The COVID-19 pandemic has profoundly affected healthcare systems worldwide. High and often inappropriate antimicrobial use has been reported in COVID-19 care, potentially increasing the risk of bacterial resistance and other adverse events. This study aimed to characterize and quantitatively assess antimicrobial use among Brazilian patients hospitalized with severe acute respiratory syndrome (SARS) due to SARS-CoV-2 infection.

This retrospective observational cohort study included patients hospitalized with SARS caused by SARS-CoV-2 at the University Hospital of Brasília (HUB) during 2020 and 2021. Data on antimicrobial regimens, duration of therapy, and days of use were extracted from medical records.

The median age was 61 years (IQR, 49–72); most patients were unvaccinated against COVID-19 (76.3%), and comorbidities were highly prevalent (90.1%). Patients were stratified by clinical severity at hospital discharge: 301 (47.2%) were classified as Severe COVID-19 and 337 (52.8%) as Critical COVID-19. Greater clinical severity was consistently associated with increased antimicrobial exposure across multiple indicators, including the proportion of patients receiving antimicrobials, days of therapy (DOT), length of therapy (LOT), and the DOT/LOT ratio and an inverse association was observed for antimicrobial-free days (AFD). According to the World Health Organization (WHO) AWaRe classification, Watch-group antibiotics were most frequently prescribed (91.9% of patients); however, Reserve-group antibiotics showed the greatest increases in both frequency and duration of use with increasing disease severity.

In this single-center Brazilian cohort, antimicrobial therapy was highly prevalent (94.4%). Higher clinical severity was strongly associated with greater antimicrobial exposure and fewer AFD.

Clostridioides difficile infection (CDI) disproportionately affects hematopoietic cell transplantation (HCT) recipients. causing significant morbidity and mortality. This study aimed to develop and validate clinical prediction models for primary and recurrent CDI within one year post-transplant in this high-risk population.

We conducted a retrospective cohort study of HCT recipients (2010–2023) at a single institution. The cohort was randomly split into derivation (70%) and internal validation (30%) sets. We compared logistic regression with backward elimination by Akaike information criterion (AIC), random forest, and LASSO regularization approaches. Candidate predictors included demographics, clinical variables, laboratory values, and medication exposures. Model discrimination was assessed using the C-statistic, and calibration by observed vs. predicted proportions across risk deciles.

Among 2,725 HCT recipients, 252 (9.3%) developed CDI within one year, and 22 (8.7% of primary CDI cases) developed recurrence. For primary CDI, the backward elimination model performed best, including five predictors: receipt of cephalosporins (OR 1.46; 95% CI, 1.02–2.11), sulfonamides (OR 1.78; 95% CI, 1.04–3.05), penicillins (OR 1.4; 95% CI, 0.96–2.02), autologous transplant (OR 0.39; 95% CI, 0.22–0.66), and insurance type (Medicare: OR 30.2; 95% CI, 16.9–53.6; Medicaid: OR 15.2; 95% CI 6.5–35.4). This model showed good discrimination (C-statistic: 0.81 in both derivation and validation cohorts) with adequate overall calibration. For recurrent CDI, elevated white blood cell count at primary diagnosis was the only independent predictor (OR 1.16; 95% CI, 1.06–1.27), with modest discrimination (C-statistic: 0.73 derivation, 0.70 validation).

We derived and internally validated prediction models for CDI in HCT recipients which could facilitate targeted preventive interventions in this high-risk population.

To determine safety and effectiveness of short (≤7 d) versus extended (>7 d) antibiotic courses for neutropenic fever in HCT recipients.

Retrospective cohort study.

Private tertiary referral center.

Consecutive sample; all patients >18 years old admitted between January 2019 and May 2024 with neutropenic fever during their index hospitalization for HCT.

Data were collected via chart review. Primary outcomes were clinical failure (30-day mortality or ICU admission) and adverse events (Clostridioides difficile infection or acute kidney injury [AKI]). Secondary outcomes included recurrent fever and length of stay (LOS). Multivariable logistic regression adjusted for age, sex, transplant type, infection type, and malignancy.

