Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure’s feasibility, validity, and reliability.

Retrospective observational study

10 CAHs

From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.

Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).

Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity—all cases identified as ASB were considered ASB—but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.

To quantify the impact of patient- and unit-level risk adjustment on infant hospital-onset bacteremia (HOB) standardized infection ratio (SIR) ranking.

A retrospective, multicenter cohort study.

Infants admitted to 284 neonatal intensive care units (NICUs) in the United States between 2016 and 2021.

Expected HOB rates and SIRs were calculated using four adjustment strategies: birthweight (model 1), birthweight and postnatal age (model 2), birthweight and NICU complexity (model 3), and birthweight, postnatal age, and NICU complexity (model 4). Sites were ranked according to the unadjusted HOB rate, and these rankings were compared to rankings based on the four adjusted SIR models.

Compared to unadjusted HOB rate ranking (smallest to largest), the number and proportion of NICUs that left the fourth quartile (worst-performing) following adjustments were as follows: adjusted for birthweight (16, 22.5%), birthweight and postnatal age (19, 26.8%), birthweight and NICU complexity (22, 31.0%), birthweight, postnatal age and NICU complexity (23, 32.4%). Comparing NICUs that moved into the better-performing quartiles after birthweight adjustment to those that remained in the better-performing quartiles regardless of adjustment, the median percentage of low birthweight infants was 17.1% (Interquartile Range (IQR): 15.8, 19.2) vs 8.7% (IQR: 4.8, 12.6); and the median percentage of infants who died was 2.2% (IQR: 1.8, 3.1) vs 0.5% (IQR: 0.01, 12.0), respectively.

Adjusting for patient and unit-level complexity moved one-third of NICUs in the worst-performing quartile into a better-performing quartile. Risk adjustment may allow for a more accurate comparison across units with varying levels of patient acuity and complexity.

Environmental features of a patient’s room depend on the patient’s level of acuity and their clinical manifestations upon admission and during their hospital stay. In this study, we wish to apply statistical methodology to explore the association between room features and hospital onset infections caused by Clostridioides difficile (HO-CDI) while accounting for room assignment.

We conducted a nested case–control study using retrospective electronic health record (EHR) data of patients hospitalized at the Ohio State University Wexner Medical Center (OSUWMC) between January 2019 and April 2021. We collected clinical information and combined that with room-based information, collected as surveys. Data were analyzed to assess the association between room factors and HO-CDI.

2427 patients and 968 unique rooms were included in the study. Results indicated protective effects for rooms with cubical curtains near the patient (OR = 0.705, 95% CI = 0.549–0.906), rooms with separate shower units (OR = 0.674, 95% CI = 0.528–0.860), rooms with wall-mounted toilets (OR = 0.749, 95% CI = 0.592–0.950), rooms with sliding bathroom doors (OR = 0.593, 95% CI = 0.432–0.816), and sliding door knobs (OR = 0.593, 95% CI = 0.431-0.815). Rooms with manual paper towel dispensers had increased odds of HO-CDI (OR = 1.334, 95% CI = 1.053–1.691) compared to those with automatic towel dispensers.

Results suggest possible association between specific room features and HO-CDI, which could be further investigated with techniques like environmental sampling. Moreover, findings from the study offer valuable insights for targeted intervention measures.

Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.

A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).

Three participating medical centers.

We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.

1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.

Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.

This trial was registered on clinicaltrials.gov, NCT04196777.

To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.

Cross-sectional electronic survey and semi-structured interviews.

Academic hospitals in the United States.

HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.

We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.

Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.

HCWs’ understanding of best collection practices and yield of BCx was limited.

Patients with chronic kidney disease suffer from immune dysfunction, increasing susceptibility to infections. The aim of the study was to investigate air contamination with respiratory viruses in a dialysis unit at a quaternary hospital using molecular detection techniques and to analyze airflow dynamics through computational fluid dynamics (CFD) simulations for a comprehensive assessment of air transmission risks.

We conducted dialysis unit air sampling using AerosolSense™ samplers. Air and clinical sampling occurred during three periods in 2022: winter, early, and late fall. A technical team maintained the dialysis unit’s ventilation system during mid fall. Ventilation system capacity and airflow rates were measured. CFD simulations were used to evaluate airflow dynamics.

