Cross-contamination from contaminated wiping cloths is an underrecognized route of pathogen transmission in healthcare settings. Reused, misapplied, or ineffective disinfectants can transfer viable bacteria between surfaces. Staphylococcus aureus and Pseudomonas aeruginosa persist under hospital conditions and are frequently isolated in healthcare environments. While many studies assess bacterial inactivation, few examine how chemistry and wipe material influence transfer when bacterial inactivation is incomplete.

Hydrogen peroxide (HP), a quaternary ammonium compound (QAC), and an ethoxylated alcohol (EA) cleaner were tested with cotton, microfiber, and meltblown polypropylene wipes. Wipes inoculated with ∼ 7 log10 CFU of S. aureus or P. aeruginosa were used on 1 ft2 Formica. Bacterial transfer to surfaces and gloves was quantified between the chemistry and material combinations using single- and multi-layer setups.

HP-based wipes demonstrated the highest bactericidal efficacy, transferring little to no viable bacteria. Polypropylene wipes consistently transferred fewer bacteria than cotton or microfiber wipes. Wipes with QAC or EA, particularly those made of cotton, transferred significantly more bacteria to surfaces and gloves. Adding layers of wipe material reduced bacterial transfer, especially for microfiber.

Chemistry and wipe material both significantly impact bacterial transfer during cleaning. HP with polypropylene wipes offered the most effective reduction in cross-contamination. Cotton and microfiber wipes paired with QAC or EA exhibited higher transfer risks, likely due to electrostatic interactions contributing to reduced antimicrobial activity. These findings emphasize the need for optimized wipe-chemistry combinations to ensure effective surface decontamination.

Timely microbiological diagnosis is central to antimicrobial stewardship in suspected central nervous system (CNS) infection. In regional settings, access to rapid diagnostics may be limited by off-site testing and reporting delays. We evaluated the association between multiplex polymerase chain reaction (PCR) turnaround time and antimicrobial use and hospital length of stay (LOS).

We conducted a retrospective cohort study of adult patients (≥18 years) undergoing lumbar puncture for suspected meningitis or encephalitis at two regional Australian hospitals in 2022. Data included time from lumbar puncture to PCR result, antibacterial and antiviral duration and days of therapy (DOT) and LOS. Associations were assessed using Spearman correlation and non-parametric tests.

Longer PCR turnaround time was associated with increased antibacterial (rho = 0.22, P = 0.012) and antiviral duration (rho = 0.38, P < 0.001). Median antibacterial duration was 2.2 days (range 0.16–10.49) and antiviral duration 2.52 days (range 0.22–21.35). Median LOS was 4.98 days (range 0.38–92.92). Median turnaround time was 44.8 hours (range 15.1–117.22). Overall, 117 patients received antibacterial therapy (median DOT 3 days, range 1–28) and 84 received antiviral therapy (median DOT 3 days, range 1–22). LOS correlated with antimicrobial duration (rho = 0.22, P = 0.012).

Delayed PCR reporting was associated with longer antimicrobial exposure and hospital stay, highlighting diagnostic turnaround time as a potential target for antimicrobial stewardship in regional settings.

To evaluate the impact of discontinuing contact precautions for vancomycin-resistant enterococci (VRE) on strain and plasmid transmission using long-read whole-genome sequencing (WGS).

Before-after trial of adults with Enterococcus bloodstream infections pre-(Jan–Oct 2021) and post-(Oct–Dec 2021 and Jan–Oct 2023) discontinuation of contact precautions for VRE infections.

Quaternary referral and transplant academic medical center.

Hospitalized adults (≥18 yr) with E. faecalis or E. faecium bacteremia.

Classical epidemiology identified potential transmissions via shared unit exposure within a 14-day window. Blood culture isolates underwent long-read WGS to assess strain and vanA plasmid relatedness. Clonal transmission was defined as <20 single-nucleotide polymorphisms. Plasmid similarity was assessed with Mash distance.

