There is limited research investigating advanced practice provider (APP) knowledge and perspectives on education in antimicrobial stewardship (AS).

Large academic children’s hospital.

APPs in Division of Pediatrics, Antimicrobial Stewardship Program (ASP) stakeholders.

We conducted four focus groups with APPs and one focus group with ASP stakeholders. APPs were asked eleven open questions about training, influences on prescribing practices, knowledge gaps and desired topics for education in AS as well as general barriers to learning. ASP stakeholders were asked five open-ended questions about teaching initiatives, knowledge gaps and high yield teaching topics for APPs.

20 APPs and 6 ASP stakeholders (1 medical director, 3 pharmacists and 2 pediatric infectious diseases fellows) participated in focus groups. Four domains and eight themes were generated. (1) Barriers to AS in Practice: lack of critical thinking and conflict between the ASP and APPs within the cultural context of the institution. (2) Approach to Education: logistical challenges to curriculum development and adopting APP centered approaches to teaching. (3) Education for New to Practice APPs: learning basics of microbiology, infectious diseases and utilizing resources to encourage AS in practice. (4) Education for Experienced APPs: learning approaches to common clinical scenarios and updates to improve AS in practice.

Curricular content should acknowledge the cultural influences of the institution, target knowledge gaps and areas of interest of learners, and be delivered via flexible and engaging learning modalities that encourage maximal participation.

This study examines gaps in mask-related behaviors, beliefs, and perceptions among healthcare personnel (HCP), investigates the influence of vaccination status on masking practices, and identifies opportunities to enhance adherence in clinical settings.

A survey was conducted among HCP providing direct patient care at State University of New York Upstate Medical University from November 2024 to January 2025.

A total of 655 HCP responded to the survey. Of these, 335 (51.1%) reported being up to date on coronavirus (COVID-19) vaccination, and 501 (76.5%) intended to receive the 2024 – 2025 influenza vaccine. Majority believed masking protects them (n = 381, 61%) and others (n = 400, 64.6%), perceived the workplace as carrying a high respiratory risk (n = 366, 58.6%), and believed patient masking offers protective benefits (n = 359, 57.4%). Self-reported masking rates were highest when participants were sick or symptomatic (n = 477, 72.8%) and lowest during respiratory specimen collection (n = 233, 35.6%). High adherence was observed when participants were symptomatic, among those who were up to date on their COVID-19 vaccination (n = 276, 82.4%) and who intended to receive the 2024 – 2025 influenza vaccine (n = 407, 81.2%).

These findings suggest self-reported masking adherence remains suboptimal, reflecting low perceived risk of COVID-19 infection in the postpandemic period. Targeted interventions highlighting masking as an important component of broader measures including vaccination, hand hygiene, and ventilation are needed to enhance hospital infection prevention and control.

Outpatient parenteral antimicrobial therapy (OPAT) is a mainstay of clinical infectious diseases practice, and OPAT-related publications continue to be prominent in journals. The objective of this article is to summarize ten clinically important OPAT-related publications from 2024.

Narrative review.

Eighty-one articles were found in a literature search, and 56 met inclusion criteria. A survey containing 25 articles was sent to an email listserv of clinicians with OPAT experience.

This article summarizes the top 10 OPAT articles published in 2024, based on those survey results.

Common themes from the top 10 OPAT articles published in 2024 included OPAT clinician workload, patient perspectives of OPAT, tools for OPAT work, and dalbavancin use.

To evaluate the evidence for arthropod-associated transmission of pathogens in healthcare facilities and synthesize available literature to support infection prevention practice and policy.

We conducted a systematic review following PRISMA guidelines. PubMed, Ovid MEDLINE, Embase, and CENTRAL were searched using terms related to insects/arthropods, microbial transmission, and healthcare-associated infection, supplemented by grey literature and citation tracking. No date, language, or study-type restrictions were applied. After deduplication and screening in Covidence, 73 studies met inclusion criteria. Eligible studies described microbial isolation or transmission involving arthropods within healthcare environments. Data were extracted by multiple reviewers using a standardized manual and verified by a senior author. Analyses were descriptive and focused on identifying evidence of patient transmission and microbial carriage among arthropods.

