Maribavir is a novel antiviral for resistant or refractory (R/R) CMV infection with a favorable safety profile. This report describes institutional use of maribavir in solid organ transplant (SOT) recipients with CMV infection to better understand antiviral stewardship opportunities.

Retrospective case series.

Tertiary referral center.

This was a single center case series of adult SOT recipients who received maribavir for treatment of R/R CMV infection. The primary outcome was treatment success by 8 weeks. Treatment failure, including development of maribavir resistance, and CMV recurrence were also assessed.

Maribavir was used for treatment of 23 episodes of CMV infection in 20 SOT recipients. Treatment success was achieved in 14 (60.9%) episodes in unique patients, with 5/14 patients (35.7%) experiencing CMV recurrence within four weeks of maribavir discontinuation. Treatment failure occurred in 9 (39.1%) of 23 treatment courses, with 6/20 (30%) patients developing treatment-emergent maribavir resistance.

Maribavir was a viable option for the management of R/R CMV infection in our real-world single center cohort, as success mirrored that seen in other studies. However, there was a clinically significant portion of patients who failed maribavir or had recurrent CMV. Continued multi-center analysis of maribavir timing, secondary prophylaxis, and patient characteristics that may predict success are warranted to help improve the stewardship of this valuable antiviral.

Outpatient antibiotic prescribing remains common despite evidence that selective non-antibiotic management is safe for low-risk uncomplicated diverticulitis. Although recent guidelines recommend withholding antibiotics in selected patients, real-world prescribing patterns and associated outcomes remain unclear.

We conducted a retrospective cohort study using nationwide Veterans Health Administration data (2016–2023) to identify emergency department visits for a first case of uncomplicated diverticulitis among patients discharged without admission. Low-risk diverticulitis was defined as age <65 years, Charlson Comorbidity Index <2, and white blood cell count <15 × 103/µL. Outcomes included antibiotic prescribing trends, assessed using linear regression, and one-year hospitalization for diverticulitis. Analyses for one-year hospitalization were stratified by age and comorbidity burden to assess effect modification. Subdistribution hazard (Fine-Gray) models estimated adjusted hazard ratios, accounting for the competing risk of death.

Among 4,249 patients with low-risk diverticulitis (median age, 51 yr; 84.6% male), 4,068 (95.7%) received antibiotics. From 2016 to 2023, the proportion managed without antibiotics remained unchanged (approximately 4%), while β-lactam use increased and fluoroquinolone use declined. Antibiotic use was not significantly associated with a reduced risk of one-year hospitalization (adjusted hazard ratio, 0.99; 95% confidence interval, 0.54–1.84; P = .99). No significant differences were observed across age-comorbidity strata or antibiotic classes, although subgroup analyses may have been underpowered.

Despite guideline recommendations, antibiotics were prescribed for most low-risk patients with uncomplicated diverticulitis, with no change over eight years. Clinical outcomes did not differ by antibiotic exposure, highlighting an opportunity to reduce unnecessary antibiotic use through outpatient stewardship interventions.

Cardiac implantable electronic device (CIED) implantations are common and expensive. Tracking post-surgical infections of these devices is a key component of monitoring health system performance and ensuring high quality care. Given human resource constraints with traditional infection prevention and control (IPC) programs, CIED infections cannot be systemically monitored in many jurisdictions. This project endeavored to implement a policy change in Alberta, Canada, using administrative data for tracking CIED infection trends over time.

Prior work validated the use of administrative data to track CIED infections. The current work focused on exploring policy options to optimize this use of administrative data and elicit feedback from knowledge users/operational leaders via a workshop and electronic communications. Options for presentation and communication modalities of data including quarterly reports or Tableau dashboards were explored.

Based on consensus from the workshop and subsequent electronic communications, three policy options were provided along with a recommended choice as well as preferred reporting options. The final options were all included in a policy brief provided to operational leadership. Ultimately, the recommended approaches of using administrative data for surveillance were accepted resulting in a policy change for CIED infection surveillance in Alberta that is currently being implemented and evaluated.

CIED infections are a devastating complication following implantation. Administrative data may offer an alternative to traditional IPC surveillance given constrained resources. Engagement and presentation of evidence-based policy options resulted in the adoption of a novel data driven policy in Alberta for CIED infection surveillance.

