Antibiotic resistance is a major global health threat, driven by inappropriate antimicrobial prescribing. Mobile health (mHealth)–based clinical decision-support systems (CDSS) may strengthen antibiotic stewardship, but evidence from resource-limited settings remains limited. This study reports the development and implementation of ComBact, an mHealth-based CDSS for seven infectious disease syndromes, examines physicians’ perceptions of its clinical utility, and evaluates system-level usability metrics at a private tertiary-care hospital in Pakistan.

A convergent parallel mixed-methods design was used. Semi-structured focus group discussions (FGDs) were conducted with internal medicine physicians who had access to ComBact for one year. Transcripts were analyzed using Braun and Clarke’s thematic framework. Quantitative analysis included system-generated data on user registration, uptake, and detailed usage metrics. Findings from both components were integrated using a joint display.

61 clinicians registered for ComBact, all accessing the dashboard at least once. The app recorded 134 sessions, with a mean of 1.23 pathway revisits per session and a mean workflow duration of 1 minute 25 seconds; 32.7% of users completed a ComBact plan. Mobile phones accounted for 57.4% of access and desktops for 42.6%. Two FGDs were conducted with fifteen physicians (median age 31 years (IQR: 27–34 yr). Five themes emerged: (1) clinical applicability, (2) user experience, (3) need of the app, (4) content limitations, and (5) recommendations.

ComBact was perceived as a user-friendly tool with meaningful potential to support antimicrobial stewardship in LMICs, though significant content and functional enhancements are needed.

This study evaluated whether treatment with oral step-down therapy compared with intravenous carbapenems alone for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli urinary tract infections (UTIs) impacted patient venous catheter days and clinical outcomes.

This multicenter retrospective study at six different hospitals in a large health system included adults (≥ 18 years) admitted for ≥ 24 hours with ≥ 1 documented UTI symptom, a ceftriaxone-resistant Escherichia coli urine culture, and receipt of ≥ 1 dose of meropenem or ertapenem between August 2022 and July 2025. The primary outcome was median venous catheter line days directly associated with antibiotic use inpatient and outpatient. Secondary outcomes included pharmacist antibiotic intervention, incidence of antibiotic-related adverse events, hospital length of stay, duration of therapy, inpatient catheter line days, projected outpatient catheter line days, presence of peripherally inserted central catheter or midline, central line-associated bloodstream infection, and treatment failure (defined as escalation of antibiotics, in-hospital mortality, urgent care/emergency department visit or readmission, or recurrence of symptomatic UTI with ESBL Escherichia coli within 30 days).

120 patients were included, with 60 in the oral step-down and carbapenem groups, respectively. Primary outcome of median venous catheter days in the oral step-down group was 0 (IQR 0–0) vs 5 (IQR 0–7) in the carbapenem group, p < .001. Secondary outcome of treatment failure in the oral step-down group was 2 (3%) vs 8 (13%) in the carbapenem group, p < .09.

Oral step-down therapy for ESBL Escherichia coli UTIs was associated with a significant reduction in venous catheter line use.

This objective of this study is to evaluate the impact of a prospective, pharmacist-driven restriction protocol on the appropriateness of IV vancomycin use in a community hospital setting.

This single-health system, multi-site, quasi-experimental study compared pre-intervention (January–March 2024) and post-intervention (January–March 2025) groups. The intervention was a mandatory pharmacist-driven protocol requiring review of every empiric vancomycin order against pre-defined, evidence-based criteria. Inappropriate orders were proactively discontinued, and providers were notified with supporting rationale. The primary outcome was the percentage of appropriate empiric vancomycin orders, assessed by chart review of 100 random patients per group. Key secondary outcomes included vancomycin days of therapy per 1,000 patient days and trough levels ordered per 1,000 patient days.

