The objectives of this study were to assess the potential effectiveness of far-UVC (222 nm) in reducing hospital-treated infections, antibiotic prescriptions, and mortality in long-term care facilities (LTCFs), as well as to evaluate the rationale for a future randomized controlled trial (RCT).

A six-month, nonrandomized, controlled, three-arm Phase II trial was conducted in LTCFs in Denmark. Facilities were allocated in a 10:1:1 ratio to usual care, far-UVC in common rooms, and far-UVC in common and residents’ rooms. The trial was conducted between November 2024 and April 2025. The primary outcome was LTCF-acquired infections treated in hospitals.

The study included 12 LTCFs with a total of 635 residents. In the usual care group (n = 470), 600 hospital-treated infections were identified with a incidence rate (IR) of 86.2 per 10,000 resident-days. In the common rooms group (n = 76), 12 infections were identified with a IR of 10.4 per 10,000 resident-days and an adjusted incidence rate ratio (aIRR) of 0.12 (95% CI: 0.04–0.34). In the common and residents’ rooms group (n = 89), 78 infections were identified with a IR of 59.1 per 10,000 resident-days and an aIRR of 0.69 (95% CI: 0.23–2.07). The aIRR for total antibiotic prescriptions was 0.52 (95% CI: 0.29–0.96) in the group with lamps in common rooms and 0.83 (95% CI: 0.50–1.37) in the group with lamps in common and residents’ rooms.

Far-UVC potentially reduces hospital-treated infections and antibiotic prescriptions in LTCFs, but these results should be considered preliminary until confirmed by an RCT.

Implementation of antimicrobial and diagnostic stewardship interventions can offer substantial return on investment while enhancing patient safety and healthcare quality. Clinical benefits include a decrease in antimicrobial resistance, shorter hospital stays, fewer adverse events from unnecessary antibiotic use, and optimized treatment protocols. We aimed to estimate the annual cost savings resulting from various interventions implemented by our Antimicrobial Stewardship Program at a single free-standing children’s hospital.

Cost analysis.

Free-standing children’s hospital.

Hospitalized patients.

We reviewed annual cost savings related to various targeted antimicrobial and diagnostic stewardship initiatives, including drug cost savings from guidelines and protocols, prevention of antimicrobial resistance, diagnostic stewardship interventions, penicillin allergy de-labeling, and sustainability efforts. Institution-level cost data were evaluated when feasible. Otherwise, cost estimates were extrapolated from the literature.

The Antimicrobial Stewardship Program saved an estimated $4,972,805 annually. This was a result of $1,155,405 in direct drug cost savings, $2,953,216 in savings related to a decrease in multi-drug resistant organisms, $75,000 in savings from penicillin allergy de-labeling, $689,184 in savings related to diagnostic stewardship interventions, and $100,000 in savings from sustainability efforts.

Antimicrobial Stewardship Programs can be associated with significant cost savings, justifying the investment. Collaboration across departments, particularly with microbiology, pharmacy, infection prevention, and service providers is central to the ongoing success of stewardship efforts, underscoring the multidisciplinary strength and efficiency of the approach.

Intravenous (IV) to oral (PO) antimicrobial stewardship initiatives can be implemented by various healthcare providers in conjunction with clinical decision support tools. Our study evaluated the impact of a prescriber-facing IV to PO alert on azithromycin and doxycycline prescribing, acquisition cost, and waste generated.

Our institution implemented an IV to PO alert at order entry for IV azithromycin and IV doxycycline with alternative dosage forms included. All emergency department and inpatient IV and PO azithromycin and doxycycline administrations were included during May 12, 2024 – September 28, 2024 (pre-group) and October 13, 2024 – March 1, 2025 (postgroup). The primary outcome was the change in PO azithromycin and doxycycline administrations over time. Secondary outcomes included cost savings and waste generated.

