The present study aims to develop and discuss an extension of hospital-acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections (HA-SIs) definition which goes beyond the use of time parameters alone.

A confirmatory factor analysis was carried out to test a suitable definition for HA-SI.

A two-center cohort study was carried out at two tertiary public hospitals in the German state of lower Saxony. The study involved a population of 366 laboratory-confirmed SARS-CoV-2-infected inpatients enrolled between March 2020 and August 2023.

The proposed model shows adequate fit indices (CFI.scaled = 0.959, RMSEA = 0.049). A descriptive comparison with existing classifications revealed strong features of our model, particularly its adaptability to specific regional outbreaks.

The use of the regional incidence as a proxy variable to better define HA-SI cases represents a pragmatic and novel approach. The model aligns well with the latest scientific results in the literature. This work successfully unifies, within a single model, variables which the recent literature described as significant for the onset of HA-SI. Further potential improvements and adaptations of the model and its applications, such as automating the categorization process (in terms of hospital acquisition) or employing a comparable model for hospital-acquired influenza classification, are subjects open for discussion.

Patients’ situations can impact their intentions to use antibiotics without medical guidance (non-prescription use) in the future. This survey determines the prevalence of intended (future) use of non-prescription antibiotics for 13 predefined situations and identifies the sociodemographic characteristics associated with intended use for these types of situations.

Patient surveys (N = 564) were conducted from January 2020 to June 2021 in the waiting rooms of 6 safety-net primary care clinics and 2 emergency departments in a private healthcare system. We used principal component analysis to identify 3 situational summary factors: barriers to a doctor visit, accessibility of non-prescription antibiotics, and previous symptom relief with antibiotics. Multivariate linear regression identified the sociodemographic predictors associated with each summary factor.

The most common situations triggering patients to use non-prescription antibiotics were a perceived high cost of doctor visits (29.8%), having leftover prescription antibiotics (50.4%), and experiencing symptom relief with prior use of antibiotics (47.5%). Multivariate regression results revealed that younger patients (P < 0.04) and patients attending the safety-net health system (P < 0.001) had more intended use of non-prescription antibiotics for all 3 summary factors.

Future stewardship interventions should consider the types of situations that drive patients’ decisions to use antibiotics without a prescription. Interventions aimed at reducing barriers to health care (eg, high costs and long waits associated with doctor appointments) and educating individuals on medically appropriate, nonantibiotic treatment options may reduce antibiotic use and antimicrobial resistance.

Antimicrobial resistance (AMR) is one of the greatest global health problems for humans, animals, and the environment. Although the association between various factors and AMR is being increasingly researched, the need to understand the contribution of social and ecological determinants, especially in developing nations, remains. This review fills these knowledge gaps by synthesizing existing evidence on the social and ecological determinants of AMR in Africa.

Twenty-four studies were selected based on predefined criteria from PubMed. 58.33% (n = 14) and 29.17% (n = 7) of the studies reported on ecological and social determinants of AMR, respectively, and 3 (12.5%) studies documented both social and environmental determinants of AMR. Sociodemographic factors include increased household size, poor knowledge, attitudes toward AMR, low educational levels, and rural residences. Indicators of poor water sanitation and hygiene, framing practices, and consumption of farm products were among the common ecological determinants of AMR and AM misuse in Africa.

Our review demonstrates the importance of social and ecological determinants of AMR among African populations. The findings may be valuable to researchers, policymakers, clinicians, and those working in lower-income countries to implement AMR prevention programs utilizing a holistic approach.

Amoxicillin suspension is frequently prescribed to children; we hypothesized that prescribing convention system constraints lead to unusual dosing regimens and unnecessary waste of the drug.

Identify antibiotic dispensing practices by community pharmacists and/or technicians to understand opportunities to decrease wasted amoxicillin liquid and optimize prescribing convention of liquid amoxicillin to children.

