To investigate and halt transmission of Burkholderia multivorans at hospitals reporting B. multivorans outbreaks in California between September 2020 and February 2023.

Case-patients were defined as adults without cystic fibrosis with B. multivorans isolated from any specimen source collected while an inpatient at an affected facility from January 2020 through February 2023 and confirmed as the outbreak strain by random amplified polymorphic DNA testing and repetitive extragenic palindromic polymerase chain reaction. We reviewed medical records to describe case-patients and identify common exposures; observations and staff interviews were completed to detect exposures to non-sterile water. Environmental samples and commercial products were tested for presence of B. multivorans. All B. multivorans isolates underwent whole genome sequencing.

We identified 25 case-patients. Most case-patients (n = 22, 88%) were hospitalized at the same hospital and received care in an intensive care unit (n = 17, 68%). Healthcare personnel reported using water and ice from ice machines for patient bathing, swallow evaluations, and pain relief. B. multivorans was identified from two ice machines at the hospital with the most case-patients in March 2022 and July 2022. All hospitals used the same brand of ice machine, filters, descaling, and sanitizing products. Clinical and ice machine B. multivorans isolates matched the outbreak strain.

The use of water and ice from contaminated ice machines likely contributed to this outbreak. Ice machines can serve as reservoirs for Burkholderia spp. and should be investigated as sources of transmission during outbreaks of water-associated organisms in healthcare settings.

To determine how inpatient mortality associated with healthcare-associated bloodstream infections (HCA-BSI) in patients with high medical complexity and risk for frailty has changed since the implementation of sepsis-response interventions and the COVID-19 pandemic.

Retrospective cohort study.

Tertiary care center.

Patients with HCA-BSI in 2010 (preintervention), 2018 (postintervention) and 2023 (postCOVID).

Using a modified Poisson regression, we estimated relative risk of inpatient mortality in 2010 (preintervention), 2018 (postintervention), and 2023 (postCOVID), associated with high Elixhauser comorbidity index (ECI), a validated score identifying increased risk of prolonged hospitalization and in-hospital mortality.

We included 931 patients. The rate of HCA-BSI (number per 10,000 patient-days) decreased from 4.2 in 2010 to 3.2 in 2018 but increased to 13.0 in 2023. Inpatient mortality was 21% in 2010, 26% in 2018, and 16% in 2023. While patients with both low and high ECI scores had a decrease in inpatient mortality in 2023, those with high ECI scores had an increase in mortality compared to 2010. ECI became a stronger predictor of mortality over time.

The decline in mortality in patients with HCA-BSI with low ECI scores was likely due to successful infection prevention, sepsis-response interventions, and improved diagnostics. Despite this decline, increased comorbidities associated with higher risk for frailty had a larger role in mortality in 2023, suggesting a need for more targeted interventions in this population.

To estimate the budget and healthcare impact of using procalcitonin (PCT)-guided antimicrobial stewardship for sepsis or lower respiratory tract infection (LRTI) in Thailand.

Cost and clinical outcomes were modeled, comparing intervention with PCT-guided antimicrobial stewardship plus routine practice versus standard of care. The primary outcome was the annual budget impact. Secondary outcomes were the duration of antibiotic treatment and numbers of antibiotic-resistant and Clostridioides difficile cases per year. Sensitivity analyses assessed parameter uncertainty. Scenario analyses explored the budget impact of variations in local clinical practice.

Hospitalized patients with suspected sepsis or with LRTI in Thailand.

PCT-guided antimicrobial stewardship plus routine practice.

The model predicted that PCT-guided antimicrobial stewardship versus standard of care for sepsis and LRTI, respectively, would result in 270.6 (95% CI: −413.9, −160.2) and 917.1 (95% CI: −1,092.3, −421.5) thousand fewer antibiotic treatment days; 1.1 (95% CI: −2.3, −.5) and 23.2 (95% CI: –45.6, −7.9) thousand fewer antibiotic-resistant cases; and 4.5 (95% CI: −11.8, −1.0) and 13.2 (95% CI: −35.4, −2.1) thousand fewer Clostridioides difficile cases. Total cost savings were estimated at 921 THB (95% CI: −2,132, −7) and 3,320 THB (95% CI: −6,617, −592), per patient per year, for sepsis and LRTI, respectively. In sensitivity analyses, the probability of cost savings was 98% for sepsis and 100% for LRTI. Scenario analyses indicated that greater cost savings could be achieved in some scenarios.

