Sinusitis is a leading reason for outpatient antibiotic prescriptions; however, diagnosis can be challenging because symptoms overlap with several common conditions. The study purpose was to evaluate concordance between sinusitis diagnoses made by primary care provider (PCP) and subsequent, objective otolaryngologist assessment among antibiotic-treated patients referred for ear–nose–throat (ENT) evaluation.

IRB-approved, retrospective cohort from 1/1/2022 to 1/31/2025 of patients >18 years old referred by in-network ambulatory PCPs to an ENT clinic for sinusitis management. Patients required objective ENT evaluation of sinusitis via nasal endoscopy, computed tomography, or magnetic resonance imaging. The primary outcome was the proportion of patients who retained a sinusitis diagnosis after ENT evaluation. Additional data included patient characteristics, alternative diagnoses, and prior antibiotic use.

Among 422 patients referred for sinusitis, 45% retained the diagnosis after ENT evaluation. Patients with a confirmed sinusitis diagnosis had a median (interquartile range (IQR)) of 2 (1–3) antibiotic courses prior to ENT referral vs 1 (1–2) in patients with a non-confirmed diagnosis (P = .085). Additionally, patients with a confirmed sinusitis diagnosis received a median (IQR) of 12 (7–21) days of antibiotics prior to ENT referral vs a median (IQR) of 10 (7–18) days in non-confirmed diagnosis patients (P = .090). Common alternative diagnoses included allergic rhinitis (30%), deviated septum (21%), laryngopharyngeal reflux (19%), and facial pain (15%).

More than half of antibiotic-treated patients referred for sinusitis did not retain the diagnosis following subsequent ENT evaluation. These findings support outpatient antimicrobial stewardship strategies focused on diagnostic reassessment and guideline-concordant management of patients with persistent or recurrent sinonasal symptoms.

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.

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.

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.

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.

Seasonal variation in bacterial epidemiology and antimicrobial resistance (AMR) has been reported across healthcare settings. We evaluated seasonal variation in community-onset bacterial detection and AMR in a multicenter healthcare system.

We conducted a retrospective cohort study of clinical cultures obtained on hospital days 0–2 across 4 hospitals from 2012 to 2016. Six bacterial organisms were evaluated. Summer was defined as July–August and winter as January–February. Multivariable logistic regression evaluated associations between season and organism detection, specimen source, and AMR, adjusting for age, admission source, diabetes mellitus, chronic dermatitis, and wounds.

Among 95,964 community-onset clinical cultures from 48,133 patients, 2,820 (2.9%) yielded a study-target organism. In unadjusted analyses, summer was associated with increased odds of Klebsiella pneumoniae (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.31–1.73) and Pseudomonas aeruginosa detection (OR, 1.30; 95% CI, 1.10–1.54). Acinetobacter baumannii demonstrated a similar but statistically uncertain pattern (OR, 1.74; 95% CI, 0.99–3.05). Season was not associated with overall target-organism detection after adjustment (adjusted odds ratio (aOR), 0.96; 95% CI, 0.88–1.04; P = .28). Resistant/intermediate isolates accounted for 386 of 1,531 (25.2%) summer and 331 of 1,289 (25.7%) winter isolates. Season was not associated with overall AMR after adjustment (aOR, 1.07; 95% CI, 0.89–1.28; P = .47).

Seasonal differences occurred in unadjusted detection of selected gram-negative organisms, but season was not associated with overall target-organism detection or AMR after adjustment. These findings support interpreting seasonal microbiologic surveillance in the context of local epidemiology and patient and healthcare-related characteristics.

Fungal blood cultures (fungal-isolator cultures) (FBCs) require extended incubation (4–6 wk) and substantial laboratory resources. However, their diagnostic yield is limited in solid organ transplant (SOT) recipients. Understanding the utilization patterns and yield of FBCs in SOT recipients is essential to inform diagnostic stewardship.

A retrospective, single-center study was conducted at Duke University Hospital (July 2021–January 2025) evaluating all FBCs collected from adult SOT recipients. Demographics, clinical indications, culture results, antifungal use, infectious diseases (ID) involvement, and outcomes were extracted from electronic medical records (EMRs).

A total of 137 FBCs from 104 SOT recipients were analyzed. The cohort demonstrated high acuity, with a median hospitalization of 32 days and a 23% 6-month mortality. Heart transplant recipients accounted for the largest proportion (37%) of FBCs, as well as the largest proportion (46%) of inappropriate FBCs. Only 1 of 137 cultures (0.7%) yielded a fungal organism (Histoplasma capsulatum); 5 grew bacterial organisms. Two-thirds of cultures were collected, although patients were already receiving antifungals. ID was consulted in 91% of cases, but recommended FBC collection in only 42%. Sixty-nine percent of cultures were collected without a suspected fungal pathogen documented in the chart.

