Zahra Kassamali Escobar

Background: Multiplexed polymerase chain reaction gastrointestinal panels (GIPs) include mostly community-acquired pathogens. Diagnostic yield of GIPs for detection of non- Clostridioides difficile targets in hospitalized patients with cancer with community versus hospital-onset diarrhea is not well defined. Methods: This cross-sectional study included stool tests from hospitalized adults with a cancer diagnosis from July 2021 to May 2025. Our center recommends a GIP primarily for patients with community-onset diarrhea and stand-alone C. difficile testing for hospital-onset diarrhea. Generalized estimating equations with Poisson regression were used to estimate the prevalence ratio (PR) of detecting ≥1 non- C. difficile target after hospital day (HD) 3 compared to HD 1–3. Results: Among 1,433 GIPs from 1,127 patients, 468 (33%) were ordered after HD 3. Most GIPs were among patients with hematologic malignancies (794/1,433; 55%) and of those tests 352/794 (44%) were ordered after HD 3. Among all GIPs, C. difficile and norovirus were detected most frequently (16% and 6%, respectively). A non- C. difficile target was detected after HD 3 on 49/468 GIPs (10%), compared to 146/965 (15%) GIPs on HD 1–3 (adjusted PR 0.73; 95% CI [0.53–1.00]; P = .053). Among 49 GIPs after HD 3 detecting ≥1 non- C. difficile target, 19 tests were ordered for new-onset diarrhea and only 5 of these patients received intentional antimicrobial therapy in response to the GIP result. Conclusions: The added diagnostic yield for detecting ≥1 non- C. difficile target by GIP in patients with cancer and hospital-onset diarrhea is limited and supports restricting GIP ordering after HD 3 on oncology units.

Nine critical access hospitals (CAHs) participated in a quality improvement cohort to understand antibiotic use for community-acquired pneumonia (CAP). Over 9 months, 64% of CAP patients received excessive antibiotic durations. Hospitals prescribing more fluoroquinolones also prescribed longer durations. We identified unique barriers to improve CAP treatment in CAHs.

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.

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.

We evaluated the prevalence and treatment of asymptomatic bacteriuria (ASB) in 17 critical-access hospitals. Among 891 patients with urine cultures from September 2021 to June 2022, 170 (35%) had ASB. Also, 76% of patients with ASB received antibiotics for a median duration of 7 days, demonstrating opportunities for antimicrobial stewardship.

Background: Appropriate use of antimicrobials for hematologic malignancy, hematopoietic stem cell transplant recipients, and other cellular therapies is vital, with infection causing significant morbidity and mortality in this unique population of immunocompromised hosts. However, often in this population the choice and management of antimicrobial therapy is complex. When selecting an antimicrobial agent, key considerations include the need for dose adjustments due to renal or hepatic impairment, managing drug interactions, the potential for additive drug toxicity among those receiving polypharmacy and therapeutic drug monitoring. Other factors include leveraging pharmacodynamic principles to enable optimization of directed therapy against challenging pathogens, as well as judicious use of antimicrobials to limit drug resistance and adverse drug reactions.Summary: This review summarizes the clinical considerations for commonly used antimicrobials in this setting, including antibacterial, antiviral, and antifungal agents. image

This article presents a multifaceted intervention to address inappropriate antibiotic prescribing for viral RTI. The authors discuss the impact over 4 years, before and during the SARS-CoV-2 pandemic.

We compared experiences with The Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adult and Children in Emergency Department and Urgent Care Settings versus Choosing Wisely to evaluate inappropriate antimicrobial prescribing in ambulatory care. Both identified the same clinics, diagnoses, and antibiotics for high-yield antibiotic stewardship interventions.

Asymptomatic bacteriuria (ASB) is common among hospitalized patients and often leads to inappropriate antimicrobial use. Data from critical-access hospitals are underrepresented. To target antimicrobial stewardship efforts, we measured the point prevalence of ASB and detected a high frequency of ASB overtreatment across academic, community, and critical-access hospitals.

Objectives:To identify characteristics of US health systems and end users that report antimicrobial use and resistance (AUR) data, to determine how NHSN AUR data are used by hospitals and health systems and end users, and to identify barriers to AUR reporting.Design:An anonymous survey was sent to Society of Infectious Diseases Pharmacists (SIDP) and Society for Healthcare Epidemiology of America (SHEA) Research Network members.Methods:Data were collected via Survey Monkey from January 21 to February 21, 2020. Respondent and hospital data were analyzed using descriptive statistics.Results:We received responses from 238 individuals across 43 US states. Respondents were primarily pharmacists (84%), from urban areas, (44%), from nonprofit medical centers (81%), and from hospitals with >250 beds (72%). Also, 62% reported data to the AU module and 19% reported data to the AR module. Use of software for local AU or AR tracking was associated with increased reporting to the AU module (19% vs 64%) and the AR module (2% vs 30%) (P < .001 each). Only 36% of those reporting data to the AU module used NHSN AUR data analysis tools regularly and only 9% reported data to the AR module regularly. Technical challenges and time and/or salary support were the most common barriers to AUR participation cited by all respondents. Among those not reporting AUR data, increased local expectations to report and better software solutions were the most commonly identified solutions to increase AUR reporting.Conclusions:Efforts to increase AUR reporting should focus on software solutions and salary support for data-entry activities. Increasing expectations to report may incentivize local resource allocation to improve AUR reporting rates.