To describe an outbreak of OXA-48–like producing Escherichia coli in a hematology ward and the infection prevention and control (IPC) measures implemented to contain it.

Prospective observational study.

Hematological ward of a tertiary public hospital.

Hematological patients.

The outbreak occurred between February and September 2024. The index case was defined as the first patient with documented colonization or infection; subsequent positive patients were considered secondary cases. Case detection relied on clinical cultures, rectal screening, and molecular assays. An extensive epidemiological investigation was conducted, including clinical data analysis, microbiological and genomic characterization, and environmental assessment. Whole-genome sequencing was performed on seven isolates. In March 2024, weekly rectal PCR-based screening was introduced alongside conventional culture surveillance.

Ten cases were identified (median age 59.5 years, 80% male). Nine patients were colonized and six developed bloodstream infections, two of which associated with additional local infections. Notably, no infection-related deaths were observed. Four cases were detected solely through molecular screening, as isolates retained susceptibility to meropenem and were not identified by cultural methods. Genomic analysis showed that all isolates shared extensive resistance and virulence profiles, confirming a clonal outbreak. Following the implementation of cohort isolation, contact precautions, targeted audits, and weekly molecular screening, no further OXA-48-like cases were detected.

The prompt introduction of molecular surveillance combined with strict IPC measures effectively controlled an OXA-48–like producing Escherichia coli outbreak in a high-risk setting.

To validate risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in patients hospitalized with community-acquired pneumonia (CAP).

Retrospective, single-center, cohort study from October 1, 2018, to March 31, 2023.

Mayo Clinic Hospital in Phoenix, AZ.

Adult patients with CAP, identified using ICD-10 diagnosis codes, receipt of systemic antibiotics for a “respiratory tract infection” within 48 hours of hospitalization, and availability of respiratory cultures.

Multivariate logistic regression was used to identify factors independently associated with MRSA or P. aeruginosa isolation in respiratory cultures.

A total of 1,485 patients met inclusion criteria; 32 (2.2%) had MRSA and 81 (5.5%) had P. aeruginosa isolated from respiratory culture. Multivariate logistic regression analyses identified substance use disorder [aOR 8.29, P < .001], influenza [aOR 7.64, P = .003], lung abscess/empyema [aOR 4.58, P = .031], and peptic ulcer disease (PUD) [aOR 4.09, P = .017] as MRSA risk factors. Bronchiectasis [aOR 3.67, P < .001], PUD [aOR 3.48, P = .006], and COPD [aOR 2.60, P = .005] were independently associated with P. aeruginosa. Immunocompromised conditions, including transplantation (solid organ and hematopoietic stem cell) and malignant tumor were not independently associated with either organism.

Our results substantiate previously demonstrated risk factors for MRSA and P. aeruginosa in CAP. We did not observe an independent association between immunosuppressed conditions evaluated and isolation of MRSA or P. aeruginosa.

Healthcare-associated infections (HAIs) are a major source of preventable harm, yet their risk remains largely invisible to patients. Infection prevention and control strategies focus primarily on system-level processes, minimal attention has been given to how consumer conceptualize risk, institutional trust, and their role in prevention. Understanding these perspectives is important for designing effective, consumer-informed infection prevention and control (IPC) strategies.

We conducted a Q-methodology study to identify shared viewpoints among Australian healthcare consumers aged over 18 years. Participants completed an online survey which included demographic questions, 5-point Likert scale items (Strongly Agree to Strongly Disagree), and Q-sort statements (n = 44) relating to HAIs, IPC initiatives, trust, and responsibility. Factor analysis using principal components and varimax rotation identified patterns of shared perspectives.

A total of 405 surveys were analyzed. Three distinct viewpoints were identified: (1) heightened anxiety and vigilance (n = 148; 37%); (2) trusting and reassurance-oriented (n = 84; 21%); and (3) concerned but balanced (n = 73; 18%). Across viewpoints there was universal agreement that antimicrobial resistance is a concern, HAIs significantly impact recovery, and patients should be informed if they acquire a HAI.

Consumer perceptions of HAI risk were heterogenous and shaped by experience and trust. The identification of three viewpoints suggest that a one-size-fits-all approach to IPC communication and engagement are unlikely to be effective, highlighting the need for tailored, transparent, and consumer-informed strategies to support more responsive IPC policy and practice.

To evaluate the knowledge, attitudes, and behaviors regarding AMR and antimicrobial use among Irish university students and to inform the development of tailored educational interventions.

Cross-sectional online survey.

Two Irish universities, 2022.

University students aged 18–25 years (N = 239).

A questionnaire incorporating validated items adapted from the World Health Organisation (WHO) and European Union (EU) barometer survey instruments was administer online. Data were analyzed using descriptive statistics, ANOVA, and principal component analysis.