Included studies spanned all world regions, most commonly from Asia and South America. Cockroaches, flies, and ants were the primary arthropods examined, with samples collected from both clinical and non-clinical hospital areas. Six studies investigated direct patient transmission, and three provided genetic or circumstantial evidence linking arthropods to patient infections, including Klebsiella pneumoniae, multidrug-resistant Enterobacter cloacae, and dengue virus. The majority of studies identified arthropods carrying clinically significant bacteria (eg, Staphylococcus aureus, Enterococcus faecalis, Acinetobacter baumannii, Pseudomonas aeruginosa), fungi (Aspergillus, Candida), and viruses.

Arthropods in healthcare environments commonly harbor clinically relevant and antimicrobial-resistant microbes, and limited but compelling evidence supports their potential role in patient transmission. Strengthened pest management and environmental hygiene are essential components of infection prevention.

Surgical site infections (SSIs) pose a significant healthcare challenge, raising patient morbidity, mortality, and costs. Various intrinsic, patient-specific, and perioperative factors contribute to SSIs. This study aims to identify SSI-associated risk factors, microorganism types, and antibiotic susceptibility patterns in surgical patients.

This is a matched-case control study.

The Lebanese American University Medical Center – Rizk Hospital, Beirut Lebanon.

The study included surgical patients.

This retrospective case-control study analyzed data from surgical patients over a five-year period, matching 113 SSI cases with controls in a 1:3 ratio by gender and surgery type.

Among 324 patients (81 cases vs 243 controls), hypoalbuminemia (<3.5 g/dL) and age ≥65 years were significantly associated with SSIs (P = .025 and P = .039), respectively. Antibiotic redosing was associated with lower odds of SSIs (OR = 0.19, P = .042), indicating a potential protective effect.

Our findings were consistent with similar studies. Elderly patients and those with hypoalbuminemia were found to be at significantly higher risk of SSIs. Also, antibiotic redosing during prolonged surgeries was associated with reduced SSI risk. In terms of SSI rates, gastrointestinal surgeries (GIs) were the highest with 42.3% of GI cases followed appropriate antibiotic protocols. Like other studies, predominant microorganisms at wound site included E. coli and coagulase-negative staphylococci.

The incidence of community-onset (CO) symptomatic urinary tract infection (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales is increasing worldwide. Our study aims were to explore the independent predictors for CO-ESBL SUTI and to compare the effectiveness of several oral therapeutics, which are used for this indication in community health settings.

Retrospective matched case-case-control and case-case studies, among insurers of Maccabi health maintenance organization, Shfella district, Israel (10–11/2019). Patients with CO-ESBL (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis) SUTI were matched to patients with CO-non-ESBL SUTI and to uninfected controls (1:1:1). Matched analyses (logistic regressions) were used to model predictors for CO-ESBL SUTI. A composite parameter for worse SUTI outcomes was compared among patients who were managed with a single, supposedly effective (ie, in vitro), oral agent.

The study consisted of 1,455 patients (ie, three matched groups of 485 patients). The independent predictors for CO-ESBL SUTI were certain recent exposures: (1) hospitalization (3 months), (2) past carriage of multidrug-resistant organisms (2 years), (3) exposure to any antimicrobial (3 months), and (4) prior SUTI (6 months). Among 331 patients with CO-ESBL SUTI, resistance rates were lowest for fosfomycin (4.9%), while outcomes were worst for patients managed with oral amoxicillin-clavulanate.

CO-ESBL SUTI independent predictors in this community region were recent hospitalization, known MDRO carriage, exposure to antimicrobials and prior SUTI. Amoxicillin-clavulanate should be avoided, even for ESBL susceptible isolates.

Mycobacterium lentiflavum is a rare, non-tuberculous mycobacterium (NTM) which is implicated in some cases of active, pulmonary non-tuberculous mycobacterial disease. The outbreak of NTM in nosocomial settings occasionally occurs and outbreak investigation with implementation of concurrent countermeasure is essential.