To describe antibiotic use and clinical outcomes in hospitalized patients with gram-positive bacteremia based on penicillin (PCN) allergy status.

Retrospective cohort study.

3,162 patients admitted to acute Veterans Health Administration facilities between January 2021 and December 2022 with ≥1 blood culture positive for methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-susceptible Staphylococcus lugdunensis (MSSL), ampicillin-susceptible Enterococcus faecalis (ASEF), Streptococcus pneumoniae (Spne), or Streptococcus pyogenes.

Calculated the prevalence ratio (PR) to determine the association, if any, between the PCN allergy label and ≥1 day alternate antibiotic use, completion of ≥50% of targeted therapy with alternate, resistant gram-positive infection (RGPI), and broad-spectrum hospital-onset infection (BSHOI) antibiotics, 7-day acute kidney injury (AKI), 60-day Clostridioides difficile infection, hospital length of stay, 90-day recurrence, and 90-day mortality.

Patients with ASEF and Spne bacteremia with a PCN allergy had higher rates of ≥1 day of alternate antibiotic use (ASEF PR 1.21 [95% CI 1.08–1.35]; Spne 1.73 [1.25–2.38]) and completing ≥50% of targeted therapy with an alternate antibiotic (ASEF 5.60 [4.22–7.42]; Spne 4.10 [1.93–8.69]). Additionally, in the ASEF bacteremia group, PCN allergy status was associated with higher rates of completing ≥50% of targeted therapy with RGPI (5.52 [4.17–7.31]) and BSHOI (2.04 [1.10–3.78]) antibiotics. Patients with MSSA/MSSL bacteremia with a PCN allergy had higher 90-day recurrence (3.68 [1.02–13.28]) and, if predominantly using vancomycin instead of cefazolin, 7-day AKI (4.48 [1.44–13.98]).

Our findings highlight opportunities for optimizing antibiotic selection and clinical outcomes among PCN-allergic patients with MSSA/MSSL, ASEF, and Spne bacteremia.

Antimicrobial resistance is a global “silent pandemic” with dentistry contributing 10%–12% of outpatient antibiotic use. In low- and middle-income countries such as India, the absence of context-specific national dental antibiotic guidelines, widespread over-the-counter antibiotic access, and diagnostic limitations complicate rational prescribing and antimicrobial stewardship.

A sequential explanatory mixed method study was conducted over 12 months in Varanasi. The quantitative component analyzed 2,844 dental prescriptions across primary, secondary, and tertiary care settings. Prescribing appropriateness was assessed using international evidence-based guidelines from the American Dental Association and Faculty of General dental Practice (UK). The qualitative component included 30 in-depth interviews with dental practitioners, analyzed using inductive thematic analysis to explore determinants of prescribing behavior.

Antibiotics were prescribed in 73.1% of cases, of which 69.6% were inappropriate. High prescribing rates observed in conditions where antibiotics are generally not indicated, including irreversible pulpitis (73.3%), apical periodontitis (92.3%), and implant procedures (100%). Broad-spectrum antibiotics predominated, particularly amoxicillin-clavulanic acid (43.0%) and cefpodoxime-clavulanic acid (21.7%). Qualitative findings identified that prescribing was driven by diagnostic uncertainty, defensive practice, patient expectations, and systemic constraints, including lack of national guidelines and unregulated antibiotic access.

Inappropriate antibiotic prescribing in dentistry reflects a context-driven, multifactorial behavioral shaped by clinical, behavioral, and structural constraints rather than a simple knowledge deficit. Addressing this challenge requires context-specific national dental antibiotic guidelines, strengthened antimicrobial stewardship, improved diagnostic support, and regulatory enforcement. The proposed IDCARE+ framework offers a practical systems-based approach to promote rational antibiotic use in similar resource-constrained settings.

Evaluate outcomes of early versus late intravenous (IV)-to-oral antibiotic transition in patients with uncomplicated Enterobacterales bacteremia.

Multicenter, retrospective observational cohort study.

Healthcare system with one tertiary care academic medical center and four community teaching hospitals.

Adults with uncomplicated Enterobacterales bacteremia, clinical stability within 72 hours of antibiotic initiation, definitive source control, ability to take oral medication, and final susceptibility reports were included. The following were excluded: never received oral antibiotic; inadequate treatment duration; transitioned back to IV therapy; inappropriate antimicrobial therapy based on dosing or susceptibilities; transferred from outside institution; immunocompromised; pregnant.

