To explore older adults’ and caregivers’ knowledge and perceptions of guidelines for appropriate antibiotics use for bacteria in the urine.

Semi-structured qualitative interviews.

Infectious disease clinics, community senior living facilities, memory care clinics, and general public.

Patients 65 years or older diagnosed with a urinary tract infection (UTI) in the past two years, or caregivers of such patients.

We conducted interviews between March and July 2023. We developed an interview guide based on the COM-B (capability, opportunity, motivation-behavior) behavior change framework. We thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques.

Thirty participants (21 patients, 9 caregivers) enrolled. Most participants understood UTI symptoms such as pain during urination and frequent urination. However, communication with multiple clinicians, misinformation, and unclear symptoms that overlapped with other health issues clouded their understanding of asymptomatic bacteriuria (ASB) and UTIs. Some participants worried that clinicians would be dismissive of symptoms if they suggested a diagnosis of ASB without prescribing antibiotics. Many participants felt that the benefits of taking antibiotics for ASB outweighed harms, though some mentioned fears of personal antibiotic resistance if taking unnecessary antibiotics. No participants mentioned the public health impact of potential antibiotic resistance. Most participants trusted information from clinicians over brochures or websites but wanted to review information after clinical conversations.

Clinician-focused interventions to reduce antibiotic use for ASB should also address patient concerns during clinical visits, and provide standardized high-quality educational materials at the end of the visit.

Vancomycin therapy is associated with an increased risk of acute kidney injury (AKI). Previous studies suggest that area under the curve (AUC) monitoring reduces the risk of AKI, but literature is lacking to support this in patients receiving longer durations of vancomycin therapy.

Retrospective cohort study.

Patients ≥18 years old, admitted between August 2015 and July 2017 or October 2017 and September 2019, and received at least 14 days of intravenous (IV) vancomycin therapy were included in the study. Our primary outcome was the incidence of AKI between trough monitoring and AUC monitoring groups using Kidney Disease Improving Global Outcomes criteria. Secondary outcomes included inpatient mortality, median inpatient length of stay, and median intensive care unit length of stay.

Overall, 582 patients were included in the study, with 318 patients included in the trough monitoring group and 264 included in the AUC monitoring group. The median duration of vancomycin therapy was 23 days (interquartile range, 16–39). Patients within the trough monitoring group had a higher incidence of AKI compared to the AUC monitoring group (45.6% vs 28.4%, p < 0.001). Furthermore, logistic regression analysis showed that AUC monitoring was associated with a 54% lower incidence of AKI (OR 0.46, 95% CI [0.31–0.69]). All-cause inpatient mortality was numerically higher in the trough monitoring group (12.9% vs 8.3%, p = 0.078).

In patients who received at least 14 days of IV vancomycin therapy, AUC monitoring was associated with a lower incidence of AKI.

Antibiotic prescribing at hospital discharge is an important focus for antimicrobial stewardship efforts. This study set out to determine the impact of a pharmacist-led intervention at hospital discharge on appropriate antimicrobial prescribing.

This was a pre-/post-study evaluating the impact of a pharmacist-led review on antibiotic prescribing at hospital discharge. Pharmacists evaluated antibiotic prescriptions at discharge for appropriate duration, spectrum of activity, frequency, and strength of dose. Each of these criteria needed to be met for an antibiotic regimen to be considered appropriate.

Moses Cone Hospital is a 535-bed community teaching hospital in Greensboro, North Carolina.

Patients ≥18 years of age discharged from the hospital with an antibiotic prescription were included. Exclusion criteria included patients discharged against medical advice, discharged to a skilled nursing facility, or prescribed indefinite prophylactic antimicrobial therapy.

A review of patients discharged with antibiotics in 2020 was performed. Patients discharged with antibiotic prescriptions from January 2021 to April 2022 were evaluated prior to discharge by pharmacists. The pharmacist made recommendations to providers based on their evaluations.

162 retrospective patients were screened, and 136 patients were screened at discharge from the hospital in the prospective cohort. 76/162 (47%) retrospective patients received appropriate antibiotic therapy at discharge, while 92/136 (68%) of prospective patients received appropriate discharge therapy (p = 0.001).

In this study examining the efficacy of stewardship pharmacist intervention at hospital discharge, pharmacist review and recommendations were associated with an increased rate of appropriate antimicrobial prescribing.

This study was conducted under the approval of the Institutional Review Board of the Moses H. Cone Health System. The approval protocol number was 1483117-1 and took effect on September 2nd, 2019. As the research was either retrospective in nature or part of the standard of care recommendations, the project was granted expedited review.

To evaluate rates of and outcomes associated with antibiotic overuse at hospital discharge for patients with common infectious diseases states.

Single-center, respective cohort study.

A large, academic medical center in the Midwest United States.

Adult patients who received antibiotics for community-acquired pneumonia (CAP), uncomplicated cystitis, or mild, non-purulent cellulitis. Patients were excluded if they did not receive antibiotic(s) upon hospital discharge, were pregnant, severely immunocompromised, had concomitant infections, died during hospitalization, or were transferred to another hospital or to an intensive care unit.