PCT-guided antimicrobial stewardship for sepsis and LRTI could deliver economic benefits compared with current standard of care in Thailand.

Antimicrobial resistance is a growing global concern. At our hospital, susceptibility of Pseudomonas aeruginosa to piperacillin-tazobactam declined from 95% to 77%, while susceptibility of Enterobacter cloacae complex decreased from 82% to 72%, prompting antimicrobial stewardship program (ASP) interventions.

ASP interventions aimed to reduce unnecessary antipseudomonal therapy with ceftriaxone recommended for low-risk patients, to replace piperacillin-tazobactam with cefepime in high-risk patients. Additionally, pharmacodynamic optimization was introduced for piperacillin-tazobactam, cefepime, and ceftriaxone. Annual inpatient antibiograms and antibiotic use (days of therapy per 1,000 patient-days) were evaluated for piperacillin-tazobactam, cefepime, meropenem, ciprofloxacin, levofloxacin, and ceftriaxone. Spearman correlation assessed the relationship between antibiotic use and bacterial susceptibility with a 1-year lag.

Over the two years following the initiation of interventions in 2023, piperacillin-tazobactam use decreased 11-fold, cefepime use increased 2.6-fold, and ceftriaxone use increased by 1.7-fold. Meropenem use declined 1.5-fold. P. aeruginosa susceptibility improved: piperacillin-tazobactam (77% to 96%), meropenem (83% to 92%), and cefepime (77% to 96%). E. cloacae complex susceptibility to piperacillin-tazobactam increased from 63% to 86%. Piperacillin-tazobactam use demonstrated a statistically significant perfect negative correlation with P. aeruginosa susceptibility. Cefepime use showed a strong positive, non-significant correlation with P. aeruginosa susceptibility, whereas the correlation between piperacillin-tazobactam use and E. cloacae susceptibility was moderately negative but not significant.

ASP-driven restriction of piperacillin-tazobactam was associated with marked improvement in P. aeruginosa susceptibility to both piperacillin-tazobactam and cefepime despite substantially increased cefepime use, suggesting shared resistance mechanisms and that piperacillin-tazobactam may be a major driver of resistance selection.

To evaluate urinalysis (UA) performance for identifying single-uropathogen bacteriuria, characterize positive cultures after normal UA, compare laboratory and point-of-care platforms, and explore the resource implications of conditional culture.

We retrospectively analyzed nonduplicate urine-culture episodes linked to same-day UA at a tertiary hospital in 2024. Pathological UA was defined as positive leukocyte esterase or nitrite. Diagnostic performance was assessed against single-uropathogen growth versus culture-negative reports. Selected culture-positive episodes underwent chart review. An exploratory model estimated resource use under a symptom- and UA-guided culture pathway.

Among 9,036 eligible culture episodes from 8,214 patients, 4,273 (47.3%) had same-day UA. The primary cohort comprised 3,969 episodes, including 925 single-uropathogen cases and 3,044 culture-negative controls. Pathological UA had 92.8% sensitivity (95% confidence interval, 91.1%–94.4%), 51.5% specificity (49.7%–53.2%), 36.8% positive predictive value (34.8%–38.7%), and 95.9% negative predictive value (94.9%–96.9%). Of 92 reviewed positive cultures after normal UA, 77 (83.7%) were classified as asymptomatic bacteriuria; seven of the remaining 15 episodes were adjudicated as probable urinary tract infection. The base-case model projected direct laboratory costs of ＄31,900 versus ＄102,700, with substantial variation across eligibility assumptions.

Most positive cultures after normal UA represented asymptomatic bacteriuria, while culture-positive probable urinary tract infection was rare. These findings support a symptom-informed, UA-guided strategy with clinical overrides.