Early transition was considered IV-to-oral antibiotic transition by day 4 of therapy. The primary outcome was treatment failure within 30 days of antibiotic completion, a composite end point encompassing infection recurrence, escalation of antimicrobial therapy, infection-related re-admission, and death. Secondary outcomes included hospital length of stay and total antibiotic duration.

225 patients were included; 133 (59.1%) transitioned to oral antibiotics early and 92 (40.9%) transitioned late. There were no significant differences in the primary composite outcome of treatment failure for early transition versus late transition (6.0% vs 6.5%, P = .877). Early transition was associated with shorter median hospital length of stay (5 vs 7 d, P < .001) and total antibiotic duration (9 vs 12 d, P < .001).

Early IV-to-oral antibiotic transition in patients with uncomplicated Enterobacterales bacteremia and clinical stability within 72 hours was effective with potential to reduce length of stay and total antibiotic duration.

To assess anti-infective use after over a decade of handshake stewardship by analyzing days of therapy per thousand patient days for all anti-infectives.

Retrospective evaluation pre- and post-implementation of handshake stewardship from October 2010 to September 2025.

A pediatric hospital in Aurora, Colorado, with a licensed bed capacity of 472 beds. Handshake stewardship at our institution began in October 2013, after two years of planning (October 2011–September 2013); prior, there was no form of stewardship (October 2010–September 2011).

All hospitalized patients administered anti-infectives during the study period.

Days of therapy per thousand patient days were extracted from the electronic medical record and stratified by unit, medication, and route of administration. Antibacterial agents were grouped by National Healthcare Safety Network Antimicrobial Use and Resistance Module categories for pediatric resistant Gram-positive and hospital-onset infections. Yearly medians were utilized to define a refinement phase.

During 12 years of handshake stewardship (2013–2025), anti-infective use hospital-wide declined 33%. A maintenance phase, when refinement in anti-infective use was observed though overall use plateaued numerically, began in October 2021.

The goal of stewardship is judicious use, not no use. We describe the maturation of a stewardship program over 12 years, demonstrating that handshake stewardship is both effective and sustainable, and that over time the focus shifts from decreased overall days of therapy per thousand patient days towards optimal use, reflected in fine-tuned use of specific agents.

The study aims at determining factors that influence antibiotic initiation, continuation, escalation, modification, and discontinuation among children admitted to pediatric intensive care unit (PICU) of a tertiary-care center in South India.

Prospective observational study.

Tertiary-care PICU in South India.

Children aged from 1 month to 18 years admitted to the PICU during the study period (1 January 2024–31 May 2024)

Clinical, demographic, laboratory, radiological, and microbiological data were prospectively collected using a structured proforma. Cases were classified as infective versus non-infective based on clinical presentation, laboratory parameters, radiological findings, microbiological investigations when available, and final diagnosis. The decision to initiate antibiotic therapy and subsequent modifications were documented.

Among 308 PICU admissions, 291 children were analyzed. Respiratory (39.5%) and nervous system (24.9%) involvement were the most common presentations. An infectious etiology was identified in 61.9% of cases. Antibiotics were prescribed in 59.1%. Factors influencing antibiotic initiation included clinical assessment, inflammatory markers, pyuria, and radiological findings. A total of 126 culture specimens were obtained. Blood cultures were positive in 2/83 (2.4%) and urine cultures in 7/14 (50%). Cephalosporin and aminoglycoside combination was the most prescribed combination during the study (48.3%). Antibiotic escalation was required in 10% of respiratory infections, antibiotics were discontinued in 74% of the nervous system cases, and culture-guided antibiotic modification was observed most in genitourinary infections.

Antibiotic prescribing in the PICU is driven by clinical, laboratory, radiological, and microbiological evidence. Structured reassessments and timely de-escalation of antibiotics represent important opportunities for antibiotic stewardship.

Antimicrobial resistance threatens the effectiveness of future therapies. Interventions to reduce the rate of unnecessary antibiotics prescription in the Swiss outpatient setting typically target primary care physicians (PCPs). However, patients might receive antibiotics from other healthcare providers. We set out to provide a descriptive analysis of total antibiotic prescribing and the providers who prescribed them among patients in such a plan.

