Antibiotic misuse drives antimicrobial resistance (AMR), and antimicrobial stewardship (AMS) interventions are central to optimizing use. For AMS strategies to be successful, current prescribing must be examined. This study uses the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification of antibiotics to investigate systemic antibiotic prescribing in a tertiary care hospital in Antigua and Barbuda.

A cross-sectional review of systemic antibiotic prescriptions for the medical, surgical, and maternity inpatient units was performed from 2014 to 2021. Data were analyzed using percentages and averages and presented according to the WHO Anatomical Therapeutic Classification (ATC) and the AWaRe classification of antibiotics.

We analyzed 27,676 oral and intravenous systemic antibiotic prescriptions, issued to 12,165 patients between 1 January 2014 to 30 September 2021. Other beta-lactam antibacterials (J01D) were the most prescribed ATC subgroup, followed by other antibacterials (J01X). 56% (n = 15,410) of prescriptions were in the Watch category, while 44% (n = 12,266) were in the Access category using the AWaRe classification. The surgical unit had the highest percentage of Access antibiotic prescriptions at 57% (n = 8,115). The maternity unit followed with 48% (n = 1,353) for Access antibiotics. In contrast, the medical unit had only 27% (n = 2,798) for Access antibiotics, while 73% (n = 7,758) were for Watch antibiotics.

A higher proportion of Watch antibiotics emphasizes the need for strengthened AMS interventions. Findings from this single-center study provide essential baseline data and support the use of the WHO AWaRe classification to identify stewardship priorities in small island states. Future research should focus on specific patient cohorts.

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.

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.

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.

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.

The rising incidence of antimicrobial resistance (AMR) underscores the urgent need for effective antimicrobial stewardship (AMS). This study assessed the impact of a tailored AMS initiative in Indian hospitals.

An AMS surveillance program was implemented across 11 Indian hospitals (January 2022–June 2023). The intervention (July 2022–June 2023) included hospital-specific antibiograms, antibiotic policy design and implementation, monitoring antibiotic consumption, and tracking multidrug-resistant organisms (MDROs). Hospital staff were trained, and compliance audits with feedback were conducted. Implementation followed the Model for Improvement methodology over 18 months.

AMS surveillance revealed significant improvement in AMS knowledge and practices from the baseline to the postintervention phase. Antibiotic compliance increased from a baseline of 10% to 71% across hospitals, reaching 73%–91% in the subsequent period. Surgical prophylaxis compliance improved substantially, particularly in hospitals with initially low adherence. Optimizations in antibiotic selection, dosing, duration, intravenous-to-oral switching, and de-escalation were also observed, resulting in significant compliance gains across all domains. Use of antibiotics classified by the World Health Organization as safer first-line options with a narrow spectrum increased, while use of second- and third-line antibiotics, including those with broader spectra and higher resistance risks, decreased, reflecting a shift toward safer prescribing practices. However, MDRO incidence rates remained variable across sites, showing room for improvement.

Locally tailored AMS interventions within a structured quality improvement framework can establish sustainable practices to mitigate AMR. These findings demonstrate effective strategies for optimizing antibiotic use and provide valuable insights for broader implementation of AMS.

Hospital-acquired infections (HAIs) pose significant challenges in the Asia Pacific region, where disparities in healthcare infrastructure and inconsistent infection prevention protocols may exacerbate patient safety risks. A recent survey of healthcare facilities across ten Asia-Pacific countries identified substantial gaps in compliance with international guidelines for sterilizing surgical implants, indicating a need for educational initiatives to drive improvement.

The Asia Safe Surgical Implant Consortium was established through collaboration among regional professional associations and met in Tokyo, Japan, to formulate consensus recommendations.

The consensus process incorporated diverse expert perspectives and current evidence, resulting in three foundational documents that addressed quality assurance in sterilization, standardized management of loaner and implantable devices, and the implementation of a robust sterilization recall policy. These recommendations emphasize the integrated use of physical, chemical, and biological indicators, thorough documentation, and timely communication to enhance sterilization practices. Ongoing regional collaboration, investment in resources, and professional development were identified as critical for achieving consistent adoption of best practices and improving surgical outcomes.

The consortium’s work provides a structured framework to support central sterile supply departments and elevate patient safety standards across the Asia Pacific region.

To compare clinical outcomes in adults with uncomplicated enterococcal bacteremia treated with intravenous (IV) therapy alone versus an early oral (PO) transition and evaluate treatment characteristics and safety outcomes.

Retrospective cohort study between January 1, 2021, and August 1, 2024. The primary outcome was clinical cure at 90 days after antibiotic completion. Secondary outcomes included treatment failure, infection-related readmission, hospital length of stay (HLOS), and 90-day mortality.

Massachusetts General Hospital and Brigham and Women’s Hospital, two tertiary care centers in Boston, MA.

Adult patients with at least one positive blood culture with Enterococcus spp. Patients were excluded if they had polymicrobial or persistent bacteremia, invasive infection, incomplete source control, died before completing therapy, or received fewer than 7 days of antibiotics.

