Antimicrobial stewardship programs (ASPs) aim to mitigate antimicrobial resistance (AMR) by optimizing antibiotic use including reducing unnecessary broad-spectrum therapy. This study evaluates the impact of ASP funding and resources on the use of broad-spectrum antibiotics in Ontario hospitals.

We conducted a cross-sectional study of antimicrobial use (AMU) across 63 Ontario hospitals from April 2020 to March 2023. The Ontario ASP Landscape Survey provided data on ASP resourcing and antibiotic utilization. The main outcome was the proportion of all antibiotics that were broad-spectrum, defined as: fluoroquinolones; third-generation cephalosporins; beta-lactam/beta-lactamase inhibitors; carbapenems; clindamycin; and parenteral vancomycin. Secondary outcomes included the proportions of individual antibiotic classes listed above and anti-pseudomonal agents. Statistical analysis involved logistic regression to determine the odds ratio (OR) of the association between ASP funding/resourcing and broad-spectrum antibiotic use.

Among 63 hospitals, 48 reported designated ASP funding/resources. Median broad-spectrum antibiotic use was 52.5%. ASP funding/resources was not associated with overall broad-spectrum antibiotic use (0.97, 95% CI: 0.75–1.25, P = 0.79). However, funding was associated with lower use of fluoroquinolones (OR 0.67, 95% CI: 0.46–0.96, P = 0.03), clindamycin (OR 0.69, 95% CI: 0.47–1.00, P = 0.05), and anti-pseudomonal agents (OR 0.76, 95% CI: 0.59–0.98, P = 0.03).

The presence of designated funding and resources for hospital ASPs is linked to reduced use of specific broad-spectrum antibiotics but not overall broad-spectrum antibiotic use. Enhancing ASP resourcing may be an important factor in limiting targeted antibiotic use, thereby increasing the effectiveness of efforts to mitigate AMR.

To describe the use of cultures for acid-fast bacilli (AFB) and situations in which AFB cultures are unlikely to be of clinical benefit.

Retrospective descriptive study of AFB cultures submitted to Sentara Health microbiology laboratory from December 1, 2021, to December 1, 2023. Data were collected from the electronic medical record and included patient demographics, the service line that ordered the culture, specimen source, and culture results.

Sentara Healthcare System.

All patients who had specimens submitted to the microbiology laboratory during the study period were included.

A total of 13,944 AFB cultures from 8,243 patients were collected during the study period. Of these, 4.72% (n = 389) patients had a positive result, and 40 of 680 positive cultures were likely contaminants or non-mycobacterial. The average number of days between culture collection and positive results was 84.32 days (SD = 49.64) and 56.25 days (SD = 8.32) for negative results. Most cultures were ordered by medical subspecialties (44.06%, n = 6,144), followed by orthopedic providers (23.34%, n = 3,254) and surgical subspecialty providers (16.11%, n = 2,246). Most specimens were pulmonary (n = 6,620) with 619 (9.35%) positive cultures. Of 3,561 AFB cultures ordered from bone specimens, only 17 were positive (0.48%). The number of specimens processed by the microbiology laboratory required 2 full-time microbiology technicians to process specimens.

Many AFB cultures were sent from patients who did not have clinical scenarios consistent with mycobacterial disease and cultures were not clinically indicated. Implementation of testing criteria could decrease AFB cultures and healthcare costs.

Periprosthetic joint infection (PJI) may result from pathogen-to-patient transmission within the environment. High-touch surfaces (HTS) areas near the operative field from previous studies had been identified as the least likely to be thoroughly cleaned between operative cases and were utilized for this study. The purpose of this study was to assess the impact of a handheld ultraviolet-c (UV-C) light-emitting diode (LED) disinfection device on the decontamination of HTS in the operating room.

This prospective study was conducted between 03/02/2021 and 04/20/2021. Tryptic soy agar contact plates were used to determine the bacterial load of the selected surfaces before the initiation of the case, after the case was complete, before manual cleaning, and after disinfection of the LED device. The plates were then incubated for 48 hours at 36º +/–1° C. Colony forming units (CFU) were recorded 48 hours after incubation. Mean, median, and range of CFU were recorded.

Average CFU per surface before and after the surgical case were 14.1 (range 0–200) and 13.5 (range 0–200) respectively, these were not significantly different (P = 0.9397). Manual cleaning reduced average CFU by 74% to 3.35 (range 0–200) per surface (P = 0.0162). Disinfection with the handheld LED unit further reduced the average CFU by 92% to 0.28 (range 0–4) per surface (P < 0.0001).

A handheld UV-C LED disinfection device may decrease environmental contamination near the operative field in HTS areas. Further research is warranted with this technology to determine if this correlates with a decrease in PJI.