FBCs had an extremely low yield (0.7%) in SOT recipients with the sole positive isolate being a dimorphic fungus. Most cultures were collected without a targeted fungal pathogen and without ID recommendation, representing an opportunity for diagnostic stewardship interventions to reduce unnecessary utilization and associated laboratory burden and cost.

Some clinical documentations, including surgical antibiotic administration data and hand-written notes, are only captured in non-digitized scanned documents, limiting their accessibility. Commercially available artificial intelligence (AI) tools may offer a means of extracting such data from scanned-in images, however, little is known about their accuracy for this application. Thus, the objective of this study was to evaluate the performance of two commercially available, protected AI tools for extracting antibiotic administration data as part of a larger study evaluating the sustainability of stewardship goals achieved during the Surgical Care Improvement Project mandatory reporting period.

A sample of surgical cases with antibiotic administration data documented only in non-digitized scanned records was manually reviewed and submitted to two commercially available AI tools (Claude Sonnet version 4.6 and OpenAI version 5.0). The AI tools were prompted to extract data about antibiotic name, dose, and administration time.

The total accuracy across all three metrics (drug, dose, timing of administration) was limited (3/14, 21.4% for Claude and 2/14, 14.3% for OpenAI), but overall excellent for identifying that an antibiotic had been administered and the type of drug administered (Claude, 100%, OpenAI, 92.8%). AI tools struggled to identify total dose administered (Claude, 50%, OpenAI, 42.9%), primarily due to challenges distinguishing aliquots from administered doses. Accuracy for identifying timing was also variable, particularly when administration time was documented using a graphic scale rather than written text.

Potential utility of these commercial tools for extracting antimicrobial use data from scanned-in records depends upon review goals and what level of precision is necessary.

To determine whether Friday–Sunday ambulatory encounters for suspected urinary tract infection (UTI) are associated with higher odds of unnecessary and overall antibiotic prescribing than Monday–Thursday encounters. We hypothesized a priori that both outcomes would be more frequent Friday–Sunday.

Retrospective cohort study with encounter-level analysis.

Ambulatory urogynecology and family medicine practices.

Adults evaluated for suspected UTI.

The primary outcome was unnecessary antibiotic prescribing, defined a priori as treatment meeting at least one criterion: asymptomatic bacteriuria, absence of pyuria, or prescribing when the urine culture was negative or nondiagnostic. Adjusted models included age, sex, race, clinic type, and insurance type. Secondary analyses omitted clinic type and stratified by clinic.

Of 780 encounters among 640 adults (93.0% female), 120 (15.4%) occurred Friday–Sunday. Any antibiotics were prescribed in 55.0% of Friday–Sunday versus 39.5% of Monday–Thursday encounters (adjusted odds ratio [aOR], 1.78; 95% CI, 1.19–2.66). Unnecessary antibiotics were prescribed in 30.8% versus 21.8% (aOR, 1.52; 95% CI, 0.97–2.39); this association was significant only in the model omitting clinic type (aOR, 1.65; 95% CI, 1.06–2.59). Prescribing when the culture was negative or nondiagnostic was more frequent Friday–Sunday (15.0% vs 7.1%; P = .004). Associations were directionally similar across clinics (adjusted interaction P ≥ .50).

Friday–Sunday encounters were associated with significantly higher odds of overall antibiotic prescribing; the association with unnecessary prescribing was directionally similar but not statistically significant after adjustment for clinic type. The excess was concentrated in culture-negative or nondiagnostic prescribing, identifying end-of-week encounters as a potential stewardship target.

To examine knowledge, awareness, and organizational culture regarding Candida auris and identify factors influencing infection control performance among hospital nurses.

Multicenter, cross-sectional study.

Six acute-care public and private general/tertiary hospitals (≥500 beds) in South Korea.

195 direct-care nurses with ≥3 months of clinical experience.

Data were collected via an online survey (Feb 1–9, 2026). The 60-item instrument assessed C. auris knowledge (19 items), awareness (16 items), organizational culture—defined as shared norms, leadership support, and safety climate for infection control (10 items)—and infection control performance (15 items). The researcher-developed measures underwent content validation (I-CVI ≥ 0.80), and all measures showed acceptable internal consistency (KR-20 = 0.902; Cronbach’s α = 0.875–0.937). Analysis included Pearson’s correlation and multiple linear regression.

Mean scores were 0.63 ± 0.19 for knowledge, 4.21 ± 0.55 for awareness, 3.64 ± 0.52 for organizational culture, and 4.03 ± 0.64 for infection control performance. Performance correlated with knowledge (r = 0.210, P = .003), awareness (r = 0.406, P < .001), and organizational culture (r = 0.498, P < .001). Organizational culture (β = 0.411, P < .001) and awareness (β = 0.265, P < .001) were significant predictors (adjusted R2 = 0.309), whereas knowledge was not (β = 0.038, P = .565).