209 patients were included, of which 119 received IV therapy alone and 90 underwent early PO transition. Gastrointestinal (41.6%) and genitourinary (32.1%) sources were most common, and 86 patients (41.1%) had immunocompromising conditions. Clinical cure was similar between the IV and early PO transition groups (73.9% vs 82.2%; P = .156), with no significant differences in secondary and safety outcomes. HLOS was significantly shorter in the early PO transition group (9 days vs 20 days; P < .001).

Early PO transition appears to be a safe and effective strategy for uncomplicated enterococcal bacteremia and was associated with reduced HLOS.

To describe the evidence on antimicrobial stewardship programs (ASPs) and strategies implemented in outpatient settings.

We conducted a scoping review to describe the evidence published since 2013 on the effects and implementation of outpatient ASP strategies and programs.

We searched Ovid MEDLINE, Embase, and Scopus from January 1, 2013 through September 3, 2024. Data were summarized in figures and tables. We categorized studies by types of ASP strategies and settings. We also summarize the reported outcomes using the RE-AIM framework.

Of 29,544 unique citations/abstracts, 285 primary studies and 37 systematic reviews were eligible. Most included primary studies were observational (k = 226) and only 59 (21%) were randomized controlled trials (RCT). Most studies were conducted in primary care (k = 135) or emergency room/urgent care (k = 79). The most commonly evaluated individual strategies were patient and/or clinician education only (k = 55), audit and feedback (k = 48), and laboratory testing (k = 45). Overall antimicrobial and inappropriate prescribing rates were the most frequently assessed outcomes; patient treatment outcomes and health care utilization were also commonly reported.

There has been substantial growth in the evidence base, but this is largely from observational studies. Evidence gaps include a need for more controlled studies, and evaluation of additional outcomes. Few studies evaluated implementation costs or barriers, reach, and sustainability. Many of these additional outcomes would provide valuable insights to aid policy makers in the most feasible and appropriate strategies for implementation.

While the disease and economic impact of gram-negative bacilli bloodstream infections (GNB-BSI) are high, treatment strategies, including transitioning from intravenous antimicrobial therapy (IVAT) to oral stepdown antimicrobial therapy (OSAT) are still in their nascent stage of development.

A systematic review and meta-analysis evaluated the clinical effectiveness of OSAT compared with IVAT for GNB-BSI. Medline and Embase were searched from January 1980 to March 2025, along with the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and reference lists of eligible studies. Randomized controlled trials and observational studies comparing OSAT with IVAT were included. Three investigators screened studies, extracted data, assessed study quality, and risk of bias, following PRISMA guidelines, ROBINS-E for observational studies and RoB 2 for randomized trials. Certainty of evidence was assessed using the GRADE framework.

Sixteen studies involving 4,858 patients who received OSAT and 4,961 patients who received IVAT were extracted for review. The pooled risk ratio for mortality and treatment failure in the primary analysis which included studies adjusting for confounders (n = 3) was 0.95 (95% confidence interval [CI]: 0.42, 2.14; I2 = 8%) and 1.11 (95% CI: 0.22, 5.51; I2 = 59%), respectively. The GRADE assessment for the primary analyses rated the evidence as very low to moderate certainty. Outcome definitions varied substantially across studies, potentially affecting pooled estimates.

Although an imbalance in the baseline characteristics of patients with GNB-BSI across the studies warranted closer attention, OSAT may be as effective as IVAT for GNB-BSI without compromising clinical outcomes. Nevertheless, high-quality RCTs are needed before making definitive recommendations.

This study examined stakeholder perceptions of gaps in antimicrobial resistance (AMR) mitigation efforts across different sectors and career stages, with the goal of generating insights to support prioritization of One Health interventions.

We conducted a cross-sectional survey of AMR stakeholders using a structured questionnaire between October and November 2025. Stakeholders were recruited through international networks across 33 countries on 5 continents. Respondents listed the top three areas in AMR mitigation efforts that they perceived as receiving insufficient attention but require greater focus to reduce the emergence and spread of drug-resistant bacterial infections. We performed thematic analysis, calculated weighted priority scores, conducted an Impact-Effort Matrix analysis, and applied Fisher’s exact tests to examine associations between themes, professional sector and career stages.

Among 103 respondents, participants spanned nine professional sectors and four career stages. Antimicrobial stewardship (18.8%, weighted score 119) and Environmental AMR and Waste (16.5%, weighted score 108) were the most frequently cited perceived gaps. Impact-Effort Matrix analysis identified four priority areas as Quick Wins (stewardship, IPC, surveillance, and animal health, accounting for 45.7% of impact), two Major Projects (environmental AMR, R&D), three Fill-ins (awareness, One Health, other/cross-cutting), and three Hard Slogs (access, financing, policy). No significant associations were observed between perceived mitigation gaps across professional sector and career stages.