Data were abstracted from the electronic medical record of ambulatory antibiotic orders for included patients based on inpatient encounters from August 1, 2021 through July 31, 2022.

Of the 182 patients included in the study, antibiotic overuse was common for all three infectious disease states: CAP (n = 87/125, 69.6%), uncomplicated cystitis (n = 21/28, 75.0%), mild, non-purulent cellulitis (n = 28/29, 96.6%). The prevailing reason for overuse was excessive antibiotic duration (n = 127/182, 69.8%; mean antibiotic duration 5.39 vs. 8.32 days, p = 0.001). Antibiotic overuse was associated with approximately one additional day in the hospital (2.48 vs. 3.32 days, p = 0.001), and an increase in emergency department visits within 30 days after discharge (1 vs. 31, p = 0.001) compared to patients without antibiotic overuse at discharge.

Antibiotic overuse was prevalent upon hospital discharge for these three common infectious disease states. Transitions of care should be prioritized as an area for antimicrobial stewardship intervention.

To describe antimicrobial therapy used for multidrug-resistant (MDR) Acinetobacter spp. bacteremia in Veterans and impacts on mortality.

This was a retrospective cohort study of hospitalized Veterans Affairs patients from 2012 to 2018 with a positive MDR Acinetobacter spp. blood culture who received antimicrobial treatment 2 days prior to through 5 days after the culture date. Only the first culture per patient was used. The association between treatment and patient characteristics was assessed using bivariate analyses. Multivariable logistic regression models examined the relationship between antibiotic regimen and in-hospital, 30-day, and 1-year mortality. Generalized linear models were used to assess cost outcomes.

MDR Acinetobacter spp. was identified in 184 patients. Most cultures identified were Acinetobacter baumannii (90%), 3% were Acinetobacter lwoffii, and 7% were other Acinetobacter species. Penicillins—β-lactamase inhibitor combinations (51.1%) and carbapenems (51.6%)—were the most prescribed antibiotics. In unadjusted analysis, extended spectrum cephalosporins and penicillins—β-lactamase inhibitor combinations—were associated with a decreased odds of 30-day mortality but were insignificant after adjustment (adjusted odds ratio (aOR) = 0.47, 95% CI, 0.21–1.05, aOR = 0.75, 95% CI, 0.37–1.53). There was no association between combination therapy vs monotherapy and 30-day mortality (aOR = 1.55, 95% CI, 0.72–3.32).

In hospitalized Veterans with MDR Acinetobacter spp., none of the treatments were shown to be associated with in-hospital, 30-day, and 1-year mortality. Combination therapy was not associated with decreased mortality for MDR Acinetobacter spp. bacteremia.

Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI.

We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed.

192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign.

Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.

Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic.

In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables.

Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9–2.1), young adults (OR 1.08, 95% CI: 0.99–1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01–1.11, OR 1.05, 95% CI: 0.89–1.23), and COVID-19 positive patients with ≥2 comorbid conditions (OR 1.55, 95% CI: 1.43–1.68).

Further analysis in more than one healthcare system should explore these ecologic relationships further to understand if these are common trends to inform ongoing stewardship interventions.

To provide fit rates for specific P2/N95 respirators and compare these results by age, sex, clean-shaven status, and fit tester experience.

Exploratory audit involving secondary analysis of existing quantitative fit testing data.

In response to the COVID-19 pandemic, healthcare services across Australia implemented respiratory protection protocols. This study details healthcare workers’ (HCWs) fit testing results from a large Victorian public health service.

Fit-tested employees of a large tertiary public health network.

Fit rates for ten individual P2/N95 respirators were calculated, and the effect of age, sex, clean-shaven status, and fit tester experience was examined via logistic regression.

4593 employees were included, with 97.98% successfully fitting at least one respirator. Males were found to have significantly increased odds of achieving fit success compared to females (OR 11.61 95%CI 1.60–84.10). Fit rates dropped by 4% with each 1-year age increase (OR 0.96 95%CI 0.94–0.98). Clean-shaven individuals were also more likely to achieve a fit compared to non-clean-shaved individuals (OR 79.23 95%CI 10.21–614.62). More experienced fit testers also yielded significantly higher fit rates (OR 3.95, 95%CI 2.34–6.67).

98% of staff achieved a successful fitting of at least one respirator, with three-panel flat fold models (Industree Trident, 3M Aura 9320A+, and 3M Aura 1870+) performing the most consistently. An individual’s ability to achieve a successful fit was associated with; male sex, younger age, clean-shaven status, and fit tester experience.

Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multimorbid patients, a non-complicated course is of utmost importance.

Retrospective analysis of patients undergoing elective oncological surgery at a tertiary reference center. Data on surgical site infections (SSI), postoperative complications (measured by Clavien-Dindo classification and Comprehensive Complication Index (CCI)), hospitalization duration, and treatment costs were collected.