To evaluate healthcare workers’ (HCWs) adherence to contact precautions (CP) in pediatric intensive care settings and to identify factors associated with compliance.

Prospective observational study.

Pediatric intensive care units (PICUs) and a pediatric surgical intensive care unit (PSCU) at a tertiary care hospital.

Healthcare workers involved in patient care activities in PICUs and PSCU.

HCWs were directly observed during patient care procedures. Adherence to CP measures was evaluated using a five-step checklist, and compliance levels were categorized as low, moderate, or high. Associations between compliance and potential influencing factors were analyzed.

A total of 367 observations were performed. High compliance was observed in 30.4% of procedures, moderate compliance in 54.2%, and low compliance in 15.4%. Compliance levels were significantly associated with professional category and ICU unit, whereas no significant association was found with the type of patient care activity or microorganism type.

Compliance with CP was suboptimal and varied according to professional category and ICU unit. These findings suggest that adherence is influenced by both individual and unit-level factors. Targeted, context-specific interventions and continuous education may improve adherence to infection control measures.

Overuse of empiric vancomycin is common in pediatric intensive care units (PICU). Our objective was to evaluate PICU clinician knowledge, attitudes, and practices regarding empiric vancomycin use.

We conducted a cross-sectional survey of clinicians in five tertiary care PICUs in August-September 2023. Survey items included Likert scale (1–5), ranking, and multiple-choice responses. Agree/Strongly Agree and Disagree/Strongly Disagree were collapsed to Agree and Disagree for analysis. Data were analyzed using descriptive statistics.

A total of 133 of 297 eligible clinicians (45%) responded to the survey. Knowledge of the spectrum of activity of vancomycin was low with only 15 of 116 (13%) respondents answering this question correctly. Approximately half of clinicians agreed that vancomycin overuse was a significant problem (72/133, 54%); responses varied from 0% to 65% across sites. Most clinicians (104/132, 79%) agreed that reducing vancomycin overuse would reduce antibiotic-associated adverse events. Clinicians had greater confidence in determining when vancomycin should be given to a patient with sepsis as compared to patients without sepsis (106/133, 80% vs 79/130, 61%). Illness severity was the factor influencing the decision to start vancomycin that ranked highest by the most respondents (55%).

PICU clinicians across five hospitals agreed that vancomycin overuse is a significant problem. Many misunderstood the spectrum of vancomycin activity and lacked confidence in determining when vancomycin should be used in clinically stable patients. Focusing stewardship efforts on improving clinician knowledge and supporting decision making, particularly for patients without sepsis, may address these barriers.

The growing incidence of colistin resistance in Acinetobacter baumannii and Klebsiella pneumoniae is a cause for concern. This study aimed to determine the epidemiological characteristics of colistin resistance in A. baumannii and K. pneumoniae clinical isolates from a tertiary-level hospital in Johannesburg, South Africa.

A retrospective data analysis was done on data retrieved from the Corporate Data Warehouse, National Health Laboratory Services from 1 January 2022 to 30 June 2024.

Of 2 900 A. baumannii and K. pneumoniae isolates, 830 underwent colistin broth microdilution (BMD) testing, with 22% (186/830) confirmed to be colistin-resistant. Colistin minimum inhibitory concentrations (MICs) ≥16μg/mL occurred in 75% of isolates. Klebsiella pneumoniae accounted for 63% (117/186) of the resistant isolates. Overall, 62% (116/186) of resistant isolates were extensively drug-resistant (XDR). Adult intensive care units (ICUs) contributed 45% (84/186) of resistant isolates.

Colistin resistance in A. baumannii and K. pneumoniae presents a significant threat in South Africa’s healthcare settings. The high proportion of resistant isolates in ICUs and of XDR phenotypes highlight the urgent need for coordinated antimicrobial stewardship (AMS) and infection prevention and control (IPC) interventions. Stronger AMS, IPC and surveillance are vital to slow this threat and preserve the effectiveness of last-line therapies.