The investigation collected 144 air samples, revealing heterogeneous virus detection rates across locations and study periods. Virus positivity correlated with the presence of patients and the effectiveness of the ventilation system. The ratio of virus air positivity to virus patient positivity was 1.84 and 3.35 during the first and the second periods, respectively, and collapsed to 0.64 after maintenance. Airflow rate measurements highlighted a ninefold discrepancy between actual and theoretical airflow (393 m3/h vs. 3530 m3/h), which was rectified by maintenance actions. Airflow dynamics and particle dispersion visualization through CFD simulations contributed to a better understanding of transmission risks.

Detection of viruses in the air, combined with CFD, revealed deficiencies in air renewal. Maintenance interventions significantly improved airflow dynamics and particle dispersion, reducing airborne virus spread.

Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.

This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.

There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.

Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.

We introduced a urinary tract infection (UTI) panel requiring symptom documentation and identification of special populations linked to reflex urine culturing and evaluated its impact on catheter-associated UTI (CAUTI) including during the COVID-19 pandemic.

Quasi-experimental encompassing 3 periods: pre-panel (January 2014–March 2015), post-panel (April 2015–March 2020), and post-panel COVID (April 2020–June 2022).

Tertiary care center inpatients.

Poisson regression and interrupted time series (ITS) analysis evaluated changes in catheter days (CD), urine cultures (UC), and CAUTI measured by 1,000 CD and patient days (PD). National Health Safety Network standardized infection ratio (SIR) and standardized utilization ratio (SUR) data were analyzed.

UC per 1,000 PD decreased after implementation (pre-panel 36.9 vs 16.6 post-panel vs 14.4 post-panel COVID, all P < .001). CD declined pre-panel versus post-panel (RR 0.37, P < .001) but not from post-panel to post-panel COVID (RR 0.94, P = .88). UTI panel implementation was associated with a 40% decrease in CAUTI rates per 1,000 CD (P < .001). During the COVID-19 pandemic (post-panel COVID), a nonsignificant increase of 13% (P = .61) in CAUTI was noted but remained 32% lower than pre-panel (P = .02). The slope of change using ITS changed from negative to positive but was nonsignificant (P = .26). CAUTI rates per 1,000 PD demonstrated greater reductions (pre- vs post-panel (RR 0.37; 95% CI, 0.29–0.47) and pre- vs post-panel COVID (RR 0.35; 95% CI, 0.26–0.46)). SIRs were unavailable before 2016, but median SIRs post-panel compared to post-panel COVID were similar (1.05 vs 1.56, respectively, P = .067).

Implementation of the UTI panel was associated with a reduction in both UC and CAUTI with the impact maintained despite the COVID-19 pandemic.

Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs.

A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention.

Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site.

Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association.

The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation.

Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33–0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55–0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged.

This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.

To describe the effect of a Stenotrophomonas maltophilia (SM) respiratory culture nudge on antibiotic use in colonized patients.

IRB-approved quasi-experiment.

Five acute-care hospitals in Michigan.

Adult patients with SM respiratory culture between 01/01/2022 and 01/27/2023 (pre-nudge) and 03/27/2023–12/31/2023 (post-nudge). Patients with active community/hospital/ventilator-acquired pneumonia or who received SM-targeted antibiotics at the time of culture were excluded.

A nudge comment was implemented 02/2023 stating: “S. maltophilia is a frequent colonizer of the respiratory tract. Clinical correlation for infection is required. Colonizers do not require antibiotic treatment.” The primary outcome was no treatment with SM-therapy; secondary outcomes were treatment with SM-therapy ≥72 hrs, length of stay, and in-hospital, all-cause mortality. Safety outcomes included antibiotic-associated adverse drug events (ADEs).