Pilot online survey of Atlanta area and National Community Pharmacists Association pharmacists or pharmacy technicians that self-reported dispensing amoxicillin suspension. Questions regarding liquid amoxicillin dispensing practices and other open comments were asked about suggestions to decrease amoxicillin waste from March 13 to April 5, 2023.

Among 68 pharmacy staff that participated, over 90% reported dispensing extra liquid amoxicillin to patients for more than 10% of the doses they dispensed. Twenty-seven respondents (39.7%) felt that amoxicillin waste was a problem; waste was most often due to package/bottle sizing issues (n = 64 of 67 responses, 95.5%). Respondents reported instructing families to dispose of extra medication in the trash (n = 51, 75%); 11 (16.2%) instructed pour the remaining in the sink; none reported requesting return to the pharmacy, and 6 (8.8%) reported other instructions. Community pharmacists observed that computerized algorithms create odd dosing amounts and that some prescribers add to the overall amount needed routinely.

Community pharmacists in this pilot survey observed prescribing conventions, manufacturing, regulatory, and electronic medical record constraints that lead to liquid amoxicillin waste or confusing amounts for families to use.

To summarize available literature and highlight research gaps pertaining to the role of a pharmacist in providing antimicrobial stewardship (AMS) interventions for antibiotics at transitions of care (TOC) from inpatient hospital settings to home.

Scoping review.

This scoping review follows the Arksey and O’Malley methodological framework. The literature search was conducted using the MEDLINE (OVID) database.

The MEDLINE (OVID) search returned 45 results. Of these, 26 were excluded during title and abstract screening and 11 were excluded after full-text review. Overall, eight studies were included in this scoping review. In six of the studies, AMS interventions were pharmacist-led. In two studies, they were led by an AMS team which included a pharmacist. Six of the studies used a similar intervention where a pharmacist led the review of antibiotics prior to patient discharge and made recommendations to change therapy where appropriate. The details of how these interventions were carried out vary between studies.

Overall, all studies included in this scoping review concluded that pharmacists have a role in providing AMS interventions at TOC. This scoping review summarized available literature pertaining to the role of the pharmacist in providing AMS interventions for antibiotics at TOC. Research gaps that were highlighted are optimal level of AMS training for pharmacists providing AMS interventions, optimal workflow, ideal method of communication to the prescriber, and quality improvement metrics.

Inpatient antibiotic use increased during the early phases of the COVID-19 pandemic. We sought to determine whether these changes persisted in persons with and without COVID-19 infection.

Retrospective cohort analysis.

108 Veterans Affairs (VA) facilities.

Persons receiving acute inpatient care from January 2016 to October 2022.

Data on antibacterial use, patient days present, and COVID-19 care were extracted from the VA Corporate Data Warehouse. Days of therapy (DOT) per 1000 days present (DP) were calculated and stratified by Centers for Disease Control and Prevention-defined antibiotic classes.

Antibiotic use increased from 534 DOT/1000 DP in 11/2019–2/2020 to 588 DOT/1000 DP in 3/2020–4/2020. Subsequently, antibiotic use decreased such that total DOT/1000 DP was 2% less in 2020 as a whole than in 2019. Driven by treatment for community acquired pneumonia, antibiotic use was 30% higher in persons with COVID-19 than in uninfected persons in 3/2020–4/2020, but only 4% higher for the remainder of 2020. In 2022 system-wide antibiotic use was 9% less in persons with COVID-19; however, antibiotic use remained higher in persons with COVID-19 in 25% of facilities.

Although antibiotic use increased during the early phases of the COVID-19 pandemic, overall use subsequently decreased to below previous baseline levels and, in 2022, was less in persons with COVID-19 than in persons without COVID-19. However, further work needs to be done to address variances across facilities and to determine whether current levels of antibiotic use in persons with COVID-19 are justified.

This cross-sectional study aims to determine the mortality trends in patients with SARS-CoV-2 infection during the pandemic in Flint, MI.