A total 239 students participated (73% female). Mean scores were high for knowledge 77.9% (SD 17.8) and attitudes 74.0% (SD 8.9) with no significant differences by gender, discipline, or health status. However, 18% reported using antibiotics without prescription, while 39%–44% of students demonstrated misconceptions across several statements relating to the use of antibiotics for non-bacterial conditions. Awareness of public AMR campaigns was low (27% “Resist” and 18% European Antibiotic Awareness Day). Principal component analysis identified four attitudinal dimensions: responsible use and preventive behavior, global and collective awareness, innovation and policy solutions, and perceived helplessness and reliance on experts.

Although students demonstrated generally high knowledge and positive attitudes towards AMR, important misconceptions and inappropriate antibiotic behaviors remained. The identified attitudinal dimensions suggest that educational interventions should extend beyond knowledge acquisition to address behavioral and attitudinal factors that support responsible antibiotic use and antimicrobial stewardship.

To evaluate the implementation and effectiveness of handshake antimicrobial stewardship interventions for surgical antibiotic prophylaxis at a quaternary hospital in Ghana.

Retrospective cross-sectional secondary data analysis.

Quaternary referral hospital in Accra, Ghana.

Adult surgical encounters (n = 227) with complete antimicrobial stewardship documentation between June and September 2024.

We analyzed antimicrobial stewardship audit records to assess recommendation acceptance, implementation, antibiotic selection concordance, and duration patterns. Outcomes were stratified by surgical service and procedure urgency. Descriptive statistics were used.

Of 227 encounters, 109 (48.0%) required stewardship recommendations, of which 78 (71.6%) were verbally accepted. However, only 39 (50.0% of accepted recommendations) were implemented. Implementation failures were primarily due to patient discharge (19.3%) and prescriber unavailability (16.5%). Duration optimization accounted for 76.1% of interventions. Overall, 43.2% of encounters exceeded the recommended prophylaxis duration (>24 hours). Emergency procedures had lower acceptance and higher missed opportunity rates compared to elective cases.

Handshake stewardship demonstrated moderate acceptance but limited implementation. Execution failures were primarily associated with specific operational bottlenecks, including patient discharge and prescriber unavailability, which were exacerbated in emergency and high-volume surgical services. These findings suggest that in resource-limited settings, stewardship models must incorporate asynchronous communication and automated system safeguards (e.g., stop orders) to overcome workflow barriers.

Antimicrobial resistance (AMR) continues to rise owing to inappropriate antimicrobial use. In many countries, especially where patients cannot afford repetitive physician consultations, patients self-prescribe antimicrobials even for self-limiting infections like pharyngitis. Well-trained pharmacists capable of effectively managing pharyngitis through clinical decision-making scores (CDS) like Centor/McIsaac score can aid antimicrobial stewardship programs (ASP). The main aim of the current study was to train pharmacists to apply validated clinical decision criteria (Centor/McIsaac) for the differential assessment of pharyngitis, promote guideline-based antimicrobial dispensing, and evaluate the effectiveness of training.

A cross-sectional, interventional study using a combination of convenience sampling and snowball sampling techniques was conducted among pharmacists and clinical pharmacy trainees in Pakistan. Educational material was developed through extensive literature search, and training sessions were conducted at community pharmacies and academic institutes. Knowledge was assessed before and after the training sessions using a self-developed, validated, structured questionnaire.

Of the 288 participants, majority of the practicing pharmacists at community pharmacies were younger than 30 years of age with an experience of less than 3 years. Most participants demonstrated poor baseline knowledge which imporved significantly following the training intervention, highlighting its effectiveness in enhancing the knowledge, beliefs, and perceptions of AMR and AMS.

Microteaching-based continuing professional development interventions can support the clinical competencies of pharmacists. These findings highlight the potential of such training interventions to improve infection management and antimicrobial stewardship and underscore the need for similar tailored programs for other clinical conditions.

To compare maternal and neonatal outcomes between mono-infections and co-infections of the reproductive tract in pregnancy due to bacteria and Trichomonas.

We conducted searches across MedLine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, Scopus, and Embase. Searches from database inception to August 5, 2024, for studies that compared reproductive tract bacterial and Trichomonas mono-infections and co-infections in pregnancy with regards to maternal and/or neonatal outcomes. Two independent investigators analyzed each study. Random-effect models were used to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. The Downs and Black scale was used to assess study quality and risk of bias.

Among 1,436 publications, nine studies met inclusion criteria. Mono-infections and co-infections showed no significant differences in delivery before the 34th week of gestation (OR 0.66, 95% CI 0.36–1.22), gestational hypertension (OR 1.30, 95% CI 0.72–2.33), preterm premature rupture of membranes (OR 0.89, 95% CI 0.50–1.58), or Apgar score < 7 at five minutes (OR 0.53, 95% CI 0.20–1.36). The analysis of birth before the 37th week rate (five studies) showed an advantage for the mono-infections group (OR 0.83, 95% CI 0.78–0.89). Mono-infections showed lower rates of neonatal death (OR 0.83, 95% CI 0.78–0.89) and intensive care unit admission (OR 0.16, 95% CI 0.03–0.86).