Among 288 isolates from 202 patients, there was no significant difference in possible epidemiologic transmissions pre-versus postdiscontinuation (9.5% vs 8.1%; P = .679). Genomic analysis identified four clonal transmission events, two of which occurred postdiscontinuation. Among 70 vanA plasmids from 54 patients, 38 highly related plasmids formed a low-diversity cluster. The proportion of cluster plasmids was not significantly different between periods (47% vs 60%; P = .267). Postdiscontinuation, vanA-positive E. faecium ST117 was more prevalent (22/44 vs 53/75; P = .024).

Discontinuation of contact precautions for VRE was not associated with increased transmission of enterococci or vanA plasmids in bloodstream infections. Transmission patterns remained largely stable, though the postdiscontinuation period showed increased prevalence of the dominant E. faecium ST117. These findings suggest limited impact of contact precautions on VRE transmission.

Irrational antibiotic consumption contributes to antimicrobial resistance, adverse effects, and rising costs. Antimicrobial Stewardship (AMS) supports rational antibiotic use through restrictive and supportive measures. In oral and maxillofacial surgery (OMFS), antibiotic consumption is consistently high, and evidence-based guidelines are often lacking. We evaluated a multimodal AMS intervention on antibiotic use in an OMFS department.

Before–after study.

OMFS department of a German university hospital.

Hospitalized patients treated in the OMFS department.

For 12 months, the AMS team conducted weekly ward visits, providing recommendations regarding antibiotic therapy and surgical antibiotic prophylaxis (SAP). In parallel, a mandatory consensus guideline covering these aspects was developed and implemented. Antibiotic use, prevalence, duration of therapy, and SAP before, during, and after the intervention were evaluated; clinical outcomes were not assessed.

Pre-intervention, over 70% of patients received antibiotics. Median duration of antibiotic therapy and SAP was 12 and 9 days, respectively. Antibiotic consumption reached 63.8 defined daily dosages per 100 patient days, exceeding national values (median 40.1). During the intervention, antibiotic prevalence decreased below 50% and the duration of antibiotic therapy and SAP was shortened to 9 and 3 days, respectively. Antibiotic consumption decreased by 26% whereas national values increased by nearly 50%. After weekly consultations ceased, antibiotic use rose again but remained below national levels.

Antibiotic consumption is high in OMFS. Regular AMS support including consensus guidelines can reduce antibiotic use substantially and sustainably. However, clinical outcomes need to be correlated and adequately staffed AMS teams are needed.

To determine if Toxin B polymerase chain reaction (PCR) cycle threshold (Ct) can help identify which patients with discordant clostridioides difficile (CD) PCR and enzyme immunoassay testing (EIA) may benefit from treatment.

Retrospective case series.

Multi-hospital tertiary Academic system.

All admitted adult patients with positive CD PCR over a 6 month period (n = 214). Patients with positive Stool PCR for other pathogens were excluded.

Chart review of all eligible patients. CD testing results, patient demographics, underlying comorbidities, symptoms prompting testing, risk factors for CD, markers of severe disease, treatment regimens, and clinical outcomes including: 30-day all-cause mortality and re-admission, and 60-day CDI repeat testing and treatment were collected.

Significant association between mortality and lower Ct values among discordant patients who were not treated compared to those who were (P = 0.042). The association between Ct values and 30-day readmission was significantly stronger among untreated patients compared to those who were treated (P = .034). A similar trend was observed among non-severe, untreated patients with low Ct values and subsequent CDI treatment within 60 days (CT < 26, 49% vs. CT > 26, 18%, P = .063).

Untreated patients with lower cycle thresholds had worse clinical outcomes compared to untreated patients with higher Ct, regardless of disease severity. A lower PCR Ct can support treatment in patients with clinical disease, positive PCR and negative toxin EIA.

Inappropriate antimicrobial use in outpatient settings, such as Emergency Departments (EDs), is associated with increased risk of morbidity, costs, and antibiotic resistance. Prescribing patterns and guideline concordance in the ED is not well described in the literature. The primary objective of this study was to describe the empiric outpatient antibiotic prescribing patterns for frequent community-acquired infections seen in the ED at a large tertiary care teaching hospital. The secondary objectives were to evaluate concordance of antimicrobial prescribing with local guidelines, quantify the proportion of patients requiring antibiotic modification based on culture results, and 30-day ED revisits for the same infection.

