Excess prescribing of antibiotics and opioids is a major public health concern. A greater understanding of prescribing patterns at the prescriber and beneficiary level could inform enhanced and integrated interventions.

Using 2023 Medicare Part D Public Use data, we conducted a cross-sectional study to assess opioid and antibiotic prescribing patterns among primary care clinicians (internal medicine, family medicine, geriatrics, nurse practitioners, and physician assistants) in New York State (NYS) treating ≥20 Medicare beneficiaries aged ≥65. For each provider, the total days’ supply of antibiotics and opioids per beneficiary was calculated. Multivariate logistic regression models identified provider and practice characteristics associated with high-prescribing.

Of the 19,823 eligible prescribers, 647 (3.3%) were high antibiotic prescribers and 554 (2.8%) were high opioid prescribers. Antibiotic high-prescribing was associated with nurse practitioners (NP) (adjusted odds ratio (aOR 2.47, 95% CI 1.83–3.34)), physician assistants (PA) (aOR 1.90, 95% CI 1.43–2.54), more years in practice (aOR 1.62 per SD, 95% CI 1.47–1.78), and panels with higher average beneficiary risk scores (aOR 1.36 per SD, 95% CI 1.29–1.43). Opioid high-prescribing was associated with geriatrics (aOR 4.30, 95% CI 1.79–10.32), NP (aOR 1.80, 95% CI 1.36–2.37), male gender (aOR 1.55, 95% CI 1.17–2.04).), greater years in practice (aOR 1.68, 95% CI 1.51–1.86), and higher proportions of dual-eligible beneficiaries (aOR 1.38, 95% CI 1.23–1.56).

A small number of NYS clinicians account for a disproportionate share of antibiotic and opioid prescribing. Identifying provider- and panel-level characteristics associated with higher prescribing may inform targeted stewardship strategies.

From 2023–2024, the Maryland Statewide Prevention & Reduction Collaborative (SPARC) led an intervention targeting broad-spectrum antibiotic use for sepsis, aiming to identify the factors that influence the success of collaborative quality improvement (QI) programs.

Evaluation of a state collaborative run QI intervention.

Acute-care facilities in Maryland.

Participating sites developed and implemented sepsis-focused interventions with SPARC support, including tailored guidance and bimonthly office hours. Following the implementation of site-level interventions, sites participated in a mixed-methods assessment guided by the RE-AIM framework including brief qualitative interviews and a 6-month follow-up.

Eight hospitals implemented multi-component, multi-disciplinary sepsis-focused interventions. Facilities involved staff from up to six departments in the implementation of interventions. All sites noted the effectiveness of SPARC in supporting sites’ intervention activities, as well as the effectiveness of the site’s interventions in creating change. Sites identified barriers impacting the implementation of their interventions including lack of resources, administrative red-tape, and challenges changing culture. Facilitators included leadership support, having a structured intervention plan, and opportunities for peer-to-peer learning. Most sites were positive about SPARC’s role identifying interventions and support, utilized information from SPARC as part of their interventions, and found it useful to hear how other institutions implement antibiotic stewardship. Six months post-assessment, all sites were continuing intervention activities.

This evaluation highlights how statewide QI collaboratives can be effective in promoting hospital-based antibiotic stewardship. Sites identified several facilitators and challenges that contributed to intervention implementation and highlighted the contributions of the SPARC team.

Erroneously labeled penicillin allergies can lead to prolonged hospitalization, increased adverse effects and infection rates with alternative antibiotics. Although elderly patients are more vulnerable to these negative outcomes, penicillin allergy assessments and de-labeling remain underutilized in this population.

To assess the efficacy and challenges of implementing penicillin allergy de-labeling in hospitalized elderly patients.

Between March 2024 and April 2025, we conducted a quality improvement study on patients who were 65 years and older, had a penicillin allergy, and were admitted to Burnaby Hospital Acute Care for Elderly (ACE) Unit. Patients were proactively screened, interviewed, and assessed for eligibility in allergy de-labeling based on PEN-FAST score ≤1, predefined criteria, clinical judgment, and patient consent. If penicillin challenge was given, patients received pharmacist follow-up and 4-week outcomes were documented. A post-implementation survey was distributed to ward healthcare staff to identify barriers to implementation.

