To evaluate antibiotic utilization in relation to antimicrobial stewardship activities in a 170-bed Touro Infirmary hospital in New Orleans.

We evaluated antibiotic utilization for antipseudomonal beta-lactams, methicillin-resistant Staphylococcus aureus antibiotics (anti-MRSA), fluoroquinolones, and ceftriaxone in relation to antimicrobial stewardship activities that were implemented at the hospital and monitored between August 1, 2018, and August 31, 2025. We recorded days of antibiotic therapy and days of intravenous antibiotic administration for 19-months baseline, during 10 months of COVID-19-dictated antibiotic utilization, and during 14 months of MRSA PCR testing at Touro (Antimicrobial Stewardship Intervention [ASI] 1), 20 months of blood culture identification (BCID) at Touro (ASI 2, time 1), followed by 22 months of BCID and other cultures sent out to University Medical Center (ASI 2, time 2).

During the observation period, days of therapy for antipseudomonal beta-lactams, anti-MRSA, and fluoroquinolones consistently and significantly decreased from baseline to ASI 2, time 2 (P < .0001 for each decrease). Days of therapy for ceftriaxone significantly increased from ASI 1 to ASI 2, time 2 (P < .0001). Days of therapy for all antibiotics consistently decreased from baseline to ASI 2, time 1 (P < .0001) but not through time 2 (P = .571). Days of intravenous administration of antibiotics significantly decreased from baseline to the COVID-19 period (P = .002) and decreased again significantly from ASI 1 to ASI 2, time 1 (P = .003).

Clinical microbiology laboratories integrated into Antimicrobial Stewardship Program are associated with reductions in days of antibiotic therapy and days of intravenous antibiotic administration at Touro Infirmary.

To analyze the dynamics of antimicrobial consumption and evaluate the clinical and economic outcomes of a comprehensive antimicrobial stewardship (AMS) program in a Ukrainian maternity hospital.

Retrospective observational study.

The study was conducted at a tertiary referral maternity hospital in Kyiv, Ukraine, using two datasets. First, a longitudinal analysis of pharmacy dispensing records (2020–2024) was performed to assess consumption trends. Second, a comparative cohort analysis of 320 women undergoing gynecological surgery (preAMS [2018] vs postAMS [2023]; n = 160 per group) was conducted to evaluate the impact of stewardship interventions. The AMS program, implemented in 2020, utilized administrative “stop-orders” for postoperative prophylaxis and pharmacy gatekeeping for broad-spectrum agents. Economic outcomes were assessed using a patient-level micro-costing approach.

A profound structural shift occurred: consumption of ceftriaxone decreased from 72.4% of total prophylactic units in 2020 to 1.4% in 2024, replaced by cefazolin (0% to 44.0%). In the clinical cohorts, unjustified postoperative antibiotic use was eliminated (46.3% in 2018 to 0% in 2023; P < .001). The transition to single-dose prophylaxis reduced the mean direct antibiotic cost by 78.4% and coincided with a decrease in the mean length of stay from 9.85 to 4.68 days (P < .001). The program generated an estimated net saving of approximately $1,040 per surgical case.

Institution-level stewardship interventions successfully shifted prescribing toward guideline-concordant use and generated substantial cost savings. This study demonstrates the resilience and feasibility of low-cost stewardship models in high-pressure, transitional healthcare environments.

In a previously conducted stepped-wedge cluster randomized trial, a multicomponent Antimicrobial Stewardship intervention reduced mean duration of broad-spectrum antimicrobial treatment by 26.6% (from 6.5 to 4.8 days) in patients with moderate-severe community-acquired pneumonia (CAP). This study presents a detailed process evaluation of the multicomponent Antimicrobial Stewardship improvement intervention.

The intervention consisted of educational activities (clinical lessons with prescription feedback, e-learning, pocket cards, and poster), local opinion leaders promoting guideline-adherent treatment, and prospective audit and feedback. The experiences with performing the intervention were evaluated using trial data; exposure data (clinical lessons, e-learning, and prospective audit and feedback); and semi-structured interviews conducted in December 2019 with eleven physicians from four hospitals.