Among 103 patients (55 short, 48 extended), mean antibiotic duration was 3.6 days (short) and 11.9 days (extended). There were more leukemia and allogeneic HCT recipients in the extended group. In multivariable analyses, antibiotic duration was not predictive of clinical failure (odds ratio [OR] 3.40; 95% confidence interval [CI], 0.50–27.55; P = .222) or composite adverse events (OR, 3.72; 95% CI, 0.94–16.22; P = .067), although the odds of AKI were greater in the extended group (OR, 4.72; 95% CI, 1.08–23.68; P = .046). Recurrent fever was uncommon. LOS was greater in the extended group (43.4 d vs 21.4 d; P = .032).

We found that shorter antibiotic courses were not associated with worse clinical outcomes or adverse events in HCT patients with neutropenic fever in the early posttransplant period. These findings support emerging evidence favoring shorter therapy.

Penicillin allergy labels (PALs) affect about 10% of people, are mostly low risk, and more common in females. Sex-based differences in prevalence and characteristics remain unclear. This study examined associations between sex, PAL, and relevant covariates, in an Ontario ambulatory hospital population.

A cross-sectional study of adults ( ≥18 years) seen at the hospital’s Urgent Medicine Clinic from 2015–2024 was conducted. Descriptive statistics compared patients by PAL status. Unadjusted and multivariable logistic regression models evaluated associations between sex and PAL, adjusting for covariates.

Among 29,645 patients (59.7% female), 3,026 (10.2%) had a documented beta-lactam allergy, of which 2,777 (9.4%) were PALs, and most (91.7%) were low risk. Females were twice as likely to have a PAL (11.6% vs 6.0%; unadjusted OR 2.17, 95% CI 2.14–2.19) and more often reported multiple medication allergies (30% vs 16%; OR 2.25, P < .05). After adjusting for covariates, female sex (OR 1.47, 95% CI 1.34–1.62), atopic conditions (OR 1.46, 95% CI 1.29–1.66), age ( >80 years [vs <65 years]: OR 1.16, 95% CI 1.02–1.32), and number of other medication allergies (2: OR 10.44, 95% CI 9.28–11.74; ≥3: OR 13.33, 95% CI 11.72–15.16 vs 0 or 1) were associated with higher odds of PAL.

Approximately 10% of patients had a PAL, mostly low risk and female predominant. Multivariable analysis identified female sex, atopy, older age, and multiple medication allergies as independent predictors; autoimmune and metabolic conditions were not. Longitudinal studies using validated allergy data and intersectionality can guide equitable evaluation.

Iteratively develop educational tools (instructional video and flyer) to improve midstream clean catch (MSCC) urine sample collection using patient and healthcare professionals’ input.

Multi-method qualitative study.

Outpatient clinics in Houston, Texas, United States.

Adult patients recruited from public and private clinics (n = 12). Healthcare professionals (HCP; nurses and medical assistants) (n = 12) providing care at participating clinics.

Twelve patient interviews and three focus groups with HCPs (May 2024–November 2024). Interviews discussed patient experiences using the educational tools to guide urine specimen collection. Focus groups elicited HCPs’ perspectives on the comprehensibility and utility of the tools in their respective clinics. We identified themes using directed content analysis.

We garnered insight into knowledge gaps and barriers for completing the MSCC process. MSCC instructions in existing educational tools were poorly understood by patients, especially among those with limited understanding of urogenital anatomy. Patient barriers to MSCC collection included physical difficulties due to poor urine stream control, mobility issues, and obesity. Patients and HCPs reported that our tools addressed patient gaps in understanding of MSCC instructions. Patients and HCPs also suggested that we accompany our tools with assistive devices and dedicated surfaces in the clinic bathrooms, to better meet patients’ needs in urine specimen collection.

Initial feedback was promising that our educational tools would improve the MSCC collection process for patients. In next steps, we will conduct feasibility pilot testing followed by a randomized controlled trial to test the effectiveness of reducing urine culture contamination.

Outpatient parenteral antimicrobial therapy (OPAT) reduces hospitalization, yet poor standardization and implementation contribute to readmission rates near 25%. The Infectious Diseases Society of America recommends structured and multidisciplinary OPAT programs. Twelve quality indicators, spanning organization, initiation, continuation, and outcome domains, have been proposed to improve OPAT delivery. Our scoping review assessed associations between reported OPAT quality indicators and patient readmission.

We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and Google Scholar from database inception through May 1, 2025, for studies of adults discharged on OPAT, managed by multidisciplinary teams, and reporting readmission rates. Data included presence of each quality indicator, team composition, and readmission rates. Readmission was categorized as low (<10%) or high (≥10%).