Out of 105 patients screened, 87 patients met study inclusion criteria. Among 34 patients deemed eligible for de-labeling, 24 patients (71%) were de-labeled from either oral amoxicillin challenge or information gathering alone. Within four weeks after de-labeling, 10 patients (42%) received beta-lactam antibiotics, and no patients received guideline-discordant broad-spectrum antibiotics. Only 1 patient experienced a delayed reaction to amoxicillin-clavulanate. From surveying ACE unit nursing, physician, and pharmacy staff, frequently reported barriers to allergy assessment and de-labeling included time and staffing constraints, and patient complexity.

Our pharmacy-driven interdisciplinary penicillin allergy de-labeling initiative is effective and safe for eligible hospitalized older adults with low PEN-FAST scores (≤1).

To model the impact of a badge system on hand hygiene and the impact of increased compliance rates on HAIs with the associated cost savings.

We consider a variable number of targeted beds within a hospital.

Using a Markov chain model, we estimate the effect of hand hygiene compliance on HAI transmission over the course of a year. Based on a given level of compliance, the estimated savings are also calculated.

With each 10% increment increase in compliance, we estimate a decrease in approximately 7.5 HAIs per year per 100 targeted beds. A 10% increase above baseline in compliance also results in around $100,000 cost savings per year per 100 targeted beds.

Due to the relative low cost of implementation and upkeep to the badge system, the reduction in HAIs and increase in cost savings make the badge system a worthwhile addition.

To describe the prevalence, patterns, and quality indicators of antimicrobial use (AMU) in Burkinabe hospitals and identify priorities for stewardship.

Multicentre, cross-sectional point prevalence survey (PPS) following the Global Point Prevalence Survey protocol.

Eight public hospitals across six cities in Burkina Faso (3 primary, 3 secondary, and 2 tertiary), February–June 2019.

All inpatients present on the survey day at 8:00. Medical records were reviewed for those receiving systemic antimicrobial agents.

Standardized ward- and patient-level data were collected on indications, agents, routes, and WHO AWaRe categories, alongside quality indicators (documented indication, stop/review date, guideline compliance, and targeted vs empirical therapy). Descriptive analyses compared hospital tiers.

Of 994 inpatients, 729 (73.3%) received ≥1 antimicrobial (range by tier: tertiary 69.7%, secondary 79.2%, primary 79.2%). Community-acquired infections accounted for 96.0% of therapeutic indications. Leading reasons were skin/soft tissue infections (12.2%), gastrointestinal infections (10.7%), and pneumonia (10.4%). Parenteral administration predominated. The most used agents were ceftriaxone (27.8%), metronidazole (15.7%), and gentamicin (9.4%). By AWaRe, Access agents comprised ∼ 50%, Watch agents ∼ 50% overall, with higher Watch use in tertiary hospitals; no Reserve antibiotics were recorded. Quality indicators were suboptimal: the indication was documented in 15.6%, the stop/review date was absent in 93.0%, and 41.1% of prescriptions were guideline-compliant. Therapy was largely empirical (98.5%). Prolonged surgical prophylaxis (>1 day) represented 86.8% of prophylaxis courses.

Antimicrobial use (AMU) prevalence in Burkinabe hospitals is high, dominated by empirical therapy and Watch-class ceftriaxone. Deficits in prescribing quality and limited diagnostic use highlight urgent needs for context-adapted antimicrobial stewardship: enforce guideline-concordant care, curb prolonged prophylaxis and unnecessary Watch-class use, and expand affordable microbiology capacity to enable targeted therapy.

To describe the revised Asia Pacific Society of Infection Control (APSIC) Guidelines for Prevention of Central Line Associated Blood Stream Infections (CLABSI) 2024.

The revised guidelines was developed by infection prevention and control experts and key opinion leaders from Asia Pacific.

Emphasis on practical implementation of Central Line Insertion and Maintenance Bundles using quality improvement approach is recommended towards the goal of achieving zero CLABSI in any healthcare setting.

Any patients with a central line in a healthcare setting

Literature search was done for recent international updates in CLABSI prevention. Recommendations were evaluated for practical and feasible implementation in low resourced settings.

The key recommendations are listed in the APSIC CLABSI insertion and maintenance guidelines. Additional measures are recommended for use where CLABSI rates remain high despite implementation of all preventive strategies to achieve institutional goals.