We performed a retrospective repeated yearly cross-sectional study from 2019 to 2023 in claims data from one insurer in Switzerland (SWICA insurance). We restricted the sample to patients registered in a managed-care plan with PCP serving as a gatekeeper in the SWICA database. We provide descriptive statistics of total antibiotic prescription fills, the proportion of antibiotics prescribed by the gatekeeping PCP vs other healthcare providers and the type of antibiotic prescribed.

The population comprised 106,307 patients in 2019 and 113,343 in 2023. The gatekeeping PCP accounted for 40% of antibiotic prescription in 2019, and 36% in 2023. In 2023, other group practices, other PCPs and hospital outpatient departments together accounted for 40% of prescription fills. Gatekeeping PCPs issued a higher proportion of Watch antibiotics than other providers in both 2019 (35% vs 25%) and 2023 (30% vs 21%).

In a restricted sample of patients affiliated in a healthcare plan where PCP serve as gatekeepers in one insurance in Switzerland, most outpatient antibiotics were not prescribed by the primary gatekeeping PCP. Future antibiotic stewardship interventions in outpatients should consider further prescribers in the network.

Penicillin allergy is the most frequently reported drug allergy, yet most labels are inaccurate or no longer clinically relevant. Mislabeling may lead to avoidance of beta-lactam antibiotics, suboptimal antimicrobial therapy, increased healthcare costs, and potential contribution to antimicrobial resistance. Pharmacists increasingly contribute to antimicrobial stewardship programs; however, their role in penicillin allergy evaluation and delabeling has not been comprehensively synthesized.

To map pharmacist-led or pharmacist-involved interventions aimed at clarifying inappropriate penicillin allergy labels and to describe reported antimicrobial stewardship–related outcomes.

This scoping review followed the PRISMA extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science were searched for English-language studies evaluating pharmacist-led or pharmacist-involved penicillin allergy interventions among adults receiving systemic antibiotics.

Of 1,269 records screened, 15 studies met the inclusion criteria. Interventions most commonly included structured allergy history assessment and risk stratification, education of healthcare professionals, and facilitation of penicillin skin testing and oral drug provocation testing. Pharmacist involvement was frequently associated with increased beta-lactam prescribing and reduced use of broad-spectrum alternatives. Several studies also reported shorter hospital length of stay and lower healthcare costs compared with usual care.

Pharmacist involvement in penicillin allergy evaluation may help optimize antimicrobial therapy and strengthen antimicrobial stewardship efforts. Integration of pharmacists into allergy assessment workflows may improve the accuracy of allergy documentation and facilitate appropriate beta-lactam use. Further research is needed to evaluate long-term clinical, economic, and implementation outcomes across diverse healthcare settings.

The Global Action in Healthcare Network develops point prevalence survey (PPS) protocol for healthcare-associated infection surveillance, particularly in resource-limited settings. This study reports the first field implementation of the Global Action in Healthcare Network (GAIHN) HAI PPS protocol and aims to evaluate the protocol and to estimate healthcare-associated infection (HAI) prevalence and antimicrobial use at a tertiary oncology hospital in Jordan.

Descriptive, cross-sectional point prevalence survey conducted using a standardized GAIHN HAI PPS protocol, coordinated by the U.S. Centers for Disease Control and Prevention, was implemented using an algorithmic REDCap-based data collection system. Targeted HAIs included bloodstream infection, pneumonia, urinary tract infection, and surgical site infection. Antimicrobial use, device exposure, microbiology, and ward-level characteristics were recorded. HAI prevalence was calculated with 95% confidence intervals.

A total of 124 patients were surveyed, 73 (58.9%) underwent full chart review. Antimicrobial use was documented in 63.7% of surveyed patients, with an Access-to-Watch ratio of 0.23. Eight HAI events were identified in six patients, corresponding to an overall HAI prevalence of 4.8% (6/124; 95% CI 2.2–10.1). Pneumonia was the most frequent HAI type. Gram-negative organisms accounted for 60% of isolates. Patients in intensive care was more likely to meet criteria for detailed review.

This pilot demonstrated feasibility for the GAIHN HAI PPS methodology and data collection system. It offers a framework for improving IPC programs and implementing evidence-based practices that can be adapted and scaled across the region, contributing to the global effort to reduce HAIs and combat antimicrobial resistance.