A retrospective chart review was conducted on a convenience sample of 200 adult patients discharged from the ED between October 1, 2022 to July 18, 2023. Data was analyzed to determine prescribing patterns and guideline concordance.

The most common infectious syndrome observed was skin and soft tissue infections (SSTIs). Overall, discordance was observed in 80% of cases, with 100% discordance seen with the treatment of COPD exacerbation and mild purulent SSTIs. Guideline discordance was predominantly due to treatment duration (67%) and antimicrobial selection (43%). Culture-directed therapy modifications were minimal (5%). There was no significant difference between antimicrobial concordance and therapy modification or between overall guideline concordance and 30-day revisit rates.

Outpatient antimicrobial prescribing in the ED remains suboptimal despite available treatment guidelines, particularly in skin and respiratory infections. Discordance, mainly driven by extended treatment durations, highlights the need for improved Antimicrobial Stewardship practices in ED settings.

Antimicrobial stewardship programs (ASPs) are designed to optimize antimicrobial use for healthcare facilities and are required at all acute care and critical access hospitals (CAHs). However, rural CAHs often lack the resources to implement robust ASPs. The purpose of this study was to evaluate the impact of adding regional remote antimicrobial stewardship services across a 14-hospital system consisting of one acute care and thirteen CAHs.

Remote ASP expansion consisted of adding an infectious disease (ID) pharmacist and two ID physicians (0.3 FTE) to provide daily stewardship activities including prospective feedback on antibiotic optimization and use education through remote chart review and communication. Antimicrobial utilization, cost savings, and Clostridioides difficile infection (CDI) rates were tracked. Intervention data and acceptance rates were also collected.

In the first twelve months following regional remote stewardship expansion, the ASP demonstrated a $619,053.97 reduction (56% decrease in Antibiotic Cost/CMI adjusted patient days) in antimicrobial expenses. While only aztreonam use was significantly reduced at the acute care facility (P < .01), the use of vancomycin, meropenem, linezolid, and aztreonam decreased by 33%, 31%, 18%, and 35%, respectively, among the CAHs (P < .001). A 53% reduction in CDI rates was observed across the health system (P < .01). The program averaged 92 interventions per month, with an overall intervention acceptance rate of 86%.

Remote ASPs represent a viable strategy for extending antibiotic stewardship expertise to resource-limited settings to achieve financial and clinical benefits.

People experiencing homelessness (PEH) and people who inject drugs (PWID) face disproportionate burdens of infection and poor clinical outcomes due to social determinants of health (SDOH) barriers such as unstable housing, limited medication access, and poor follow-up care. The study purpose was to evaluate the impact of a multi-model quality improvement (QI) bundle on outcomes of hospitalized PEH/PWID.

A pilot QI initiative was implemented at an urban academic hospital in Detroit (June 2022–April 2023) targeting hospitalized PEH/PWID requiring ≥2 weeks of antimicrobials. Bundled prospective intervention included specialty consultation, tailored antibiotic education, medication cost inquiry, Meds-to-Beds delivery, enhanced case management coordination, and referrals to community-based organizations addressing SDOH needs. Ninety-day clinical outcomes were described.

42 patients were included: 26% PEH, 29% PWID. Patients were predominately men (62%), White (57%), and with a median (IQR) age of 43.5 (32.5–53) years. Common infections included bacteremia (60%), bone/joint infections (50%), and endocarditis (31%); Staphylococcus aureus was the leading pathogen. Over half of patients were discharged on oral antibiotics. Treatment adherence remained low: 29% self-discharged, 52% were unreachable postdischarge, and 21% attended scheduled follow-up. 43% of patients achieved clinical cure and 38% experienced disease progression within 90 days. Emergency department revisits (29%) and hospital readmissions (43%) were frequent.

Despite a multi-model QI intervention, hospitalized PEH/PWID with complicated infections experienced significant barriers to care, resulting in poor adherence and outcomes. Pragmatic, scalable interventions and community partnerships are needed to improve health outcomes.