Reproductive tract non-viral co-infections may exacerbate adverse neonatal outcomes compared to mono-infections. Future studies are needed to establish a more robust correlation between infections numbers and pregnancy outcomes.

To determine trends and predictors of cefdinir use for common pediatric infections in the United States.

Retrospective cohort study, 2016–2023.

U.S. outpatient encounters (ambulatory, emergency department, urgent care) included in the Medicaid MarketScan database.

Children aged 0–18 years diagnosed with bacterial rhinosinusitis, pharyngitis, urinary tract infection (UTI), acute otitis media (AOM), or community-acquired pneumonia (CAP).

We assessed cefdinir prescription rates by diagnosis and year, comparing to other commonly administered antibiotics. We used logistic regression to identify demographic predictors of cefdinir use.

Among 7,346,547 encounters, most common diagnoses were AOM (36.9%) and bacterial pharyngitis (36.2%). Patients were predominantly non-Hispanic White (53.0%), 1–5 years-old (41.1%), and seen in ambulatory settings (75.3%). Cefdinir was prescribed in 10.4% of encounters, ranking among the top prescribed antibiotics. After an initial increase, use declined post-2020 to 7.6%. In children 1–18 years-old, younger age was uniformly associated with higher odds of cefdinir prescription across all diagnoses. This pattern was inconsistent among infants <1 years-old across diagnoses but persisted for UTI, with ORs of 9.38 (95% CI, 8.91–9.88) for <1 years-old and 5.91 (95% CI, 5.76–6.06) for 1–5 years-old versus 15–18 years-old patients. NH Black patients and those seen in urgent care or the emergency department were less likely to receive cefdinir.

Despite a small decline in use since 2020, cefdinir use remains substantial, especially among young children with UTI. Continued efforts to reduce inappropriate use and promote antibiotic stewardship are warranted.

To investigate clinicians’ rationale for low-value ordering of urine cultures (UC).

Qualitative descriptive study.

A public tertiary acute hospital in New Zealand.

Doctors and nurses working in the Emergency Department, General Medicine, and General Surgery.

In-depth structured interviews were conducted with 18 doctors and 8 nurses. We analyzed the data using inductive thematic analysis focused on exploring the behavioral and psycho-socio-cultural influences behind ordering of low-value UC.

We generated four main themes encompassing patient and non-patient factors behind low-value testing. (1) In the grey zone: described patient presentations which were considered clinically ambiguous, such as undifferentiated infectious symptoms, delirium, communication challenges, and catheters. (2) The pressure to act: illustrated how the fear of uncertainty and expectations of patients and families, colleagues, healthcare systems, and hierarchies impacted clinician decision-making and defensive testing practices. (3) It depends on who you talk to: highlighted how inconsistent knowledge, communication, and perceptions of harm between individuals, services, and professions contributed to unnecessary tests. And (4) It’s just how we do things here: reflected dogma and inertia behind institutional conditions and a culture of over-testing. An additional theme, (5) Solutions to change the culture, explored participants ideas to improve UC ordering behaviors.

Diagnostic stewardship interventions to reduce low-value UC requests must address the multiple, often compounding, patient and non-patient factors that influence clinicians’ behavior.

Antimicrobial stewardship programs (ASPs) are difficult to implement in hospitals with limited access to infectious disease (ID) specialists. Electronic consultation–based tele-stewardship may offer a scalable solution; however, evidence regarding its implementation and impact remains limited. This study evaluated the impact of an eConsult-based remote antimicrobial stewardship program on antimicrobial consumption and resistance patterns.

Single-center retrospective observational study.

A 500-bed tertiary care hospital without on-site ID specialists.

In total, 27,863 patients were hospitalized.

An asynchronous eConsult-based tele-stewardship program using the ExpertTWIN system was implemented in February 2025. Data from February 2024 to January 2026 were analyzed using a Bayesian structural time-series model.

During the intervention period, 145 cases were reviewed. Carbapenem use decreased; use of antipseudomonal and narrow-spectrum agents showed evidence of increases, whereas use of anti-MRSA agents and total oral and intravenous antimicrobial use showed evidence of reductions. The incidences of carbapenem-resistant Pseudomonas aeruginosa, two-drug-resistant P. aeruginosa, and MRSA showed evidence of reductions, whereas third-generation cephalosporin-resistant Escherichia coli increased. Culture specimen submission showed evidence of an increase. There was no clear evidence of reductions in all-cause in-hospital mortality or length of stay. Total antimicrobial costs were unchanged.