94 patients were included: 53 (56.4%) pre- and 41 (43.6%) post-nudge. Most patients were men (53, 56.4%), had underlying lung disease (61, 64.8%), and required invasive ventilatory support (70, 74.5%). Eleven (11.7%) patients resided in a long-term care facility. No treatment with SM therapy was observed in 13 (23.1%) pre- versus 32 (78.0%) post-nudge patients (P <0.001). There were no differences in secondary outcomes. Antibiotic-associated ADEs were common (33/41, 76%) in patients who received ≥72hrs of SM-therapy: fluid overload (18, 44%), hyponatremia (17, 42%), elevated SCr (12, 29%), hyperkalemia (5, 12%). After adjustment for confounders, post-nudge was associated with 11-fold increased odds of no treatment with SM-therapy (adjOR, 11.72; 95%CI, 4.18–32.83).

A targeted SM nudge was associated with a significant reduction in treatment of colonization, with similar patient outcomes. SM-treated patients frequently developed antibiotic-associated ADEs.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain.

We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events.

Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment.

A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

To identify risk factors for methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) nasal carriage and surgical site infection (SSI) among patients undergoing fracture fixation procedures who were included in a quality improvement protocol involving screening patients for S. aureus nasal carriage and treating carriers with intranasal mupirocin and chlorhexidine bathing.

Retrospective cohort study.

Level 1 trauma center.

1,254 adults who underwent operative fixation of 1,298 extremity or pelvis fractures between 8/1/2014 – 7/31/2017.

We calculated rates of S. aureus nasal carriage and SSI. We used multivariable stepwise logistic regression and selected the final models based on Akaike information criterion.

Of the 1,040 screened first procedures, 262 (25.19%) were performed on S. aureus nasal carriers: 211 (20.29%) on MSSA carriers and 51 (4.90%) on MRSA carriers. Long-term care facility residence (odds ratio [OR] 3.38; 95% confidence interval [CI] 1.17–9.76) was associated with MRSA nasal carriage. After adjusting for statistically and clinically significant variables, MRSA carriage was significantly associated with any SSI (OR 4.58; 95% CI 1.63–12.88), S. aureus SSI (OR 10.11; 95% CI 3.25–31.42), and MRSA SSI (OR 27.25; 95% CI 5.33–139.24), whereas MSSA carriage was not. Among S. aureus carriers, any chlorhexidine use was documented for 232 (88.55%), and any intranasal mupirocin was documented for 85 (40.28%) MSSA carriers and 33 (64.71%) MRSA carriers.

MRSA carriage was associated with a significant risk of SSI after operative fracture fixation. Many carriers did not undergo decolonization, suggesting that a simplified decolonization protocol is needed.

Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose Clostridioides difficile, which can circumvent more appropriate targeted C. difficile testing, resulting in treatment of incidentally detected colonization. We sought to reduce C. difficile diagnosis via a gastrointestinal pathogen panel (GIPP).

Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024.

Mayo Clinic Arizona—a single academic medical center and associated clinics.

Adult patients receiving C. difficile testing and/or treatment.

Preferred C. difficile testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with C. difficile removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify C. difficile ordering practices and knowledge gaps.

At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was C. difficile (517 of 1,018, 51%), which resulted in treatment for C. difficile infection in 94.9% (337 of 355) of cases. Following GIPP C. difficile target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (P < .001). Prescribing of C. difficile treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed C. difficile diagnosis during the postintervention period.

Removing C. difficile from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.

Skin and soft tissue infections (SSTIs) account for over 2.8 million annual emergency department (ED) visits and often result in suboptimal antibiotic therapy. The objective of this study was to evaluate a set of interventions in minimizing inappropriate prescription of antibiotics for presumed SSTIs in the ED.

Case vignette survey.

A national sample of emergency medicine (EM) physicians.

Each vignette described a clinical scenario of a presumed SSTI (cellulitis or abscess) and included a unique combination of zero to five interventions (outpatient follow-up, inappropriate antibiotic request flag, thermal imaging for cellulitis or rapid wound MRSA PCR for abscess, patient education/shared decision-making, and clinical decision support). Out of 64 possible vignettes, we asked participants to respond to eight vignettes. Following each vignette, we asked participants if they would prescribe an antibiotic in their everyday practice (yes/no). We built adjusted hierarchical logistic regression models to estimate the probability of prescribing an antibiotic for each intervention and vignette.

