Alyssa Y. Castillo

Background: The Healthcare Effectiveness Data and Information Set’s antibiotic utilization for respiratory conditions (AXR) is a new, broad antibiotic prescribing metric. Higher AXR values indicate higher respiratory encounter prescribing rates. Relationships between clinician-level AXR and prescribing/diagnostic practices are unclear. Methods: This was a retrospective observational study of respiratory urgent care (UC) encounters across 32 UC centers in our health system, conducted from 1 July 2022 to 30 June 2025. Correlations between clinician-level AXR and prespecified outcomes (tier 3 prescribing, antibiotics for pharyngitis despite negative group A Streptococcus antigen testing, sinusitis/acute otitis media (AOM) treatment/diagnosis rates, narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy, and <7-day treatment duration for sinusitis/AOM in patients ≥2 years) were assessed using quartile-based logistic regression and weighted Spearman correlations. Results: Among 528 444 respiratory encounters, 37.1% (195 891) were associated with an antibiotic prescription; 303 clinicians were included. Clinicians in the highest AXR quartile (AXR quartile 4 [Q4]) were more likely to be in Q4 than in quartile 1 for the following: tier 3 prescribing (odds ratio, 15.38 [95% confidence interval, 5.58–42.39]), pharyngitis prescribing despite negative group A Streptococcus testing (11.16 [4.04–30.79]), and the treatment (8.95 [3.23–24.80]) or diagnosis (33.92 [11.14–103.27]) of sinusitis/AOM. AXR-Q4 clinicians were less likely to be in Q4 for narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy (odds ratio, 0.36 [95% confidence interval, .17–.77]) and prescriptions of <7 days for sinusitis/AOM for patients ≥2 years old (0.25 [.11–.55]). Conclusions: In our UC network, high clinician-AXR was correlated with antibiotic prescription/diagnostic measures. AXR can serve as an efficient screening metric but should be paired with prescription/diagnosis-specific measures and prescription characteristics to guide outpatient stewardship efforts.

Little is known about antibiotic use and antimicrobial resistance among people who inject drugs and people who experience homelessness. Here, we identify key antibiotic stewardship challenges unique to these important patient populations and outline concrete street stewardship interventions to better understand and/or ameliorate these challenges.

We evaluated 249 asymptomatic patients receiving antibiotics for urinary infection: 222 had asymptomatic pyuria and/or nitrituria (ASPN) and 133 had asymptomatic bacteriuria (ASB, growth ≥10⁵ colony forming units/ml). ASPN identified 40% more cases of unnecessary antibiotics compared to ASB and may be a more comprehensive measure of unnecessary antibiotic use.

Antibiotic utilization for respiratory conditions (AXR) is a new Healthcare Effectiveness Data & Information Set ^® (HEDIS^®) measure designed to complement disease-specific metrics to improve outpatient antibiotic prescribing. Unique challenges include ensuring clinicians understand the metric and establishing appropriate goals within different health systems and service lines. Successful implementation requires awareness of the metric’s limitations and may be enhanced by co-reporting with condition-specific antibiotic use metrics to prioritize local interventions.

We describe our experience implementing an intensive quality improvement cohort pilot focused on managing asymptomatic bacteriuria in 19 critical access hospitals. Participation in the pilot was high, and almost all sites identified an improvement goal and collected clinical data. Barriers to implementation included staffing shortages, turnover, and lack of bandwidth.

Accurate reporting of healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN) is a critical function of infection prevention and control (IPC) teams. Validation was performed to increase inter-rater reliability in HAI adjudication among infection preventionists. Benefits included improved data integrity, enhanced team performance, and individual growth.

The ability to provide feedback to a colleague is a key skill required for professional growth and patient safety. However, these conversations are limited by time constraints, differences in values, and a culture of “noninterference.” This advocacy-inquiry-identify-teach framework creates an organized approach to initiating successful “challenging” conversations with peers.

Non-specific respiratory symptoms overlap with coronavirus disease 2019 (COVID-19). Prompt diagnosis of COVID-19 in hospital employees is crucial to prevent nosocomial transmission. Rapid molecular SARS-CoV-2 testing was performed for 115 symptomatic employees. The case positivity rate was 2.6%. Employees with negative tests returned to work after 80 +/− 28 minutes.