A surveillance program is recommended to monitor outcomes and compliance with bundles. Ongoing review of the performance data with appropriate interventions made should facilitate efforts towards zero CLABSI rate.

Hospital-attributable central line-associated bloodstream infections (HA-CLABSI) are associated with severe patient outcomes. Published data on HA-CLABSI epidemiology in hospitals locally remains limited. This study aimed to determine the HA-CLABSI incidence and risk factors to inform targeted infection prevention practices.

Retrospective, nested case-control study was performed at Singapore General Hospital from January 2018 to December 2020, involving 127 cases and 252 controls. HA-CLABSI cases developed CLABSI ≥ 3 calendar days of hospitalization. Controls had central line inserted but did not develop CLABSI. Cases and controls were matched on 1:2 ratio for central line insertion date. Multivariable conditional logistic regression was performed to identify independent risk factors for HA-CLABSI, with adjusted odds ratio (aOR), 95% confidence intervals (CI) and p-values reported. Variables with p-value < 0.05 were statistically significant. HA-CLABSI incidence rate was calculated per 1,000 central line-days.

HA-CLABSI incidence rate during the study period was 8.4/1,000 central line-days. Independent risk factors for HA-CLABSI were transfer to high-risk areas (aOR: 2.03, 95% CI: 1.05–3.92), immunocompromised health status (aOR: 4.62, 95% CI: 2.20–9.69), antibiotic administration (aOR: 7.41, 95% CI: 3.24–16.92), and total parenteral nutrition (aOR: 3.61, 95% CI: 1.49–8.77) being included as indications for central line insertion, insertion of PICC (aOR: 13.61, 95% CI: 3.12–55.53), presence of non-tunneled central lines (aOR: 2.95, 95% CI: 1.48–5.87) and prior MRSA acquisition (aOR: 3.41, 95% CI: 1.83–6.35).

HA-CLABSI remains a significant concern despite on-going infection prevention efforts. Risk factors identified facilitate development of targeted, evidence-based interventions.

To describe the revised APSIC Environmental Hygiene Guidelines for prevention of healthcare-associated infections inclusive of surface cleaning, air and water quality.

The revised guideline was developed by Infection Prevention and Control key opinion leaders from Asia Pacific.

This guideline emphasizes on practical implementation of environmental hygiene for prevention of healthcare-associated infections inclusive of surface cleaning, air and water quality relevant to Asia Pacific settings.

Any patients hospitalized in healthcare setting.

Literature search was done for recent international updates in environmental hygiene inclusive of surface cleaning, air and water quality. Recommendations were evaluated for practical and feasible recommendation in low-resourced settings in Asia Pacific.

The key recommendations are listed in the best practices for cleaning patient care areas. Additional measures are recommended to improve the air and water quality in healthcare settings.

Implementation of environmental hygiene in Asia Pacific should take into consideration of the air and water quality in addition of surface cleaning. Measures to assess the cleanliness should be performed using conventional visual assessment, environmental cleaning and disinfection checklist, auditing, and additional measures (e.g., environmental culture or fluorescence).

Effective antibiotic stewardship programing in clinical settings necessitates a good understanding of local prevalences of antimicrobial resistance and important patient and community risk factors. However, most studies are limited in sample size and geographic coverage.

This study utilized phenotypic resistance data of Escherichia coli from the Veteran’s Health Administration of the United States (U.S.), incorporating 126,777 unique cultures from veteran outpatients from seven Midwest states from 2010 to 2023, to examine the spatial pattern and important individual- and county-level risk factors for resistance to four important classes of antibiotics. We utilized Bayesian conditional autoregressive zero-inflated Poisson regression models to generate smoothed rates of resistance in each county and multilevel logistic regression models to detect risk factors for resistance.

High overall rates of resistance were seen for fluoroquinolone (29%) and TMP-SMX (22%). Geographic variation was seen among and between antibiotic classes. Certain urban regions in the southern parts of Illinois, Indiana, and Ohio had higher local resistance rates for fluoroquinolone and TMP-SMX. Being male, having diabetes, and previous exposure to antibiotics are significant risk factors for all classes of antibiotics while the significance of other risk factors varied across classes.

Diverse geographic patterns of resistance level may reflect differences in local prescribing practices, while the differential correlations with risk factors likely reflect their clinical indications and prescribing patterns in clinical settings. The local resistance rates and risk factors for different classes of antibiotics should provide important guidance in practicing empirical prescribing and antibiotic stewardship in clinical settings.