Of 2,610 studies screened, 18 (5,027 patients) met criteria. The median readmission rate was 11.3 (IQR 8–20). All studies reported a structured OPAT program and formal OPAT team. Initial patient assessment by a competent team member was more common in studies with lower readmissions. Reporting more indicators (range 4–11) did not significantly correlate with fewer readmissions. Organization and initiation indicators were reported more frequently than continuation and outcome indicators. All programs included an infectious diseases physician; 94% included nurses, 55% pharmacists, 28% social workers, and 11% hospitalists.

Higher quantity of reported indicators did not predict fewer readmissions. Future research should explore team engagement, including potential roles of hospitalists and social workers to strengthen care transitions, and the impact of continuation and outcome indicators on readmissions.

Due to occupational exposures, healthcare professionals (HCPs) face an increased risk of infectious diseases, particularly in low-resource settings. Despite infection prevention and control (IPC) policies, systemic and behavioral barriers exist in Cameroon. This study assessed the uptake of occupational vaccines (hepatitis B and COVID-19) and IPC knowledge among HCPs in Fako Division of Cameroon.

A cross-sectional study was conducted from January to May 2024 among 276 HCPs from four health facilities in Fako Division. Data were collected using a pretested, structured, self-administered questionnaire. Multivariable logistic regressions were employed to identify predictors of good IPC knowledge and combined vaccine uptake. Significance was set at a P value of <.05.

Hepatitis B vaccine uptake was 67.4%, while COVID-19 was 32.6%. Doctors had the lowest hepatitis B vaccine uptake (50.7%), while midwives had the lowest COVID-19 vaccine uptake (25.0%), compared with other healthcare cadres. Only 34.8% of HCPs demonstrated good IPC knowledge, despite high reported access to personal protective equipment (PPE) (87.3%) and IPC guidelines (87%). Older age (aOR: 2.41, 95% CI: 1.33–4.39) and previous occupational exposures (aOR: 2.14, 95% CI: 1.17–3.93) were significantly associated with combined vaccine uptake. PPE availability (aOR: 2.64, 95% CI: 1.04–6.74), >7 years of work experience (aOR: 3.22, 95% CI: 1.11–9.35), and contract employment status (aOR: 4.40, 95% CI: 1.47–13.21) were predictors of good IPC knowledge.

The study highlights gaps in occupational vaccine uptake and IPC knowledge among HCPs in Fako, with significant disparities across professional cadres. There is an urgent need for integrated, experience-based IPC training and targeted vaccine advocacy.

To determine whether operating room (OR) shoe covers prevent surgical site infections (SSIs) and to assess their environmental and clinical impact.

Scoping review.

Hospital operating room environments in international healthcare systems.

We searched Emcare, Embase, MEDLINE, and SCOPUS for studies examining shoe covers and outcomes related to bacterial contamination or SSIs. Data were synthesized descriptively.

Six studies met inclusion criteria. Evidence was mixed regarding bacterial contamination: some showed fewer colony forming units with shoe covers, while others found no effect or even higher contamination. Only one study assessed clinical outcomes, reporting fewer SSIs following reduced use of disposable PPE (including shoe covers). No study demonstrated a direct SSI reduction from shoe covers alone.

Evidence does not support OR shoe covers in preventing SSIs. Their use adds environmental burden through single-use plastics. More rigorous studies are needed to confirm these findings and guide sustainable infection prevention practices.

Suppressive antibiotic therapy (SAT) is used to prevent recurrent prosthetic joint infections (PJI) among patients who undergo debridement, antibiotics, and implant retention (DAIR). We aimed to assess SAT outcomes among younger, immunocompetent patients.

Retrospective cohort study.

Immunocompetent patients <65 years of age who received DAIR for PJI of the hip, knee, or shoulder.

Veterans Affairs hospitals.

SAT was divided into short-term (oral antibiotics given for <3 months after guideline concordant therapy) and long-term SAT (>3 months to 5 years of oral antibiotics). The primary outcome was treatment failure (TF) and mortality combined. SAT was a time-dependent covariate in Cox proportional hazards models.

Of the 938 patients, 15% received short-term SAT, 20% received long-term SAT, and 65% did not receive SAT. Short- and long-term SAT were significantly associated with decreased hazards of TF or mortality (short-term SAT adjusted hazard ratio (aHR) = 0.27; 95% confidence interval (CI): 0.11, 0.67; Long-term SAT aHR = 0.52; 95% CI: 0.30, 0.89). Short-term SAT was significantly associated with C. difficile infection (aHR: 3.47; 95% CI: 1.38, 8.74). Short-term SAT (aHR: 7.83; 95% CI: 4.80, 12.77) and long-term SAT (aHR: 1.68; 95% CI: 1.19, 2.38) were significantly associated with antibiotic-associated diarrhea. Long-term SAT was not significantly associated with TF alone (aHR = 0.61; 95% CI: 0.32, 1.16).