A total of 25,529 azithromycin (56% IV, 43% PO) and 40,584 doxycycline (27% IV, 73% PO) administrations were included in the pre-group. The postgroup included 32,505 azithromycin (22% IV, 78% PO) and 44,601 doxycycline (12% IV, 88% PO) administrations. An increase of almost 38.9% (95% CI 34.9 to 43.0%) in the proportion of PO azithromycin and 17% (95% CI 14.4 to 19.6%) in the proportion of PO doxycycline was observed immediately after alert implementation. Azithromycin and doxycycline total waste decreased by 270.3 and 230.6 kg, respectively. Monthly savings of USD 28,739.48 were calculated for azithromycin and USD 46,637.87 for doxycycline.

A prescriber-facing IV to PO alert led to increase PO administrations of azithromycin and doxycycline with reduction in cost and waste generated.

Estimate changes in antibiotic prescribing among advanced practice clinicians (APCs)—nurse practitioners (NPs) and physician assistants (PAs)—compared to physicians in 2022 versus 2011 to inform antibiotic stewardship efforts.

Retrospective descriptive analysis of antibiotic prescription rates for 2011 and 2022 using county-level prescription dispensing data by provider type from IQVIA Xponent® (numerator) and population census estimates (denominator). Prescribing rates among physicians and APCs (NPs and PAs) nationally, by state, and by rurality of county are reported.

Overall outpatient antibiotic prescribing rates in 2022 declined by 19.2% compared to 2011, from 877 to 709 prescriptions per 1000 population. The physician rate declined by 45% (628 to 345 per 1000 population), whereas the rate for APCs rose by 104% (124 to 253 per 1000 population), particularly for NPs (148% increase from 65 to 161 per 1000 population). The increase in NP prescribing rates was distinctly higher in seven contiguous Southeastern states (163 to 393 per 1000 population from 2011 to 2022, respectively), where rates were higher within rural counties (range, 385 to 651 per 1000 population by state in 2022).

APCs accounted for 1 in 3 outpatient antibiotic prescriptions in 2022, more than doubling their rate per capita over the past decade. This increase was especially prominent for NPs, particularly within the Southeast region, likely reflecting their growing role as rural primary care clinicians. Integration of APCs for outpatient antibiotic stewardship efforts is essential.

To evaluate the impact of requiring infectious source selection on systemic antimicrobial orders for stewardship tracking.

Multicenter, health system quality improvement project across 17 hospitals and 21 emergency departments.

All inpatient and ED antimicrobial orders with an indication between September 1 and September 30, 2024 were analyzed. Primary outcome: Prevalence of selected infectious sources. Secondary outcomes: indication frequency, free-text use, and concordance between selected and documented sources in 500 random orders.

Among 57,118 orders, empiric indication was most common (71%). Top sources: respiratory (23%), urinary/renal (19%), skin/soft tissue (16%). Concordance was 95%. Free-text entries (2.6%) often matched existing options; dental/oral emerged as a new category.

Infectious source selection was evaluated and supports future targeted stewardship interventions.

The aim was to describe the development and implementation of Firstline (www.Firstline.org), a mobile antimicrobial stewardship (ASP) application (app) created to address barriers to robust ASP in Colorado hospitals.

A mixed-methods pragmatic implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from October 2023–December 2025.

ASP teams at Children’s Hospital Colorado and Denver Health partnered with Firstline to develop the app using locally curated content. The app launched in October 2023 with a multifaceted dissemination campaign. Reach was assessed using geocoded user data. Effectiveness and adoption were evaluated using cross-sectional surveys at two time points. Implementation was characterized by analyzing utilization patterns. Maintenance was assessed by tracking monthly active users over two years.

Within the first year, 4,409 unique Colorado users downloaded the app, representing 15% of state clinicians (19% in Denver Metro; 5–17% in rural regions). Survey respondents (n = 215) reported high satisfaction: 63.9% and 72.9% found the app very easy to use, 71.3% and 83.2% reported enhanced antibiotic selection knowledge, and 100% advocated for ongoing support. Among respondents, 10% reported their facilities had formally adopted Firstline guidelines. The most frequently accessed content included common, high-impact infections. Monthly active users remained stable (average 871) over two years.