Evaluate whether a complex outpatient antimicrobial therapy (COpAT) program led by advanced practice providers (APPs) conducting transition-of-care (TOC) services improves post discharge patient follow-up and reduces hospital readmission.

Pre- and postimplementation cohort study comparing outcomes 6 months before and 5 months after COpAT launch.

706-bed tertiary university teaching hospital.

Adult patients admitted to the hospital with bone and joint infections, seen by our inpatient infectious disease consultation service and discharged with at least fourteen days of antimicrobial therapy, with follow-up at our specialized musculoskeletal infectious diseases clinic.

The APP led pilot COpAT program was launched on March 1st, 2024, with a multidisciplinary team including an infectious diseases physician, APP, nurse, medical assistant, and TOC pharmacists. Patients enrolled at hospital discharge and were scheduled for APP-led TOC visits within fourteen days, followed by a physician visit.

The pre- and post-intervention groups included 100 and 135 patients, respectively. Mean postdischarge follow-up time decreased from 20.1 to 9.1 days (P < .001), and patients seen within fourteen days increased from 42% to 83% (P < .001). Readmission rates and emergency room visits did not change significantly. TOC pharmacy engagement rose from 8% to 42% (P < .001), and both TOC pharmacy and APP interventions frequently addressed medication errors, side effects, and treatment modifications.

A structured, COpAT program with APP and TOC pharmacy involvement optimizes postdischarge follow-up, strengthens antimicrobial outpatient monitoring, and supports timely intervention for patients with complex infections.

Infectious disease (ID) care involves a diverse range of professionals, yet the shortage and geographical disparity of ID physicians, among other professionals, remain underexplored. This cross-sectional descriptive study aimed to elucidate the distribution of ID physicians, infection control (IC) pharmacists, and IC nurses in Japan, focusing on the interrelations among the ID workforce within medically relevant geographical units.

Publicly available data from 335 secondary medical areas (SMAs) in Japan, with a population of 125 million, were analyzed. Workforce distribution was assessed using the Gini index to quantify inequalities and spatial clustering across the SMAs per capita, per hospital bed, and per unit area. χ2 test was used to assess the association of hospital characteristics with the presence of each professional.

The research subjects were 1,729 ID physicians, 1,371 IC pharmacists, and 2,657 IC nurses, whose workplace data were available in Japan as of 2023. The Gini coefficients for the densities of ID physicians, IC pharmacists, and IC nurses per 100,000 people were 0.46, 0.34, and 0.28, respectively. The density of the ID workforce per unit area (1,000 km2) showed a positive correlation ( > 0.8) with any combination of ID physicians, IC pharmacists, and IC nurses. A total of 186 SMAs (56%) had at least one member from each professional group and 13 (3.9%) lacked staff from all three.

The substantial variation in ID workforce composition across SMAs suggests opportunities for both regional and national policy and identifies new avenues for improving access to ID care.

Mucocutaneous fungal infections, particularly oral and genital candidiasis, are the most common fungal diseases in neonatal populations. Although generally mild, non-invasive Candida infections can serve as sources of colonization increasing the risk of progression to invasive candidiasis, especially in preterm neonates.

This study aimed to describe the infection prevention and control (IPC) measures, including contact precautions, disinfection of environment and shared devices and the review of hand hygiene protocols implemented during an outbreak of neonatal Candida spp. infections in a newborn nursery and special care unit of a secondary hospital, and to analyze associated neonatal and maternal risk factors.

An observational cohort study was conducted following the identification of an outbreak between April and June 2024. A case was defined as a neonate with clinical signs of oral or genital candidiasis and/or microbiological confirmation from mucosal swabs.

125 neonates and mothers were included, 16 neonates (12.8%) met the case definition. Female sex, small-for-gestational-age status, Apgar score <7, and need for phototherapy were significantly associated with infection. Maternal primiparity also showed a significant association, whereas maternal vaginal Candida colonization and antibiotic exposure did not. After the implementation of IPC measures, decline of cases was observed. All affected neonates received antifungal therapy and recovered fully without progression to invasive disease.

This outbreak demonstrates that even full-term neonates can be at risk for mucocutaneous Candida infection. The application of IPC measures highlights the importance of surveillance, and environmental sanitation in controlling infection transmission.