Records from 1,663 consecutive adult patients (≥18 years of age) with confirmed SARS-CoV-2 infection, admitted and discharged from our facility from 03/2020 through 02/2022, were abstracted and analyzed. Multivariable logistic regression analysis was performed to examine the association between study explanatory variables (ie, sex, age, co-morbidities, etc.) and the primary study outcome (ie, mortality).

During the 2-year study period, the overall crude 90-day mortality rate was 16.1% (267/1663), being lowest in the period 5 (Table 1). Male sex, older age, certain co-morbidities, supplemental oxygenation use, and lack of immunization were associated with mortality. Therapeutics such as remdesivir and steroids were not associated with improved survival.

Despite substantial changes in supportive care, management and circulating variants, SARS-CoV-2 carried a significant mortality risk. Vaccination coverage in this high-risk study sample was low, at only 12%. Public health efforts should be focused at overcoming the barriers to vaccine acceptance in this high-risk unique population.

The primary objective was to determine the rate of clinical actions taken post-discharge on updated microbiology results by an ID pharmacist-led team. Secondary objectives were to describe the microbiology results requiring intervention, characterize interventions by type and severity, and determine time from result to clinical review.

Retrospective cohort study.

Four hospitals within Mayo Clinic, including two large academic centers and two Mayo Clinic Health System sites.

Adult patients at four sites within Mayo Clinic from 1/1/2019 to 2/28/2023. Eligible patients had a hospitalization with an ID consult and an updated microbiology result reported after discharge.

Pharmacists reviewed a report of selected patients with microbiology tests that resulted post-discharge within the last 24–96 hours. Interventions were recorded electronically in real-time by the pharmacist. Of those patient encounters with an intervention, a sample of 200 patient encounters was randomly selected for detailed chart abstraction.

A total of 6,792 encounters with at least one microbiology result reviewed post-discharge were identified. Of these encounters, 1977 (29%) had at least one resulting intervention. Median time from test update to clinical review was 27.2 hours (IQR 21.6–69.6). The highest severity ratings, in which failure to intervene may have resulted in patient harm, were assigned to the intervention in 28% of cases.

For patients seen by an inpatient ID consult service, a post-hospital discharge microbiology result review process performed by ID-trained pharmacists effectively addressed abnormal results during the transition of care. Similar processes may be considered at other institutions.

Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for Clostridioides difficile infection (CDI). The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in HSCT patients.

Single-center, retrospective cohort.

Tertiary care academic medical center in New Jersey.

Patients ≥18 years old during admission for the HSCT were included. Patients who were admitted <72 hours or who had an active CDI prior to HSCT day 0 were excluded.

Medical records of patients admitted between January 2015 and August 2022 to undergo an allogeneic or autologous HSCT were reviewed. The primary end point was the incidence of in-hospital CDI. Secondary end points included the incidence of vancomycin-resistant enterococci (VRE) bloodstream infections, VRE isolated from any clinical culture, gram-negative bloodstream infections, hospital survival, and hospital length of stay. Exploratory end points, including 1-year survival, relapse, and incidence of graft-versus-host disease, were also collected.

A total of 156 HSCT patients were included. There was 1 case of CDI (1 of 81, 1.23%) in the OVP group compared to 8 CDI cases (8 of 75, 10.67%) in the no OVP group (P = .0147). There were no significant (P > .05) between-group differences in incidence of gram-negative bloodstream infections, hospital survival, and length of stay. There were zero clinical cultures positive for VRE.

In-hospital incidence of CDI in HSCT patients was significantly decreased with OVP. Randomized controlled trials are needed in this high-risk population to assess the efficacy and risks of OVP for CDI.

The aim of this study was to assess the clinical value of urinary tract infections (UTIs) guideline algorithms and the role of nonspecific symptoms to support clinical decision-making in nursing home residents.

