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Communications during outbreaks and public health emergencies of infectious diseases can be challenging. Information provided by scientific organizations and federal agencies as well as international organizations may be misunderstood if not contextualized for specific audiences. Furthermore, lengthy statements and documents may be difficult to comprehend by the public, clinicians and others preparing and responding to outbreaks. We evaluated the use of generative artificial intelligence (AI) models to develop visual communications and infographics, using the recent 2026 Ebola outbreak as a case study. We identify the strengths and challenges of using AI models for producing outbreak communication materials.
During humanitarian emergencies, infectious diseases may present during the acute, subacute, and/or recovery phase, requiring focused surveillance and management. Effective response depends on early identification, appropriate isolation, and timely public health notification. Prevention strategies addressing shelter, potable water, sanitation, vector control, nutrition, immunization, and health education are essential in eliminating or reducing the likelihood of outbreaks. Disaster-related infectious disease management requires an integrated, systems-based approach encompassing identification, surveillance, clinical care, public health, prevention, and infrastructure resilience. This manuscript provides a narrative review of relevant sources to guide facilities in identifying and managing key infectious diseases during disasters with a focus on United States (US) based recommendations. Resources include best practices from the American College of Physicians (ACEP), US Centers for Disease Control and Prevention (CDC), US Federal Emergency Management Agency (FEMA), World Health Organization (WHO), and US National Emerging Special Pathogens Training and Education Center (NETEC).
We examined five common targets for diagnostic stewardship that have been associated with improved patient outcomes. For each, we estimated the financial and reputational impact of each intervention on a typical 200 bed community hospital. These estimates can be adjusted for individual hospital estimates.
Results:
We found consistent savings and potential improvements in hospital metrics associated with these different diagnostic stewardship interventions. Clostridioides difficile (CDI) diagnostic stewardship showed ＄125,617 expected savings plus a likely additional 75% reduction in the hospital-acquired condition (HAC) CDI metric. Urine culture stewardship showed ＄34,111–＄92,361 in savings with an additional 30% reduction in the HAC catheter-associated urinary tract infection metric. Procalcitonin de-implementation showed ＄78,938 expected savings from test discontinuation. Expanded respiratory pathogen panel stewardship showed ＄383,650–＄668,000 in savings, depending on degree of reduction and replacement with focused viral testing. Blood culture stewardship showed ＄1,860,800 in savings with an additional 33%–80% reduction in HAC central line associated bloodstream infection and MRSA bacteremia metrics.
Conclusions:
In total, a 200-bed hospital implementing all five interventions could expect an approximate ＄2,482,616–2,825,216 in laboratory and clinical savings. These interventions would also improve many HAC metrics, providing an additional ＄200,000–＄600,000 in savings, depending on baseline performance. Finally, reputation metrics, such as Leapfrog grades, would also improve.
Healthcare sustainability is a multidisciplinary field that seeks to mitigate healthcare’s environmental consequences. Antimicrobial stewardship and healthcare sustainability both aim to reduce wasteful resource use while maximizing patient safety. However, a strong partnership between antimicrobial stewardship and healthcare sustainability has yet to develop. To facilitate environmentally sustainable decision-making in antimicrobial prescribing, we developed a web-based calculator (EcoRxChoice (www.ecorxchoice.com)) where users can enter different antimicrobial regimens and compare how much plastic waste each regimen creates. This work was supported in part by the Society of Infectious Diseases Pharmacists (SIDP), reflecting SIDP’s commitment to strengthening sustainability as a practical extension of antimicrobial stewardship and empowering infectious disease pharmacists to make measurable environmental impact through evidence-based care.
Antibiotics are frequently prescribed for acute sinusitis despite national guidelines recommending antibiotics only if specific symptom criteria are met. We aimed to define the proportion of acute sinusitis encounters meeting criteria for antibiotic prescribing, characterize prescribing practices, and identify factors associated with guideline-discordant prescribing.