Most intervention components were conducted as planned. However, clinical lessons and e-learning were scheduled more frequently, while prospective audit and feedback was temporarily interrupted in some hospitals. Clinical lessons were on average attended by 31% of the target audience and 44% completed the e-learning. Feedback was provided in 56% of patients receiving broad-spectrum antimicrobials. Clinical lessons, prospective audit and feedback, and local opinion leaders, were identified as the most effective components. Pocket cards were regarded as easy to implement. While e-learning content was judged useful, its perceived effectiveness was reduced by “e-learning fatigue.” The poster was considered of low effectiveness.

Based on participant experiences, key components of an effective stewardship intervention for improving antimicrobial use in hospitalized CAP patients included prospective audit and feedback, clinical lessons with prescription feedback, pocket cards, and actively engaged local opinion leaders.

To evaluate antibiotic prescribing practices in a Nigerian tertiary hospital using World Health Organization (WHO)-recommended process measures for Antimicrobial Stewardship (AMS).

Retrospective cross-sectional study. Patient folders (n = 231) between July 2019 and July 2020 were reviewed using a standardized tool. Relevant data were extracted and analyzed descriptively using SPSS v23, after ethical approval.

Jos University Teaching Hospital (JUTH), a tertiary hospital in Nigeria.

A simple random sample of patients admitted to the male medical wards during the review period.

Antibiotics were prescribed in 178 cases (77.1%) but only 149 (64.5%) had a documented indication. Of the patients with no documented indication for antibiotics, 35.3% still received them, often justified as prophylaxis. Ceftriaxone (31.8%) and metronidazole (24.5%) were the most prescribed antibiotics. Correct posology was observed in 77.5% of prescriptions. Adherence to prescribed regimens was low (25.3%), with financial constraints and missed doses being major barriers. Antibiotic time-outs were observed in 34.3% of cases with only 24.7% cases shifting to definitive therapy based on culture results. Empirical therapy accounted for 75.3% of prescriptions.

The study revealed suboptimal implementation of AMS principles, characterized by a high reliance on empirical therapy and poor adherence to guideline-based practices. This underscores the urgent need for institutional AMS programs to optimize antibiotic use in similar low- and middle-income country hospital settings.

This study assessed knowledge, perceptions, practices, and barriers regarding Antimicrobial Stewardship (AMS) among community pharmacists in New Zealand.

A cross-sectional study using a self-administered online questionnaire distributed nationwide to community pharmacists.

A structured questionnaire was distributed via email to 3,226 pharmacists between January and March 2025, assessing demographics, knowledge of antimicrobial resistance (AMR) and antibiotic use, perceptions of AMS, current practices, and barriers. A total of 325 responses underwent quantitative analysis using Mann–Whitney U and Kruskal–Wallis tests (P < .05). The Relative Importance Index ranked barriers.

Most respondents (82.8%) perceived community pharmacists as holding a significant role in AMS. While demonstrating strong AMR knowledge (median score 5/7) and positive attitudes (82.7% agreed AMS should be implemented in community pharmacies), practices varied considerably. Patient education on proper antibiotic use was consistent (81.6% always/often), but education on resistance issues was less frequent (40.6% occasionally). Only 27.7% always/often reviewed prescriptions against local guidelines. Primary barriers were lack of time (66.5%), lack of support from higher authorities (64.3%), inadequate staff numbers (61.5%), and limited access to patient records (54.2%). Younger, less experienced pharmacists demonstrated higher knowledge scores (P < .05).

Community pharmacists in New Zealand are well-positioned for effective AMS but are hindered by structural and system-level barriers rather than knowledge deficits. Recommendations include developing AMS guidelines tailored to community pharmacists, implementing joint training with prescribers, and establishing annual e-learning refresher modules.