Surveys were completed by 113 EM physicians. The thermal imaging, rapid wound MRSA PCR, and patient education/shared decision-making interventions showed the largest decrease (15–20%) in antibiotic prescribing probability. Vignettes with a combination of both a diagnostic intervention (thermal imaging or rapid wound MRSA PCR) and a patient education/shared decision-making intervention had the lowest prescribing probabilities.

We recommend future research focuses on the development and integration of novel diagnostic tools to identify true infection and incorporate shared decision-making to improve diagnosis and management of SSTIs.

To evaluate the hospital-reported cost of care, clinical burden, and incidence of hospital-onset bacteremia and fungemia (HOB) for hospital admissions with surgical site infections (SSI).

A cross-sectional study of 38 acute-care hospital admissions with a procedure under the National Healthcare Safety Network (NHSN) surveillance for SSI was conducted. SSI admissions were identified through NHSN reporting by the hospital. Clinical outcomes were estimated for SSI compared to no SSI controls using propensity matching and multivariable adjusted models that controlled for patient and hospital demographics; these endpoints were also compared for SSI admissions with and without HOB co-occurrence.

The rate of hospital-reported SSI was 0.15 per 100 admissions with a procedure under surveillance for SSI. Admissions with SSI compared to no SSI had significantly higher incremental hospital-reported cost of $30,689 and length of stay (LOS) was 11.6 days higher. The incidence of HOB was 6-fold higher in admissions with SSI compared to no SSI. For SSI admissions with HOB vs. no HOB, HOB added $28,049 to cost of care and 6.5 days to the LOS.

Hospital-reported SSIs were associated with higher clinical and economic burden. Patients with SSI and HOB had even more deleterious outcomes. These data may inform programs to augment infection prevention bundles targeting SSIs and downstream complications or comorbidities like HOB.

To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language.

Multi-center cohort study.

Nine organizations (92 locations) from 22 states and Washington, DC.

Patients ages 6 months–18 years evaluated April 2022–April 2023, with acute viral respiratory infections, otitis media with effusion (OME), acute otitis media (AOM), pharyngitis, community-acquired pneumonia (CAP), and sinusitis.

We compared the use of first-line (FL) therapy as defined by published guidelines. We used race/ethnicity, insurance, and language as exposures. Multivariable logistic regression models estimated the odds of FL therapy by group.

We evaluated 396,340 ARI encounters. Among all encounters, 351,930 (88.8%) received FL therapy (98% for viral respiratory infections, 85.4% for AOM, 96.0% for streptococcal pharyngitis, 83.6% for sinusitis). OME and CAP had the lowest rates of FL therapy (49.9% and 60.7%, respectively). Adjusted odds of receiving FL therapy were higher in Black Non-Hispanic (NH) (adjusted odds ratio [aOR] 1.53 [1.47, 1.59]), Asian NH (aOR 1.46 [1.40, 1.53], and Hispanic children (aOR 1.37 [1.33, 1.41]), compared to White NH. Additionally, odds of receiving FL therapy were higher in children with Medicaid/Medicare (aOR 1.21 [1.18–1.24]) and self-pay (aOR 1.18 [1.1–1.27]) compared to those with commercial insurance.

This multicenter collaborative showed lower rates of FL therapy for children of the White NH race and those with commercial insurance compared to other groups. Exploring these differences through a health equity lens is important for developing mitigating strategies.

Clostridioides difficile (C. difficile) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of C. difficile spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on C. difficile spores.

Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with C. difficile spore loads ranging from 105 to 107 spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the C. difficile spores were recovered, plated on C. difficile growth media, and colony forming units were counted. The efficacy of copper (log10 kill) was estimated using a Bayesian latent variables model.

After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log10 kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log10 kill, respectively).

Copper coupons can substantially reduce C. difficile spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.

We aimed to determine whether benchmarking antimicrobial use (AU) to antimicrobial resistance (AR) using select AU/AR ratios is more informative than AU metrics in isolation.