National Healthcare Safety Network (NHSN) surveillance definitions are foundational for infection prevention benchmarking and public reporting. The PNEU2 pneumonia criteria require radiographic documentation of “infiltrate,” “consolidation,” or “cavitation.” However, modern radiology reporting increasingly favors alternative descriptors such as “opacities” and “airspace disease,” potentially leading to systematic misclassification of clinically apparent pneumonia cases.

We conducted a retrospective review of central line-associated bloodstream infections (CLABSIs) in a surgical intensive care unit at a tertiary academic medical center over 12 months. Cases meeting all NHSN PNEU2 clinical and laboratory criteria were screened, and associated radiology reports were independently reviewed by infection prevention specialists and clinicians. Cases excluded solely due to radiographic terminology were identified and qualitatively analyzed. Informal radiologist input regarding terminology equivalency was obtained.

Approximately 10 cases met all clinical and laboratory criteria for NHSN-defined pneumonia but were excluded solely because radiology reports used terms such as “bilateral opacities,” “airspace disease,” or “patchy opacities” rather than NHSN-required terminology. Clinicians and radiologists confirmed these findings were consistent with pneumonia and reflected contemporary reporting conventions rather than clinical ambiguity.

Semantic mismatches between evolving radiology language and static NHSN definitions result in systematic underreporting of clinically meaningful pneumonia events, undermining surveillance validity and institutional benchmarking. We propose three solutions: an expanded terminology list developed with radiology societies, a clinical adjudication pathway for cases with equivalent imaging findings, and a hybrid tiered classification model. Multidisciplinary collaboration is essential to align surveillance definitions with modern clinical practice.

Estimate regional and seasonal variation in bacterial infection burden in Veterans Health Administration (VHA) facilities and its relationship to antibiotic prescribing .

Retrospective cross-sectional study.

VHA records of ICD codes and prescription orders from October 2022 to September 2024 were aggregated to month and facility. The percent of patient visits for bacterial conditions (visit burden) as well as monthly total days supply and mean days supply of antibiotic prescriptions were calculated for each facility. Regional and seasonal variation in bacterial condition burdens in VHA facilities, and potential discordance between bacterial condition burden and antibiotic prescribing amounts were assessed.

Among the 135,694,718 care visits in 130 VHA facilities during the study period, 7,812,818 (5.8%) were for bacterial conditions. Bacterial condition visit burdens within VHA were highest in the US Northeast, with stable percentages of bacterial condition visits over time. The highest total antibiotic prescribing loads were observed in Southern facilities that did not have the highest bacterial condition percent. In models accounting for visit burden, region and season, total antibiotic days were significantly higher in non-Northeastern facilities, while mean prescribing days were not significantly associated with region but were significantly lower in seasons other than summer.

While some VHA facilities in the US South have the highest ratios of bacterial conditions, regionally aggregated infection visit burdens are similar across the country. There is a disconnect in the relationship between bacterial condition visit burdens and total days of antibiotic prescribing in some Southern facilities, suggesting opportunities for stewardship efforts.

Extensively drug-resistant Acinetobacter baumannii (XDR-AB) is a significant cause of healthcare-associated infections, particularly in neonatal intensive care units. This study aimed to determine the prevalence of XDR-AB colonization and the odds of subsequent invasive infection. The secondary objectives were to identify risk factors and in-hospital outcomes.

A retrospective study was conducted among 485 neonates admitted to Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, from June 1, 2020 to December 31, 2022, using laboratory data and medical records.

Among 485 neonates, 116 babies (23.9%) were colonized with XDR-AB, with a median colonization age of 4 days. A total of 32 neonates developed invasive infections. Invasive XDR-AB disease was significantly more common among colonized neonates (29 neonates (25%)) compared to 3 (0.81%) non-colonized neonates. In-hospital mortality was significantly higher in colonized neonates (12 (10.34%)) compared to non-colonized neonates (5 cases (1.36%)). Other in-hospital outcomes were not significantly associated with colonization status. Independent colonization risk factors were all affected by confounding.

This study highlights the high prevalence of early colonization and subsequent invasive disease with its associated mortality in neonates. Screening of neonates for early colonization helps in empiric antibiotic choices for those found to be colonized.