The emphasis on antimicrobial stewardship among stakeholders highlights a perceived disconnect between stewardship policy adoption and on-the-ground practice. The Impact-Effort Matrix provides a decision-support tool that may assist policymakers and funders in prioritizing One Health interventions.

Antimicrobial stewardship programs (ASPs) promote optimal antimicrobial use in pediatrics; however, data describing structure, personnel effort allocation, and activity distribution across regular and after-hours workflows remain limited.

We conducted a cross-sectional survey of pediatric ASPs across the U.S. from September to October 2024 using ASP/ID-related listservs. Respondents reported institutional structure, personnel effort allocation, initiatives, and participation in an after-hours ASP on-call model, with additional details from programs reporting on-call participation.

Twenty-two pediatric ASP responses were included, most from academic medical centers (81.8%) and programs covering 101–250 beds (41%). Median physician full-time equivalents (FTEs) increased with institutional size, ranging from 0.1 for institutions with < 100 beds to 0.8 for those with >500 beds. Pharmacist FTEs were a median of 1 for institutions with ≤ 500 beds and increased to 2.25 for programs >500 beds. Most programs reported to Quality and Safety (45%) or discipline-specific departments (41%), with funding primarily attributed to Pharmacy (73%). During regular working hours, nearly all programs performed prospective audit and feedback (100%), responded to ASP-related inquiries (95.5%), and facilitated antimicrobial de-escalation (90.9%). Six programs (27.4%) reported participation in an ASP on-call model, most commonly providing remote coverage during evenings, weekends, and holidays. After-hours activities were largely limited to time-sensitive interventions, including preauthorization and responding to inquiries.

Pediatric ASPs demonstrate variability in structure, personnel effort allocation, and stewardship activities. ASP on-call coverage remains uncommon and is typically focused on time-sensitive interventions, reflecting targeted deployment of stewardship resources outside regular working hours.

This study examined antibiotic stewardship in hospital outpatient departments (HOPDs) and alignment with CDC Core Elements for outpatient settings. It also explored challenges that The Joint Commission accredited hospitals face when implementing hospital-based interventions in outpatient settings.

Qualitative study using in-depth interviews

HOPDs included hospital-affiliated primary care, urgent care, emergency departments, specialty care, surgical centers, wound care, and dental clinics.

Respondents included Antibiotic Stewardship Program (ASP) lead pharmacists and physicians with and without infectious disease specialization, clinical pharmacists, and accreditation coordinators.

We conducted in-depth interviews with ASP leaders from a cross-section of hospitals of varied size and system membership. We used MAXQDA 2022 (VERBI Software, 2021) and the Framework Method to organize and analyze interview transcripts.

We interviewed 42 ASP leaders from 28 hospitals. Findings show that ASPs encountered financial constraints in expanding stewardship into HOPDs. Few hospitals had dedicated leaders or extra staffing for outpatient stewardship. Many hospitals did not have outpatient clinics represented on their ASP committee. Although most hospitals had treatment guidelines, tracked antibiotic use, and provided education for HOPDs, these often focused on inpatient priorities. Challenges in implementing hospital-based interventions in HOPDs included staffing limitations, clinical and operational differences between settings, interpreting requirements, and electronic health record and information technology limitations.

Our research suggests that improving antibiotic stewardship within HOPDs necessitates recognizing the unique attributes of these settings, identification of specific resource requirements, and development of tailored strategies, rather than employing inpatient approaches.

To assess temporal trends in hospital-acquired infections (HAIs) prevalence, antimicrobial resistance (AMR) patterns, and associated risk factors of multidrug resistance (MDR)-related HAI in a Tunisian hospital between 2023 and 2025.

Repeated point-prevalence surveys (PPSs).

Sahloul University Hospital, Sousse, Tunisia.

All patients hospitalized for more than 48 hours during each surveys.

Data on HAI prevalence, isolated pathogens, and AMR profiles were collected through three PPSs conducted annually from 2023 to 2025. HAIs were defined according to the criteria of the Centers for Disease Control and Prevention. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes.

From 2023 to 2025, 126 pathogens were responsible for 101 HAIs among 752 surveyed patients. The overall HAI prevalence was 10.9%, with no significant difference between the survey years (trend P = .430). Bloodstream infections were the most common type of HAI. Microbiological documentation was available for 94% of cases. Gram-negative bacteria predominated (72.2%) with Klebsiella pneumoniae (15%) as the leading pathogen. Overall, 41.2% of isolates were classified as MDR, with no significant trend over time (trend P = .068). Enterobacterales resistant to third-generation cephalosporins accounted for 14.3% (18/126) and carbapenem-resistant Enterobacterales for 7.9% (10/126).

Prolonged hospital stay (>8 d) and ICU admission were independently associated with MDR-related HAIs (adjusted OR = 15.759, 95% CI: 3.691–67.285, P < .001 and OR = 3.612, 95% CI: 1.584–8.237, P = .002).

Repeated PPSs are an effective surveillance strategy for monitoring HAIs and AMR. These findings support the implementation of targeted antimicrobial stewardship and enhanced infection control interventions in Tunisian hospitals.