We retrospectively measured AU (antimicrobial therapy days per 1,000 days present) and AU/AR ratios (specific antimicrobial therapy days per corresponding AR event) in two hospitals during 2020 through 2022. We then had antimicrobial stewardship committee members evaluate each AU and corresponding AU/AR value and indicate whether they believed it represented potential overuse, appropriate use, or potential underuse of the antimicrobials, or whether they could not provide an assessment.

Two acute-care hospitals.

Hospitalized patients.

In semi-annual facility-wide analyses, echinocandins had a median AU/AR ratio of 658.5 therapy days per fluconazole-resistant Candida event in Hospital A, IV vancomycin had a median AU/AR ratio of 114.9 and 108.2 therapy days per methicillin-resistant Staphylococcus aureus event in Hospital A and B, respectively, and linezolid had a median AU/AR ratio of 33.8 and 88.0 therapy days per vancomycin-resistant Enterococcus event in Hospital A and B, respectively. When AU and AU/AR values were evaluated by stewardship committees, more respondents were able to assess antimicrobial use based on AU/AR values compared to AU values. Based on AU/AR ratios, most respondents identified potential overuse of echinocandins and IV vancomycin in Hospital A, and potential overuse of linezolid and IV vancomycin in Hospital B.

Select AU/AR ratios provided informative metrics to antimicrobial stewardship personnel, which can be used to motivate audits of antimicrobial administration to determine appropriateness.

Validate a public health model identifying patients at high risk for carbapenem-resistant Enterobacterales (CRE) on admission and evaluate performance across a healthcare network.

Retrospective case-control studies

Adults hospitalized with a clinical CRE culture within 3 days of admission (cases) and those hospitalized without a CRE culture (controls).

Using public health data from Atlanta, GA (1/1/2016–9/1/2019), we validated a CRE prediction model created in Chicago. We then closely replicated this model using clinical data from a healthcare network in Atlanta (1/1/2015–12/31/2021) (“Public Health Model”) and optimized performance by adding variables from the healthcare system (“Healthcare System Model”). We frequency-matched cases and controls based on year and facility. We evaluated model performance in validation datasets using area under the curve (AUC).

Using public health data, we matched 181 cases to 764,408 controls, and the Chicago model performed well (AUC 0.85). Using clinical data, we matched 91 cases to 384,013 controls. The Public Health Model included age, prior infection diagnosis, number of and mean length of stays in acute care hospitalizations (ACH) in the prior year. The final Healthcare System Model added Elixhauser score, antibiotic days of therapy in prior year, diabetes, admission to the intensive care unit in prior year and removed prior number of ACH. The AUC increased from 0.68 to 0.73.

A CRE risk prediction model using prior healthcare exposures performed well in a geographically distinct area and in an academic healthcare network. Adding variables from healthcare networks improved model performance.

To better delineate multiplexed gastrointestinal polymerase chain reaction (PCR) panel (MGPP) diagnostic and therapeutic stewardship for patients undergoing treatment for acute leukemia including indications and benefits of testing, optimal timing, and interpretation of results.

We retrieved all MGPP ordered on 662 consecutive patients admitted with newly diagnosed acute leukemia between June 2015 and May 2024.

Regional referral center for acute leukemia.

Fifty-one (17%) of 305 MGPP obtained on the 198 patients who underwent testing identified at least one and 4 (1%) more than one diarrheagenic pathogen. The probability of a positive result was greater if obtained as an outpatient [20/52(38%)], but was not related to type of leukemia, sex, or age. Among the positive results, the pathogens identified included Clostridioides difficile (78% of tests), norovirus (16%), diarrheagenic Escherichia coli (6%), adenovirus 40/41 (4%), and Giardia lamblia (4%). The results of 30 of the 305 tests resulted in a change in treatment (28 C. difficile, 2 G. lamblia). For the MGPP C. difficile results with an accompanying toxin determination, this included treatment following 16/19 tests with a positive toxin result and 11/19 with a negative. Actionable results other than C. difficile were rarely seen in the inpatient population.

MGPP testing is most useful when administered as an outpatient and of little benefit for inpatients with hospital-onset diarrhea. Since MGPP is sensitive and does not distinguish between colonization and causes of diarrhea, caution is needed in interpretation of results, especially for toxin-negative C. difficile.