Design:
This retrospective cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024 and March 31, 2024. Encounter notes were reviewed for appropriate antibiotic prescribing criteria as per national guidelines. Encounters were evaluated for drug selection and duration concordance based on local guidelines. A multivariable logistic regression analysis was performed to identify predictors of inappropriate antibiotic prescribing.
Setting:
Emergency departments, urgent care centers, and primary care clinics.
Results:
Antibiotic prescribing criteria were met for 67.6% of included encounters. Antibiotics were prescribed in 93.5% of encounters that met prescribing criteria, and 80.2% of encounters that did not. Both drug selection and duration were guideline-concordant in 49.2% of total encounters. On multivariable analysis, predictors of inappropriate antibiotic prescribing included cough (OR 2.15, 95% CI 1.08–4.29; P = 0.03) and symptom duration between 7 and 9 days (compared to <6 days; OR 7.70, 95% CI 3.24–18.31; P < 0.001). Electronic encounters were associated with lower odds of prescribing compared to in-person encounters (OR 0.03, 95% CI 0.01–0.09; P < 0.001).
Conclusions:
Most encounters for acute sinusitis result in an antibiotic prescription, despite prescribing criteria not being met. These findings may aid antimicrobial stewardship programs in benchmarking and optimizing antibiotic prescribing for acute sinusitis.
Candida auris (also referred to as Candidozyma auris) is an emerging multidrug-resistant fungal pathogen associated with high morbidity and mortality. Existing infection prevention and control (IPC) guidance has largely focused on adult populations, with limited recommendations for pediatric healthcare and non-healthcare settings.
Methods:
The Society for Healthcare Epidemiology of America (SHEA) convened a multidisciplinary expert panel to develop IPC recommendations for C. auris. The panel developed recommendations using a structured, iterative Delphi consensus process with rounds of discussion, refinement, and anonymous electronic voting with predefined consensus thresholds. Panelists reviewed relevant peer-reviewed and gray literature integrated with expert judgment and practical considerations. Preambles and remarks provide additional context and guidance.
Results:
This consensus statement provides recommendations for prevention of C. auris in pediatric acute care settings, non-acute healthcare settings, and non-healthcare congregate settings. Recommendations incorporate pediatric risk factors and care and address screening practices, isolation precautions, caregiver–infant/child dyad considerations, room placement and rooming in, breastfeeding and skin-to-skin practices, visitation, use of shared spaces, environmental cleaning and disinfection, and management of medical and non-medical equipment, including toys. Recommendations emphasize coordination with local infection prevention and public health partners.
Conclusions:
This SHEA consensus statement addresses gaps in pediatric-specific IPC guidance for C. auris. The recommendations provide a practical framework to support prevention of transmission within the context of pediatric clinical, developmental, and family-centered care.
Dr. Anthony Harris is Professor of Epidemiology and Public Health and Internal Medicine, and Head of the Division Genomic Epidemiology and Clinical Outcomes of Health Care Outcomes Research. He is an infectious disease physician and epidemiologist whose research interests include emerging pathogens, antimicrobial-resistant bacteria, hospital epidemiology/infection control, epidemiologic methods in infectious diseases, and medical informatics. He has published over 360 papers. He has current or has had funding from the NIH, CDC, VA, and AHRQ to study antibiotic resistance and hospital epidemiology. He is extremely proud of his mentoring track record.
Antimicrobial stewardship programs (ASPs) optimize antimicrobial use to ensure the best patient outcomes from infections. Since the initial publication of this guidance in 2014, accreditation standards have bolstered antimicrobial stewardship requirements in various healthcare settings, and antibiotic use and resistance data reporting requirements have further increased the scope and resource needs of ASPs. The purpose of this guidance is to outline and update the knowledge and skills necessary to lead ASPs, organized by basic, intermediate, and advanced skills recommended for stewards practicing in acute care, outpatient care, and long-term care settings. This update was developed by a multidisciplinary group of antimicrobial stewardship experts from key organizations and with diverse backgrounds engaged in advancing the practice of antimicrobial stewardship. It does not specifically address healthcare resources, staffing models, reporting structures, or percentage of full-time equivalents needed to conduct this work, which will be addressed by future multi-society publications.