Organizational culture and awareness are the primary drivers of C. auris infection control performance. Hospitals should complement knowledge-based training with supportive organizational environments, supervisor feedback, and unit-level systems that facilitate consistent practice.

Determine the prevalence of Staphylococcus aureus mupirocin resistance in a Neonatal Intensive Care Unit (NICU) population to inform decolonization regimen decisions. Investigate highly resistant methicillin-resistant S. aureus (MRSA) isolates for stain relatedness and horizontal transmission events.

Mupirocin susceptibility of S. aureus isolates from nares of NICU patients was evaluated by E-test. Strain relatedness of nine MRSA isolates with high-level mupirocin resistance along with one blood isolate was analyzed by whole-genome sequencing. An epidemiological investigation was performed using electronic medical record data.

Overall S. aureus mupirocin resistance was 12.7% (89/102) with MRSA isolates exhibiting a 38% (11/29) resistance rate. All sequenced MRSA isolates were the same strain and possessed the mupA gene. Five patients tested positive on admission, four patients acquired the strain in our NICU, and one patient’s acquisition status was indeterminant.

Overall, mupirocin resistance among S. aureus isolates was low; however, MRSA isolates demonstrated a higher-than-expected resistance rate. A highly resistant strain was introduced into our NICU and transmitted to several patients, most likely due to a gap in contact precaution implementation. Simplified mupirocin susceptibility testing, clearer interpretation standards and validated alternative therapies for all age groups should be prioritized if mupirocin continues to be nationally recommended and implemented as a decolonization therapy.

AmpC B-lactamases cause resistance to broad-spectrum B-lactams with variable expression dependent on bacterial species. Practice remains heterogenous regarding treatment of infections caused by AmpC organisms. This study aimed to assess the impact of a microbiology comment-based stewardship intervention on the definitive treatment of low-risk AmpC-producing Enterobacterales bacteremia.

This was a pre- and posttest quality improvement study conducted at Island Health Authority. A stewardship intervention involving amendment of a microbiology report comment regarding inducible resistance was implemented on February 13, 2023. Patients aged 18 and older with blood cultures growing low-risk AmpC-producing organisms were included. The primary end point of proportion of patients receiving ceftriaxone or piperacillin-tazobactam was compared between pre- (June 2021 to February 2023) and postintervention periods (February 2023 to October 2024). Secondary end points included clinical outcomes, ceftriaxone/piperacilin-tazobactam resistance rates, and C. difficile infection.

A total of 56 patients were included (25 preintervention and 31 postintervention). Definitive ceftriaxone/pipercillin-tazobactam antibiotic therapy was prescribed more frequently postintervention compared to preintervention (45.8% vs 5.0%, P < .001). After adjusting for critical illness, patients in the postintervention group had 17.7-fold higher odds (CI 1.9–162.6) of receiving definitive ceftriaxone or piperacillin-tazobactam (PTZ) compared to the preintervention group. No patients required retreatment for the same organism initially cultured, and neither group had ceftriaxone or PTZ resistance documented within 30 days posttreatment completion.

The microbiology comment-based antimicrobial stewardship intervention led to increased ceftriaxone and PTZ prescribing for low-risk AmpC-producing Enterobacterales bloodstream infections compared to carbapenems, without affecting patient outcomes and increasing resistance rates.

To assess trends in healthcare-associated infection (HAI) prevalence, distribution by infection site and pathogen, and factors associated with HAI occurrence.

Five repeated point prevalence surveys (2017–2025).

Hedi Chaker University Hospital, a tertiary-care teaching hospital in southern Tunisia.

HAIs were defined per CDC/NHSN criteria. Temporal trends were assessed by Poisson regression and associated factors by multivariate logistic regression.

HAI prevalence increased significantly from 8.6% in 2017 to 21.8% in 2025 (Prevalence Ratio (PR) = 1.11; 95% CI: 1.06–1.15; P < .001), an estimated annual rise of 10%. Bloodstream infections (PR = 1.17; P = .004) and skin and soft tissue infections (PR = 1.17; P = .035) both increased significantly. Pneumonia and lower respiratory tract infections were the most frequent HAI type (26.2%). Among microbiologically documented HAIs (45.9%), Gram-negative bacilli predominated: Escherichia coli (23.5%), Pseudomonas aeruginosa (18.5%), and Klebsiella pneumoniae (17.6%). Multidrug-resistant (MDR) organisms accounted for 34.5% of isolates and increased significantly (PR = 1.12; P = .033). Independent risk factors were peripheral venous catheter use (Adjusted Odds Ratio (AOR) = 4.36; 95% CI: 2.78–6.84; P < .001), undernutrition (AOR = 2.02; 95% CI: 1.23–3.32; P = .005), and Intensive Care Unit admission (AOR = 2.08; 95% CI: 1.10–4.46; P = .048).