We demonstrated use of Firstline across Colorado, with increasing engagement in rural areas. High user satisfaction, sustained engagement, and emerging institutional adoption suggest this “stewardship in your pocket” model offers a unique, scalable approach to extending ASP support beyond academic medical centers.

To evaluate feasibility of establishing syndromic respiratory virus surveillance in a network of U.S. nursing homes, using CLIA-waived point-of-care (POC) molecular PCR testing, with centrally delivered results.

Single-arm feasibility pilot study.

Twenty-three nursing homes (NHs) in six U.S. states, representing approximately 2,500 residents.

A CLIA-waived POC molecular PCR testing device was implemented for on-site testing of respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and influenza A and B from collected nasal swabs. Symptom data was entered at the time of testing. Test results were transmitted to a centralized, web-based dashboard providing near real-time surveillance from November 2023 to January 2025. Surveys of NH staff assessed device usability, workflow integration, impact on testing procedures, and infection and outbreak awareness.

The established syndromic respiratory virus surveillance network conducted 1,745 point-of-care tests between November 2023 and January 2025, identifying 360 infections, including 160 COVID-19, 115 influenza A and B, and 81 RSV infections. Symptom data was captured for 99.5% of tests. Implementation was associated with high data completeness and integration into facility testing workflows. Staff reported an impact on testing protocols, infection awareness, and time to diagnosis.

Implementation of a CLIA-waived POC molecular testing device with centralized reporting was feasible across a geographically diverse NH network. The system achieved high data capture, identified substantial viral activity, and demonstrated value for clinical management using real-time diagnostic results. This approach can be adapted for local, regional, or national real-time reporting or future pragmatic interventional studies.

To evaluate the impact of systemwide antimicrobial stewardship interventions on antibiotic prescribing patterns for community-acquired pneumonia(CAP) in a community health system.

Retrospective pre-post implementation study.

Adult acute care hospitals in a community health system.

Adults 18 years or older admitted to an acute care hospital with a diagnosis of CAP identified by ICD-10 codes.

This retrospective, pre-post implementation study was completed at four adult acute care hospitals in a community health system. Antimicrobial stewardship interventions targeted toward CAP were rolled out between July 2020 and March 2021. Data to capture prescribing habits was collected pre and postimplementation. The inclusion criteria were patients who were at least 18 years old, admitted to an adult acute care hospital, and diagnosed as CAP based on ICD-10 code, while exclusion criteria were patients who were transferred from another hospital, had a pneumonia with an onset of 48 hours or later after admission, or had a concomitant non-respiratory tract infection during receipt of antibiotics for CAP. The primary outcome was percentage of patients who received empiric anti-MRSA or antipseudomonal antimicrobial coverage for CAP in accordance with current guideline recommendations.

Four hundred patients were included in the analysis, with 207 patients in the preimplementation arm and 193 patients in the postimplementation arm. The percentage of patients who received appropriate empiric coverage significantly increased from 34.7% in the preimplementation group to 60.1% in the postimplementation group (P < .0001).

Multifaceted antimicrobial stewardship interventions significantly improve guideline-concordant empiric MRSA and P. aeruginosa antimicrobial coverage.

To measure aerosol generation during various medical procedures that are potentially aerosol generating and determine whether these aerosols contain viral and/or bacterial pathogens that may pose a risk to healthcare personnel.

Observational.

Tertiary care academic hospital.

Convenience sample of adult patients undergoing one of the following procedures: extubation, bronchoscopy, mechanical ventilation, noninvasive ventilation, suctioning, nebulized medication administration (NMA), sputum induction, nasopharyngeal swab, or tracheostomy change.