Outbreak investigation.

A tertiary care medical center.

Hospitalized patients during the outbreak period.

In April 2024, a cluster of patients with Mycobacterium lentiflavum–positive sputum cultures, presumed to be due to nosocomial transmission, was identified at the study center. A retrospective review of cases dating back to February 2023 revealed 27 patients with M. lentiflavum infection whose isolates had initially not been speciated. According to the American Thoracic Society (ATS) criteria for diagnosing pulmonary non-tuberculous mycobacterial (NTM) disease, two of these patients met the criteria for active disease. Multi-locus sequence typing of 12 isolates demonstrated 100% clonality, indicating a common source. A concurrent outbreak investigation identified contaminated faucet aerators in hospital wards as the likely source of transmission. All faucet aerators and caps were manually cleaned and disinfected using liquid sodium hypochlorite, after which no further cases were detected.

The present study described a nosocomial cluster of M. lentiflavum colonization and infections at a tertiary care center, with contaminated faucet aerators identified as the likely source. Prompt identification of such NTM clusters in healthcare settings is essential to initiate timely treatment and prevent further transmission.

To describe an outbreak of Burkholderia cepacia complex at a tertiary care hospital in Karachi, Pakistan, highlighting contributing factors, potential sources, and system-level gaps identified during the investigation.

Outbreak investigation.

A 655-bed tertiary care teaching hospital in Karachi, Pakistan.

All individuals who had positive blood cultures by non-lactose fermenting, oxidase-positive, Gram-negative rods that could not be further characterized.

On September 26, 2020, the Department of Infection Prevention and Hospital Epidemiology (DIPHE) was notified of multiple positive blood cultures. An outbreak investigation was initiated, including chart reviews, laboratory analysis, environmental sampling, assessing central line insertion practices, and evaluating the manufacturing site. Clinical Laboratory Standards Institute (CLSI) guidelines were used for microbiological identification and susceptibility testing.

Thirty-five patients with positive cultures were identified between September 15 and October 22, 2020. While environmental sampling did not yield growth, significant breaches at the suppliers‘ facility were identified in chlorhexidine gluconate (CHG) storage and quality control. Although cultures of CHG were negative, the product’s withdrawal led to a marked decline in new cases. Moreover, while resources were unavailable for genomic testing, antimicrobial susceptibility patterns were similar in all the case strains, suggesting a common source.

This outbreak highlights the role of contaminated disinfectants in healthcare-associated infections. It also revealed systemic gaps in disinfectant quality control, storage facilities, and diagnostic capacity, delaying outbreak recognition and response. It is essential to strengthen regulatory oversight, implement standardized testing protocols, and enhance microbiological diagnostic infrastructure to lower the risk of similar outbreaks.

To evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify areas for improvement in the delivery of stewardship interventions.

Cross-sectional survey study.

A 1200-bed tertiary care public hospital in Portugal.

Physicians with antibiotic prescribing privileges in inpatient settings. All physicians with active institutional e-mail addresses were invited to participate.

An anonymous web-based questionnaire was administered between June and December 2024. The survey addressed six domains: (1) antibiotic knowledge; (2) awareness and use of local prescribing protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of antibiotic restriction policies; (5) use of informal consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions.

A total of 154 prescribing physicians responded (response rate: 10%), including specialists (75.3%) and residents (24.0%). Most respondents were aware of institutional protocols (78.6%), but 66.9% reported rarely or never consulting them, citing accessibility and reliance on personal knowledge as key barriers. Participation in case discussions was limited (25.3%) but viewed as highly useful. Awareness of restrictive antibiotic policies was low; however, 69.5% indicated that these policies influenced their prescribing behavior. Respondents expressed strong interest in regular feedback on antimicrobial use and resistance trends.

Key areas for improvement in ASP implementation include enhancing access to protocols, expanding case-based discussions, clarifying communication around restrictions, and establishing regular feedback mechanisms. These findings may inform efforts to align ASP strategies with clinical realities in similar hospital settings.