstrated favorable clinical and safety outcomes with our COpAT program and substantial cost savings using existing infrastructure. COpAT allows efficient use of healthcare resources including decongestion of hospitals.

Develop a Staphylococcus aureus wound antibiogram among patients who use fentanyl (PWUF) presenting with acute S. aureus skin and soft tissue infections (SSTIs) in Philadelphia, Pennsylvania.

Retrospective, multisite cohort study.

Individuals presenting to emergency departments or admitted to inpatient units of four Penn Medicine hospitals with an acute S. aureus SSTI and illicit fentanyl use within the previous year.

We described susceptibilities of S. aureus isolated from wound cultures among the PWUF cohort and compared these to the health system’s wound antibiogram. We compared frequency of in-hospital medication treatment for opioid use disorder among patients who left the hospital prior to vs after the availability of S. aureus susceptibilities.

Among 131 S. aureus isolates from 131 PWUF, 35/131 (26.7%) were susceptible to oxacillin, 73/121 (60.3%) were susceptible to clindamycin, 77/122 (63.1%) were susceptible to tetracycline, and 119/126 (94.4%) were susceptible to trimethoprim-sulfamethoxazole. PWUF displayed significantly reduced susceptibility to oxacillin and tetracycline compared to the health system’s outpatient wound S. aureus antibiogram. Compared to patients discharged prior to susceptibility availability, more patients discharged after the reporting of susceptibilities were administered buprenorphine or methadone in the hospital (82.0% vs 51.4%, P < 0.001).

High nonsusceptibility to clindamycin and tetracycline suggests these agents should not be prescribed as empiric therapy for acute S. aureus SSTI in PWUF in Philadelphia. PWUF would benefit from joint management by infectious diseases and addiction medicine experts to ensure prescription of active therapy. Additional study is needed of PWUF in other regions.

To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system.

Retrospective, quasi-experimental study.

A large academic safety-net institution.

Adults (≥18 years) with GN-BSI, defined by at least one positive blood culture for specific gram-negative organisms. Patients with polymicrobial cultures or contaminants were excluded.

Implementation of a GN-BSI clinical care guideline based on a 2021 consensus statement, emphasizing 7-day antibiotic courses, use of highly bioavailable oral antibiotics, and minimizing repeat blood cultures.

The study included 147 patients pre-intervention and 169 post-intervention. Interrupted time series analysis showed a reduction in the median duration of therapy (–2.3 days, P = .0016), with a sustained decline (slope change –0.2103, P = .005) post-intervention. More patients received 7 days of therapy (12.9%–58%, P < .01), oral antibiotic transitions increased (57.8% vs 72.2%, P < .05), and guideline-concordant oral antibiotic selection was high. Repeat blood cultures decreased (50.3% vs 30.2%, P < .01) without an increase in recurrent bacteremia. No significant differences were observed in 90-day length of stay, rehospitalization, recurrence, or mortality.

Guideline implementation was associated with shorter antibiotic therapy durations, increased use of guideline-concordant oral antibiotics, and fewer repeat blood cultures without compromising patient outcomes. These findings support the effectiveness of institutional guidelines in standardizing care, optimizing resource utilization, and promoting evidence-based practices in infectious disease management.

Evaluate the effects of handshake stewardship on adult general surgical units.

Retrospective quasi-experimental pre- and post-intervention study.

A total of 1,278 bed academic medical center with a level 1 trauma center in St. Louis, Missouri.

Adults admitted to general surgery units.

Once weekly handshake antimicrobial stewardship rounds were initiated in January 2022 on adult general surgery units. The handshake stewardship team consisted of an infectious diseases (ID) physician and pharmacist who reviewed charts of patients receiving systemic antimicrobials without a formal ID consult. Antimicrobial recommendations were delivered in person to general surgery teams including trauma, geriatric trauma, and emergency/general surgery.

A total of 1,241 charts were reviewed during the post-implementation period with 391 interventions. Seventy-two percent of those interventions were accepted and the acceptance rate improved over the 18-month post-implementation period. Total antimicrobial usage significantly decreased between the pre- and post-implementation period (608 vs 542 d of therapy/1,000 d present, P = 0.004). An interrupted time series found that there was an immediate (P < 0.001) and sustained (P < 0.001) decrease in antibiotic spectrum index during the post-implementation period. No difference was found for in-hospital mortality between the pre- and post-implementation periods [28 (1%) vs 29 (1%), P = 0.791].

A once-weekly handshake antimicrobial stewardship program was successfully implemented in general surgery units. Antimicrobial use significantly decreased without negatively impacting hospital mortality.