Inappropriate antibiotic prescribing contributes to antibiotic resistance threats. In outpatient settings, antibiotics are often incorrectly prescribed for acute respiratory illnesses (ARI). Characteristics associated with inappropriate antibiotic prescribing at New York City (NYC) outpatient ARI visits were assessed to identify opportunities for interventions.
Methods:
Using IQVIA’s commercial Medical Claims and Longitudinal Prescription datasets, medical diagnosis codes identified outpatient visits for ARI during 2019–2022, which were linked to antibiotics obtained at a pharmacy (as a proxy for prescribed antibiotics) within 3 days post-visit. Univariate analyses were conducted describing visit, patient, and provider characteristics. Modified Poisson regression with robust error variance was used to calculate unadjusted relative risks (RR) and 95% CI for visit-level characteristics associated with inappropriate prescribing.
Results:
Among 3,493,444 ARI outpatient visits, 5.1% linked to an inappropriate antibiotic prescription. Among all ARI, bronchitis/bronchiolitis had the highest percentage (25.5% of bronchitis/bronchiolitis visits) and highest risk of inappropriate prescribing relative to asthma/allergy (RR: 18.03; 95% CI: 17.70, 18.38). Adults aged 65–79 years were over twice as likely to be prescribed inappropriate antibiotics relative to children (RR: 2.21; 95% CI: 2.17, 2.25). Inappropriate prescribing was highest in urgent care (8.4%) (RR: 1.25; 95% CI: 1.23, 1.27) relative to offices and among internal medicine physicians (8.0%); relative to these physicians, risk of inappropriate prescribing among all other physician specialties was lower.
Conclusions:
Inappropriate antibiotic prescribing at ARI outpatient visits was uncommon. Tailoring interventions to providers such as internal medicine physicians or those in urgent care settings may improve prescribing practices.
As Antimicrobial Stewardship and Healthcare Epidemiology (ASHE) concludes its first five years of existence, we reviewed and summarized the career perspectives publications. ASHE Careers publications are structured interviews with luminaries in infection prevention, public health, and antimicrobial stewardship, where leadership and professional development themes are individualized and explored. Across 14 published interviews from experienced infectious disease professionals identified, we synthesized 10 important themes amongst them. Among them emerged a strong emphasis on the central role of mentorship in career development, the importance of maintaining adaptability, and willingness to explore emerging opportunities of an ever-changing field. Together, these lessons offer guidance for those seeking direction or growth in healthcare epidemiology.
Non-sterile gloves (NSG) are essential for reducing transmission of pathogens and for protecting patients and staff. Their overconsumption can lead not only to an increased risk of cross-contamination but also increased plastic waste and downstream environmental effects. Glove reduction campaigns worldwide have safely and successfully reduced their inappropriate use and associated waste. In this multidisciplinary commentary, we discuss the sweeping public health and environmental consequences of NSG overuse and strategies to implement a successful glove stewardship campaign.
This national survey aimed to describe the work settings, characteristics, employment activities, scope, functions, and challenges of the pharmacist workforce responsible for infectious diseases (ID) and antimicrobial stewardship (AMS)-related tasks in the U.S.
Methods:
An internet-based QualtricsXM survey was distributed to 22,749 unique individuals with potential ID or AMS job responsibilities via email listservs for three national pharmacy organizations, and was open from 9/25/2024 to 10/24/2024. A respondent was considered engaged in ID/AMS activities if they reported involvement in at least one of 14 activities directly related to ID/AMS.