HAI prevalence increased significantly from 2017 to 2025, with a sharp peak in 2025 and concurrent rises in bloodstream infections and MDR pathogens. These findings call for strengthened programs targeting modifiable risk factors and underscore the need for a national HAI surveillance network.

Analyze the impact of two different discharge medication reconciliation (DMR) models on antibiotic prescribing at hospital discharge across a health system.

Multi-center, retrospective evaluation from September 1, 2024, to August 31, 2025.

The M Health Fairview system consists of ten hospitals, eight in the Minneapolis/St. Paul area, one of which is a quaternary level academic medical center (AMC). The other two hospitals are located >60 miles from a metropolitan area.

Participants ≥18 years discharged with an oral antibiotic prescription intended to treat pneumonia, urinary tract infection, or Gram-negative bacteremia were included. Participants with a history of hematopoietic stem cell or solid organ transplant, or neutropenia during the index admission were excluded.

At nine of the hospitals, pharmacists complete a full DMR, which includes documentation of pharmacist interventions, the rated significance of the intervention, and time to complete DMR. The AMC completes DMR only on “high risk” medications which includes oral antimicrobials.

No statistically significant difference in pharmacist intervention rates between DMR models was detected. The overall pharmacist intervention rate was 8.4%, though the targeted DMR site was higher at 13.6%. The most common pharmacist intervention was recommending an alternative duration. The mean duration exceeded reference durations in the indications of CAP, cUTI, and Gram-negative bacteremia from a urinary source.

This review emphasizes the opportunity for pharmacist interventions given the low rates of appropriate antibiotic durations seen across the health system. Accurate recording of interventions is an opportunity for automated integration within the EHR.

Diverticulitis is a common indication for inpatient antibiotic therapy. Therapeutic Guidelines (eTG) are available to inform practice, but uncertainty remains over rates of adherence to guidelines and outcomes related to antibiotic choice. The authors aimed to assess the degree of compliance to local prescribing guidelines and associated outcomes for inpatients with acute diverticulitis.

Patients admitted to the Mater Hospital Brisbane between January 2019 and December 2023 with proven diverticulitis were included. Clinical, biochemical, treatment, and 90-day outcome data were assessed. Key clinical outcomes and prescribing practices were compared in relation to compliance.

A total of 445 patients comprising 155 (35%) with complicated and 290 (65%) with uncomplicated diverticulitis were included. Overall guideline compliance was 252/445 (57%) and was lower for complicated 55/155 (35%) compared with uncomplicated diverticulitis 197/290 (68%), P < 0.01. In multivariable analysis, complicated diverticulitis at presentation was the only significant variable associated with non-compliance, aOR: 2.73 (95% CI: 1.68–4.46, P < .001). Non-compliant prescriptions were also associated with a longer course of intravenous therapy, median 5 (IQR: 3–7) vs 3 (IQR: 2–5) days, P < .001. There were no associations with adverse outcomes in relation to compliance.

The overall adherence to antimicrobial prescribing guidelines for management of diverticulitis was poor. Clinicians were most likely to prescribe non-compliantly for patients presenting with complicated diverticulitis. However, compliance was not associated with adverse outcomes. This suggests guideline-compliance is safe and there is limited benefit of broad-spectrum therapy, with potentially increased adverse effects.

Although antimicrobial stewardship programs (ASPs) have been shown to improve antibiotic prescribing and reduce antimicrobial resistance, evidence from community hospitals remains scarce, particularly regarding the determinants of acceptance of ASP recommendations. This study aimed to evaluate the acceptance of ASP interventions in a community hospital and to identify the factors associated with their acceptance.

Retrospective observational study.

A 113-bed community hospital in Spain.

Hospitalized patients receiving or considered for antimicrobial treatment who were reviewed through a prospective audit and feedback between July 2021 and February 2024.

ASP interventions were prospectively collected in a structured database. Bivariate analyses and a multivariable logistic regression were performed to evaluate factors associated with recommendation acceptance.

A total of 437 ASP interventions were recorded. Acceptance was documented for 343 interventions (78.5%), of which 264 were accepted (77.0%). In bivariate analysis, acceptance was associated with clinical service, source of infection, microbiological culture, antimicrobial indication, type of ASP recommendation, age, and white blood cell count. In the multivariable analysis (n = 343), clinical service remained the only variable independently associated with acceptance among those included in the model. Interventions targeting surgical services were significantly less likely to be accepted compared with medical services (adjusted OR, 0.28; 95% CI, 0.12–0.64; P = .002).

Acceptance of ASP interventions in a community hospital varied significantly by clinical service, with lower acceptance in surgical services. These findings support tailoring antimicrobial stewardship strategies to specific clinical contexts.