Antimicrobial resistance (AMR) is a growing public health threat, and we currently lack accurate measures to track and trend this resistance. We developed the antibiotic resistance index (ARI) that aggregates resistance of Gram-negative bacilli (GNB) into a single metric which can be tracked across healthcare settings and over time.

Culture data were collected from adult patients who met the CDC adult sepsis event criteria across 10 Barnes-Jewish HealthCare (BJC) hospitals between January 2018 and December 2023. An antibiotic’s effective spectrum (AES) was calculated as the ratio of susceptible GNB to all identified GNB. The ARI was calculated as the sum of the AES to which the isolate was resistant. Using the 20 most common GNB and 15 most common anti-GNB antibiotics routinely tested in antibiograms, we calculated the ARI for each BJC hospital during the study years.

18,854 GNB cultured from 12,803 patients meeting CDC adult sepsis event criteria were included. AES varied between 0.15 for ampicillin and 0.94 for amikacin. A. calcoaceticus-baumannii complex had the highest ARI of 6.64 (IQR 4.00–9.28). Median hospital-level ARI fluctuated between 2.12 (IQR 0.40–3.83) in 2018 to 2.20 (IQR 0.34–3.86) in 2023. The ARI trajectories over time varied by medical center.

ARI aggregates AMR in GNB and may facilitate monitoring across locations and over time. ARI and antibiotic effective spectra redefine narrow and broad spectrum of activity and offer a starting point for antibiotic utilization metrics.

Early review of intravenous (IV) antimicrobial therapy is central to antimicrobial stewardship (AMS), however scalable models for general medical patients are limited. We evaluated a pharmacist-led digital intervention to optimize IV antimicrobial prescribing.

A prospective, quasi-experimental before-and-after study was conducted between May 2022 to February 2023 across six general medicine units at a tertiary hospital. AMS recommendations were delivered electronically via Microsoft Teams®. Adult inpatients receiving IV antimicrobials for >24 hours were included, excluding those with COVID-19, under Infectious Diseases consultation or receiving palliative care. The primary outcome was median IV antimicrobial duration. Secondary outcomes included AMS recommendation type, recommendation acceptance, length of stay (LOS), 30-day infection-related readmission, IV therapy recommencement, and inpatient mortality. Antibacterial consumption was analyzed from July 2021 to through December 2024 to evaluate sustained impact.

Among 723 antimicrobial orders (474 treatment episodes in 458 patients), median IV duration was comparable between phases (intensive: 2.75 days; baseline: 3.00 days). LOS was shorter during the intensive phase compared to baseline (5.5 vs 7.6 days; P = .04), particularly in patients without bacteremia. Readmissions and mortality were unchanged. Of 400 AMS recommendations, 67% were IV-to-oral switches; overall acceptance was 78%. Piperacillin-tazobactam use declined, and sustained reductions in aminoglycosides, ampicillin and IV flucloxacillin were observed. A reduction in total antibiotic prescribing (combined IV and oral prescribing) was also observed.

The digital pharmacist-led AMS intervention did not reduce IV duration, likely reflecting strong baseline prescribing, but was associated with shorter LOS and a reduction in total antibacterial use. This program offered a scalable, sustainable alternative to resource-intensive face-to-face models.

To synthesize evidence on institutional spillover effects of antimicrobial use (AMU) on antimicrobial resistance (AMR) and Clostridioides difficile infections on individuals without direct antimicrobial exposure.

Systematic review.

Three databases were searched through August 2024 for studies evaluating spillover effects of AMU on unexposed individuals in institutional settings. Study characteristics, AMU, and outcomes were extracted. Study quality was assessed based on underlying methodology to detect spillover effect. A hybrid synthesis, including effect direction and meta-analysis of studies reporting continuous AMU and non-aggregate outcomes was utilized. Reporting followed PRISMA guidelines.