Results:
A total of 796 pharmacists with ID or AMS job responsibilities responded (3.5% response rate), with 607 working clinically or administratively in ID or AMS further categorized in four mutually exclusive groups based on formal and informal ID/AMS responsibilities. Respondents were predominantly female (66%), less than 40 years of age (59%) and white (82%). ID-specific training was completed by 41.8%, and 74% reported having student loan debt at graduation. Work-related activities were diverse and most frequently included: staffing or taking calls on weekends related to ID/AMS, AMS, educating learners or healthcare providers about ID-related topics, precepting learners, and conducting ID-related research and/or quality improvement projects. Respondents frequently indicated they lacked adequate job resources.
Conclusions:
The results highlight the extensive responsibilities placed on ID/AMS pharmacists to fulfill multiple roles. Pharmacists frequently lack ID-specific training or dedicated time for AMS responsibilities. The workforce is young, suggesting a need for both increased capacity for training programs and strategies for workforce retention.
Sporting events are opportunities for athletes to shine and fans to celebrate. Mass gatherings, including mega sporting events, are linked to substantial communicable disease transmission and requires multi modal, complex preparation and trained response teams. The 2026 FIFA World Cup™ tournament will span 48 teams in three different host countries. This expert commentary aims to review frequently implicated infections and high consequence pathogens; review preparedness strategies for healthcare personnel(HCP), infection prevention and control(IPC) teams, emergency department(ED) and disaster preparedness teams; and emphasize the need for closed loop communication and use of technology. The authors hope this commentary is practically used as a reference for clinicians and public health entities in host cities but also a blueprint for considerations in future sporting events—which are projected to increase.
Dr. Mark Rupp served as Medical Director of the Infection Prevention Department at Nebraska Medicine for 28 years and as Chief of the Division of Infectious Diseases for 14 years before assuming his current role as Interim Chair of the Department of Internal Medicine at the University of Nebraska Medical Center (UNMC) in 2025. He is a Past President of the Society for Healthcare Epidemiology of America (SHEA; 2009) and delivered the SHEA Lecture at IDWeek 2020.
Dr. Rupp has authored more than 200 peer-reviewed articles, 48 book chapters, three textbooks, and holds three U.S. patents. He is an internationally recognized expert in clinical infectious diseases and healthcare epidemiology and is a frequent national and international speaker, educator, and media contributor.
To describe the revised Asia Pacific Society of Infection Control (APSIC) Guidelines for Prevention of Central Line Associated Blood Stream Infections (CLABSI) 2024.
Design:
The revised guidelines was developed by infection prevention and control experts and key opinion leaders from Asia Pacific.
Setting:
Emphasis on practical implementation of Central Line Insertion and Maintenance Bundles using quality improvement approach is recommended towards the goal of achieving zero CLABSI in any healthcare setting.
Patients or participants:
Any patients with a central line in a healthcare setting
Interventions:
Literature search was done for recent international updates in CLABSI prevention. Recommendations were evaluated for practical and feasible implementation in low resourced settings.
Results:
The key recommendations are listed in the APSIC CLABSI insertion and maintenance guidelines. Additional measures are recommended for use where CLABSI rates remain high despite implementation of all preventive strategies to achieve institutional goals.
Conclusions:
A surveillance program is recommended to monitor outcomes and compliance with bundles. Ongoing review of the performance data with appropriate interventions made should facilitate efforts towards zero CLABSI rate.
Outpatient parenteral antimicrobial therapy (OPAT) is a mainstay of clinical infectious diseases practice, and OPAT-related publications continue to be prominent in journals. The objective of this article is to summarize ten clinically important OPAT-related publications from 2024.
Design:
Narrative review.
Methods:
Eighty-one articles were found in a literature search, and 56 met inclusion criteria. A survey containing 25 articles was sent to an email listserv of clinicians with OPAT experience.
Results:
This article summarizes the top 10 OPAT articles published in 2024, based on those survey results.
Conclusions:
Common themes from the top 10 OPAT articles published in 2024 included OPAT clinician workload, patient perspectives of OPAT, tools for OPAT work, and dalbavancin use.