SAT was significantly associated with decreased death or TF and increased side effects. Benefits and risks must be weighed before prescribing SAT to younger, immunocompetent patients.

This study aimed to identify gaps and barriers to the use of antimicrobial resistance (AMR) surveillance data in Uganda and to recommend enhancements to improve policy and intervention outcomes.

A comprehensive assessment was conducted within a framework of infrastructural and system analysis, stakeholder engagement, and data management simulations.

The assessment consisted of three components: (1) assessing data utilization through stakeholder engagement to identify barriers in data translation and use; (2) evaluating the existing infrastructure and surveillance system supporting AMR data flow; and (3) simulating processes of data management and flow to contextualize identified gaps.

Findings revealed deficiencies in the AMR data governance structure and informatics capabilities. Stakeholders highlighted limited access to data and analytical capacity as barriers to effective decision-making. The existing infrastructure lacks the capability for real-time data analysis, which limits the ability to inform national and health facility policies. Strengthening data management processes, enhancing analytical tools, and fostering stakeholder collaboration at all levels are recommended for efficient data utilization.

Addressing these gaps is crucial for strengthening AMR surveillance in Uganda, enabling more effective data use to guide intervention and policies, and ultimately improving public health outcomes.

Penicillins are the most frequently prescribed antibiotics for a broad range of infections. In North America, up to 15% of hospitalized patients report a penicillin allergy, but research has shown that 98% of these patients can tolerate penicillins. Removing inaccurate allergy labels is an essential component of antimicrobial stewardship. While allergy delabelling used to be complex or require an allergist referral, the emergence of new tools, such as the PEN-FAST score, facilitates direct delabeling of low-risk patients.

The primary objective of this study was to trial the use of the PEN-FAST scoring tool at a major tertiary care center in Canada. Secondary objectives included measuring the pharmacy workload associated with the delabeling process.

A prospective pilot study was implemented at a Canadian tertiary care hospital to identify new patients with a penicillin allergy label, perform a review of their medical history, obtain a PEN-FAST score, and if applicable, implement an oral challenge with amoxicillin.

Most of the 155 screened patients were delabeled based on their medical history. Twenty-nine patients were eligible for an oral challenge, and three challenges were conducted.

PEN-FAST scoring in combination with direct oral challenge is a practical tool that can be prospectively implemented by pharmacists.

To quantify and map regional variations in antibiotic consumption across Tanzania using national supply-chain data to guide antimicrobial stewardship (AMS) priorities.

A retrospective facility-level analysis was conducted using antibiotic distribution data from the electronic Logistics Management Information System (eLMIS), covering the period from July 2020 to June 2024.

Public healthcare facilities across Tanzania’s 26 administrative regions.

Antibiotic consumption was standardized using the WHO Anatomical Therapeutic Chemical (ATC) classification and expressed as defined daily doses per 1,000 inhabitants per day (DID). Variations by region, facility level, and antibiotic class were analyzed descriptively and visualized through geospatial mapping. National trends and forecasts for 2025–2027 were modeled using autoregressive integrated moving average (ARIMA) and polynomial regression models.

A total of 1.63 million facility-level records were analyzed. National antibiotic consumption rose from 142.4 to 182.8 DID between 2020–2021 and 2023–2024 (a 28% increase). Dispensaries accounted for 71% of the total DID, underscoring the dominant role of primary-care facilities in antibiotic distribution. Dar es Salaam (37.9 DID), Ruvuma (34.5 DID), and Lindi (34.0 DID) recorded the highest cumulative consumption, whereas Katavi (13.7 DID) and Geita (15.4 DID) had the lowest. Access-category antibiotics comprised ≥60% of all consumption, Watch agents 35–40%, and Reserve agents ≤0.1%. Forecasting predicts continued national growth, reaching ≈ 215 DID by 2027 if current trends persist.

Antibiotic consumption in Tanzania is concentrated in the coastal and southern regions. Geospatial analytics and digital supply chain enable targeted, data-driven stewardship interventions in resource-limited settings.