Four aerosol characterization instruments measured aerosol characteristics (particle mass, number, size); average baseline and procedure measurements were compared to identify changes in aerosolized particles associated with each type of procedure. SKC BioSamplers were used for viral and bacterial pathogen recovery. Clinical data were reviewed to examine patient characteristics that might impact pathogen recovery.

Among 93 sampled procedures, differences between baseline versus procedure measurements were only notable for NMA and sputum induction. Smaller increases in some particle measurements were observed for the single extubation sample. None of the 248 BioSampler specimens were positive for a respiratory virus, even though for 39 procedures, the patient had a recent clinical specimen that was positive for a respiratory virus. Thirty-two samples (13%) had positive bacterial cultures, all of which represented common skin/environmental contaminants or upper respiratory microbiota.

In this study, significant aerosol generation was only observed during NMA and sputum induction. No viral pathogens and minimal bacteria were recovered from these medically generated aerosols. These data suggest that some procedures that are considered “aerosol-generating” may pose little infectious risk to healthcare personnel.

To evaluate knowledge and attitude toward antibiotic use and self-medication with antibiotics.

Cross-sectional study.

A Thai public university.

Medical students.

An anonymous online survey was conducted among pre-clinical- and clinical-year medical students between January 2023 to February 2024.

Of the 538 students included, 391 (65%) and 147 (35%) were in pre-clinical and clinical years, respectively, and 59% were female. Most of the students (>90%) were knowledgeable about the names of antibiotics and importance of adhering to prescribed antibiotic regimen. Less than 50% were knowledgeable about antibiotic resistance in gonorrhea and resistance transmission among humans or animals to humans. Clinical-year students had significantly higher knowledge score about antibiotic use than pre-clinical-year students (10 vs. 8 of 15; P < .001). Most students agreed that antibiotic resistance is mostly caused by human actions and antibiotic use and resistance should be taught early in a high school. Pre-clinical-year students were more-likely than clinical-year students to agree that alternative treatments are always available when antibiotics are ineffective. In multivariable logistic regression analysis, factors associated with higher antibiotic knowledge score were higher academic years (P < .001). While being pre-clinical-year students was independently associated with using antibiotics without appropriate indications (any diarrheal illnesses, upper respiratory tract infections and abrasions) and stopping antibiotic prematurely (P < .001).

Interventions to improve knowledge and practices regarding antibiotic use should be tailored to students’ academic years and be guided by the study’s findings.

To assess the feasibility of implementing C-reactive protein point-of-care testing (CRP-PoCT) for patients presenting with respiratory tract infections (RTIs) in primary care.

Feasibility study.

General practice (GP) and community pharmacy in rural Victoria.

Five GPs and a community pharmacist used CRP-PoCT for RTI patients aged 12–65 years for two months between August and December 2023.

Data on testing, prescribing, and implementation barriers and facilitators were collected from patient records and surveys of GPs and pharmacists. Feasibility outcomes were analyzed using descriptive statistics and content analysis.

Fifty-five patients were screened, with recruitment rates of 87.5% (35/40) in GP clinics and 67% (10/15) in community pharmacies, and a retention rate of 100%. Adherence to the testing protocol was 100% in both settings; however, adherence to the prescribing protocol was 76% in GP practices and 100% in pharmacies. Common RTI symptoms were cough (70%, n = 30), fever (58%, n = 25), and sore throat (44%, n = 19). Antibiotics were prescribed to 36.4% (12/33) of GP patients and 10% (1/10) of pharmacy patients. Pharmacists managed patients with OTC medicines (80%, 8/10) or immediate GP referral (10%, 1/10). CRP-PoCT feasibility was rated highly by GPs [median 6/7 (IQR 4–6)] and moderately by the pharmacist (4/7). Key implementation facilitators identified were nurse/technician support, medicare funding, clear workflows, and GP–pharmacy collaborative practice agreement.

With mitigation of practical challenges, CRP-PoCT can be feasibly implemented in rural GP–pharmacy settings to enhance antibiotic stewardship for acute respiratory infections in primary care.