The eConsult-based tele-stewardship program reduced carbapenem use and was associated with favorable changes in several antimicrobial-use, resistance, and diagnostic measures, although third-generation cephalosporin-resistant E. coli increased. No clear changes in clinical outcomes were observed. This model may offer a practical and scalable ASP strategy for hospitals without on-site ID specialists.

To evaluate the effect that discontinuing contact precautions for children with methicillin-resistant Staphylococcus aureus (MRSA) had on MRSA healthcare-associated infections (HAIs).

Retrospective, nonrandomized, observational, quasi-experimental study.

A large pediatric healthcare system including two tertiary children’s hospitals with level 4 neonatal intensive care units (NICUs).

Hospitalized children.

Contact precautions for children infected or colonized with MRSA was discontinued in October 2018. Prospective surveillance for MRSA HAIs was performed using standard definitions. Control charts monitored changes in annual MRSA HAI rates from 2014 to 2025. In March 2024, active surveillance cultures for MRSA were initiated in NICU A primarily for antibiotic stewardship purposes. MRSA nasal cultures were obtained upon admission and repeated every two weeks unless a patient was positive for MRSA. Healthcare-associated (HA) conversion was defined as a positive MRSA culture after one or more negative surveillance cultures.

Annual MRSA HAI rates/1000 patient days decreased for the System, Hospital A and Hospital B. Rates remained stable for NICU A and NICU B. Between March 2024 and December 2025, there were 1904 MRSA surveillance cultures from 682 patients in NICU A. Thirty-seven patients (5.4%) had a positive MRSA surveillance culture. HA conversion occurred in 21 patients (3.1%).

After seven years, discontinuing contact precautions for MRSA did not result in increased MRSA HAI rates in a large pediatric healthcare system. NICU MRSA HAI rates remained stable, and HA conversion of MRSA was low.

To evaluate antibiotic prescribing knowledge and confidence before versus after deployment of a web-based clinical decision support tool at an academic dental center.

Pre and post survey instrument.

Academic dental center in the United States.

Dental students, residents, and faculty.

Participants completed a series of seven clinical vignettes assessing their antibiotic prescribing knowledge and confidence using 5-point Likert scale questions pre (2022) and post (2025) deployment of a web-based educational tool. The survey questions included content about antibiotic prophylaxis and treatment for dental infections. Mean Likert scale responses were compared before and after deployment of the tool. The responses were analyzed individually, pooled, and stratified by training level. Sensitivity analyses were conducted comparing results between tool users and non-users.

Two hundred and thirteen participants completed the pretool deployment survey, and 116 participants completed the post survey. Respondents were slightly less likely to prescribe antibiotics after having access to the tool (median pooled 5-point Likert Scale score 2.55 vs 2.67; P = .07). However, antibiotic prescribing confidence did not change significantly (median pooled score 3.37 vs 3.24; P = .21). Stratified results showed substantial variability based on individual vignette. Self-reported users of the tool (n = 37) demonstrated no differences in knowledge versus non-users (n = 97; P = .76) but did demonstrate a trend toward more confidence in their decisions (P = .07).

Uptake of a web-based antibiotic prescribing tool was low overall and was not associated with any change in antibiotic prescribing knowledge and confidence. Additional interventions are needed to improve tool use in dental settings.

To evaluate outcomes in patients with ceftriaxone-non-susceptible, non-extended-spectrum beta-lactamases (ESBL), Enterobacterales bacteremia treated with carbapenem and non-carbapenem treatment options.

This pilot retrospective chart review evaluated adult patients admitted between January 2021 and November 2024 with a bacteremia caused by a non-ESBL, ceftriaxone-non-susceptible, piperacillin/tazobactam-sensitive, cefepime-sensitive, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, or Proteus mirabilis. Patients were stratified into 3 groups depending on the administered targeted treatment (cefepime or piperacillin/tazobactam vs carbapenem vs other).

Of the 76 patients who were screened, 40 patients were analyzed. There were 28 patients in the cefepime or piperacillin/tazobactam group, 8 patients in the carbapenem group, and 4 patients in the other antibiotics group. The median age of the cohort was 77 years, most patients were female, and 30% of patients were in septic shock. The most common source of infection was genitourinary (63%). Thirty-day mortality was 3.8% in the cefepime or piperacillin/tazobactam group, 14.3% in the carbapenem group, and 0% in the other antibiotic group (P = .611). There was no significant difference in any of the secondary outcomes.

In this pilot retrospective chart review, there was no difference between carbapenem and non-carbapenem treatment for ceftriaxone-non-susceptible, non-ESBL Enterobacterales bacteremia. Better understanding of the resistance mechanisms and collaboration with other healthcare systems to increase sample size may help assess optimal treatment of these organisms.