Of 5916 screened studies, five observational studies met inclusion criteria. Three were conducted across 68 hospital wards (ward-level exposure), and two across 693 nursing homes (facility-level exposure). Three studies evaluated all antimicrobial classes; two focused on penicillins, fluoroquinolones, and carbapenems. Two studies examined C. difficile, one MRSA, one carbapenem-resistant Enterobacterales, and one reported combined AMR and C. difficile outcomes. Low to moderate quality evidence indicated a positive spillover effect direction with increasing facility AMU. Meta-analysis of three studies yielded a pooled IRR of 1.54 (95% CI 0.85–2.80) per 100 days of therapy per 1,000 patient-days, with significant heterogeneity (I2 = 97.6%).

This review identified five studies suggesting a positive association between institutional AMU and collateral risks of AMR and C. difficile among unexposed individuals. Findings were limited by methodological heterogeneity and potential publication bias. Standardizing terminology, specifying spillover mechanisms, and adopting robust observational designs can enhance future research on spillover effects.

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.

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.

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.

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.

Piperacillin–tazobactam is a beta-lactam antibiotic with a distinct R1 side chain compared to other penicillins, therefore the risk of cross-reactivity should be theoretically low. Despite this difference, antimicrobial guidelines recommend against using piperacillin–tazobactam in patients with penicillin allergies. There is limited data available regarding piperacillin–tazobactam use in patients with a penicillin allergy, or rates of cross-reactivity. Therefore, the objective of this study was to assess the incidence of cross-reactivity to piperacillin–tazobactam in patients with a labeled penicillin allergy.

This was a retrospective study of patients admitted to Surrey Memorial Hospital (SMH) between November 1st, 2021 to January 31st, 2024 assessing tolerance to piperacillin–tazobactam in patients with prior labeled penicillin allergies. Baseline characteristics and outcomes were collected from electronic medical records (EMR).

Of the 191 patients included, 98% were found to tolerate one or more doses of piperacillin–tazobactam. This included 95 patients with “low risk delayed reactions,” 90 patients with “high risk anaphylactic reactions,” and 2 patients with “well-documented delayed reactions,” to penicillins. Only four patients out of 191 had documented intolerance to piperacillin-tazobactam post-exposure.

This study suggests that piperacillin–tazobactam has a low risk of intolerability (2%) in patients with labeled penicillin allergies, and that it is reasonable to consider piperacillin–tazobactam as an alternative to carbapenems and other broad-spectrum antibiotics for most patients with a previous penicillin allergy.

Antibiotic stewardship programs (ASPs) aim to optimize antibiotic prescribing, as prolonged use increases the risk of adverse events, antimicrobial resistance, and unnecessary healthcare costs. This study aimed to determine the period prevalence of prolonged antibiotic treatment durations for community-onset infections in Dutch hospitals and to identify risk factors.

A retrospective cohort study was conducted among adults treated for urinary tract infections (UTI), respiratory tract infections (RTI), or skin and soft tissue infections (SSTI) in four Dutch secondary care hospitals from January 1, 2021, to December 31, 2023. Patients were included if they were admitted for ≥12 hours and treated with antibiotics within 48 hours. Antibiotic prescriptions were linked to infectious diagnoses to calculate length of therapy and compared against national guidelines to assess prolonged treatment. Backward stepwise multivariable logistic regression was used to identify risk factors.

Of 9,878 admissions, 39.6% had UTIs, 44.9% RTIs, and 15.4% SSTIs. Prolonged antibiotic use was observed in 30%, with the highest proportion in RTIs (49.6%). Among RTIs, prolonged use occurred in 51.0% of community-acquired pneumonia (CAP) and 55.9% of aspiration pneumonia, with a combined median excess duration of 1.6 days (IQR: 0.9–3.6)). Prolonged use was 14.3% in UTIs and 13.1% in SSTIs. Risk factors included positive cultures, intravenous-to-oral switch, aspiration pneumonia or CAP (RTIs), and cystitis (UTIs).

A high period prevalence of patients with RTIs receiving prolonged antibiotic treatment was observed. The identified risk factors should be considered in ASPs to improve prescribing and reduce non-guideline-concordant antibiotic therapy.