In a preplanned secondary analysis of a cross-sectional study including nursing home residents with a presumed UTI, 2 prediction models were used in a decision curve analysis (DCA): (1) guideline-based and (2) extended: nonspecific symptom(s) added to the guideline model. The stringent outcome definition for “true UTIs” included symptom improvement during adequate antimicrobial therapy, based on susceptibility test results. The outcome of a DCA is the Net Benefit to quantify the performance of the prediction models, visualized in a decision curve.

Dutch nursing homes (n = 13).

Nursing home residents with a presumed UTI.

Of the 180 residents with a presumed UTI, 43 fulfilled the definition of “true UTI” (23.9%). The Net Benefit of the guideline-based model was low and the corresponding threshold range was small (21%–28%). The extended model improved the prediction of UTIs. However, the clinical usefulness of the extended model was still limited to a small threshold range (10%–28%).

The clinical usefulness of the current guideline-based algorithm to diagnose UTI in nursing home residents seems limited, and adding nonspecific symptoms does not further improve decision-making due to the small threshold probability. Given the poor performance of the guideline-based model, refinement of the guidelines may be required.

Dutch trial registry: NTR6467; date of first registration, 25/05/2017.

The acceptability of an electronic HH monitoring system (EHHMS) was evaluated among hospital staff members.

An electronic HH monitoring system was implemented in June 2020 at a large, academic medical center. An interdisciplinary team developed a cross-sectional survey to gather staff perceptions of the EHHMS.

The survey was conducted at a public, tertiary acute care hospital.

The survey included current employees and staff. 1,273 participants responded. The mean age was 44.9 years (SD = 13.5). Most of the samples were female (71%) and non-Hispanic white (83%).

A survey was conducted between June and July 2021. Responses were analyzed using Stata statistical software. Multiple logistic regression models were constructed to examine factors associated with negative perceptions of the EHHMS and its radiofrequency identification (RFID) badge. Supporting qualitative analyses were performed using Atlas.ti version 9.

Three-quarters (75%) of respondents reported neutral to negative perceptions of the EHHMS and its associated badge. Respondents reported limited influence on HH practices. Age, campus location, length of employment, job role, and opinion on data sharing were associated with negative perceptions of the EHHMS and RFID badge. Position in a direct patient care role was associated with negative perceptions of the RFID badge.

Perceptions of the EHHMS aligned with previous research. Identified associations provide opportunities for targeted education, outreach, and intervention to increase acceptability and uptake. Lack of acceptance is explained by poorly perceived ease of use and usefulness, as well as challenges in implementation.

The aim of this study was to determine if oral beta-lactam therapy is non-inferior to alternative therapy at discharge following inpatient treatment with an IV cephalosporin for acute pyelonephritis.

Institutional Review Board (IRB)-approved, multicenter, retrospective, non-inferiority cohort (15% non-inferiority margin).

Six hospitals within two healthcare systems.

Hospitalized patients admitted to the medical floor with acute pyelonephritis without urologic abnormalities who received cefazolin or ceftriaxone followed by step-down therapy.

Patients were discharged with either an oral beta-lactam or an oral alternative agent (ie, fluoroquinolone or trimethoprim-sulfamethoxazole) to complete therapy. The primary objective was treatment failure defined as a composite of hospital readmission or an ED visit for a urinary cause within 30 days of discharge of the index hospitalization. Data were extracted manually from the electronic medical record.

A total of 211 patients were included; 122 received an oral beta-lactam and 89 received an oral alternative agent at discharge. There was no difference in 30-day treatment failure between the two groups (4.9% vs 5.6% for oral beta-lactams vs oral alternatives, respectively. Absolute difference = 0.7%; 95% CI -5.4% to 6.8%; P = .82). The median length of hospital stay, number of patients treated with intravenous ceftriaxone, duration of IV therapy, and median duration of oral therapy were no different between groups.

In non-ICU patients admitted for pyelonephritis without urologic abnormalities, oral beta-lactams were non-inferior to oral alternatives for step-down therapy. In finding non-inferiority between the regimens, we show the feasibility of administering oral beta-lactams to complete therapy for acute pyelonephritis.