Between 09/2019 and 03/2020, 152 patients were identified. 16/152 patients (11%) reported PA, while 136/152 (89%) did not. There were no differences in age, BMI, Charlson Comorbidity Index, and smoking status between groups (p > 0.4). Perioperative beta-lactam antibiotics were used in 122 (89.7%) and 15 (93.8%) patients without and with reported PA, respectively. SSI and mean numbers of infections occurred non-significantly more often in patients with PA (p = 0.2 and p = 0.47). The median CCI was significantly higher in PA group (26 vs. 51; p = 0.035). The median hospitalization duration and treatment costs were similar between non-PA and PA groups (4 vs 3 days, p = 0.8; 16’818 vs 17’444 CHF, p = 0.4).

In patients undergoing cancer surgery, reported PA is common. Failure to question the unproven PA may impair perioperative outcomes. For this reason, patient and provider education on which reactions constitute a true allergy would also assist in allergy de-labeling. In addition, skin testing and oral antibiotic challenges can be performed to identify the safe antibiotics and to de-label appropriate patients.

The COVID-19 pandemic was associated with increased rates of hospital-acquired infections. During the early months of the pandemic, we observed high rates of hospital-acquired bloodstream infections (HA-BSIs) among COVID-19 patients, prompting the implementation of intensified prevention measures.

To assess the prevalence of HA-BSI among mechanically ventilated COVID-19 patients, identify risk factors, and evaluate the effect of prevention measures.

We conducted a retrospective matched case-control study in adult medical step-up units between March 1, 2020, and March 31, 2021. We matched mechanically ventilated COVID-19 patients with ventilated non-COVID-19 patients based on age group and length of stay before ventilation. In response to the high rates of HA-BSI among COVID-19 patients, a comprehensive infection control intervention was implemented.

A total of 136 COVID-19 patients were matched with 136 non-COVID-19 patients. No significant differences were observed in pre-hospitalization characteristics. The central venous catheter utilization ratio was higher in COVID-19 patients (83.6%) versus 35.6% in the control group (p < 0.001). During pre-intervention, 35.2% (32/91) of COVID-19 patients developed HA-BSI, compared to 17.8% (13/73) in the control group (p < 0.001). Following the intervention, no significant difference was observed between the groups (17.8% (8/45) versus 15.9% (10 /63), p = 0.79). In a multivariate analysis, HA-BSI was associated with low body mass index (OR 0.9 (95% CI 0.9–1.0), p = 0.015)) and presence of temporary dialysis catheter (OR 2.7 (95% CI 1.0–7.3), p = 0.05)).

Mechanically ventilated COVID-19 patients were at higher risk for developing HA-BSI compared to non-COVID-19 patients. Intensified prevention measures were associated with decreased rates of HA-BSI.

Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI.

Retrospective cohort study.

Veterans Health Administration.

Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection.

We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 and mortality among patients with PA-BSI. Additional predictors included demographics, comorbidities, disease severity, antimicrobial susceptibility, and treatment.

A total of 6,714 patients with PA-BSI were identified. Throughout the study period, PA resistance rates decreased. Mortality decreased during the pre-COVID-19 period and increased during the COVID-19 period. Mortality was not significantly different between pre-COVID-19 (24.5%, 95% confidence interval [CI] 23.3–28.6) and COVID-19 period/COVID-negative (26.0%, 95% CI 23.5–28.6) patients, but it was significantly higher in COVID-19 period/COVID-positive patients (47.2%, 35.3–59.3). In the modified Poisson analysis, COVID-19 coinfection was associated with higher mortality (relative risk 1.44, 95% CI 1.01–2.06). Higher Charlson Comorbidity Index, higher modified Acute Physiology and Chronic Health Evaluation score, and no targeted PA-BSI treatment within 48 h were also predictors of higher mortality.

Higher mortality was observed in patients with COVID-19 coinfection among patients with PA-BSI. Future studies should explore this relationship in other settings and investigate potential SARS-CoV-2 and PA synergy.

This study aimed to determine the impacts of the COVID-19 pandemic and policy measures and delineate the impact of each on a cohort of Thai citizens.

A cross-sectional study was conducted among 2,500 Thai people from October 2020 to January 2021. A questionnaire collecting demographic information and other data was sent to eligible subjects.

Overall, 51.6% and 49.5% of participants felt the impacts of COVID-19 and policy measures at the highest level, respectively. The study demonstrated that the weighted effect of the impact of the COVID-19 outbreak was statistically (p < .001) greater than that of policy measures on family (0.664 vs 0.618), education (0.562 vs 0.557), and the economy (0.643 vs 0.572). The weighted effect of the impact of policy measures was statistically (p < .001) greater than that of the COVID-19 pandemic on people’s daily activities (0.675 vs 0.651), cultural/traditional or community way of life (0.769 vs 0.736), access to healthcare services and infection prevention supplies (0.410 vs 0.390), and mental health (0.625 vs 0.584).

About half of the participants had a high level of impact from both the COVID-19 pandemic and policy measures. The results of this study suggest that policy measures need to be judged with caution, and the government should provide more comprehensive support to reduce the impact on people’s lives.