Analysis of 200 patients (100 per group) showed that the appropriateness of empiric IV vancomycin orders significantly increased from 55% pre-intervention to 97% post-intervention (P < .001). Days of therapy per 1,000 patient days decreased from 69.3 to 64.2 (P < .041), and vancomycin trough levels ordered per 1,000 patient days decreased by 41% (52.3 vs. 31.1, P < .001). Crucially, no significant differences were observed in 30-day mortality, suggesting the improvements were achieved without compromising patient safety in patients who received vancomycin.

Implementation of a prospective, pharmacist-driven empiric IV vancomycin restriction protocol offers a practical, effective strategy for institutions seeking to increase appropriateness of empiric IV vancomycin orders.

Community-acquired pneumonia (CAP) is a major cause of hospitalization, and pathogen identification is often limited by low diagnostic yield of conventional microbiological methods. Respiratory multiplex PCR (mPCR) enables rapid pathogen detection, but its role in antimicrobial treatment modification for inpatients with CAP remains unclear. This study evaluated the association between mPCR testing and antimicrobial modification in hospitalized patients with CAP.

This retrospective, single center cohort study included hospitalized patients with CAP identified using ICD-10 codes between July 2023 and February 2025. Respiratory mPCR was performed within the first 24 hours of admission using combined nasopharyngeal/oropharyngeal (NP/OP) swabs. The primary outcome was antimicrobial treatment modification guided by mPCR results and documented by physicians. Secondary outcomes included antimicrobial de-escalation and hospital length of stay.

In this cohort of 145 patients, mPCR detected a pathogen in 56 patients (38.6%): viral pathogens in 30 (20.7%) and bacterial pathogens in 26 (17.9%). Overall antimicrobial treatment was modified in 54 patients (37.2%). Modification guided by mPCR results and documented by physicians occurred in 37 patients (25.5%). Among these 37 modifications, 35 (94.6%) were classified as antimicrobial de-escalation. Hospital length of stay did not differ significantly across mPCR results.

In hospitalized patients with CAP, mPCR facilitates targeted antimicrobial treatment modification and drives high rates of de-escalation. These findings demonstrate the significant utility of mPCR in optimizing clinical decisions and enhancing antimicrobial stewardship.

Candidozyma auris, Candida glabrata, and C. krusei are all fungal pathogens intrinsically resistant to azoles. Patient characteristics and outcomes were compared for patients with cultures positive for these three pathogens.

A retrospective cohort study was performed involving patients from an 11 acute care safety net hospital system in New York City. Echinocandin susceptibility rates and patient outcomes, including overall mortality and lengths of hospital stay, were compared for patients with C. auris versus C glabrata/krusei.

Resistance to caspofungin was low in all three pathogens. Compared to patients with C. glabrata/C. krusei, patients with C. auris had similar mortality rates. However, compared to patients harboring C. glabrata/C krusei, those with C. auris had longer hospital stays when discharged to a skilled nursing facility, including from the time from culture positivity to discharge (78 ± 148 vs 33 ± 44 d, P = .06). Multivariate regression analysis revealed two factors associated with length of stay: presence of C. auris (P < .001) and hemodialysis (P = .051).

Echinocandin resistance was unusual, and overall mortality rates were similar, for patients with C. auris, C. glabrata, and C. krusei. However, for patients discharged to skilled nursing facilities, the length of hospital stay was longer for patients with C. auris. The implementation of lifelong contact precautions for C. auris may be an impediment for discharge planning.

This study addresses treatment of intra-amniotic infection (IAI) by comparing timely receipt of recommended antibiotic administration between cefoxitin and traditional antimicrobial therapy, ampicillin and gentamicin, with or without clindamycin.

This retrospective cohort study was conducted at a large, multi-site health system. The combination therapy group treated with ampicillin plus gentamicin, with or without clindamycin from June 2022 to May 2023, was compared to patients treated with cefoxitin from June 2023 to May 2024, following an institutional guideline update.

Pregnant individuals aged 16 and older with diagnosed or presumed IAI were included.

Three hundred patients were included, 150 each in both the combination therapy and cefoxitin groups. Baseline characteristics were similar between the combination therapy and cefoxitin patients. Vaginal delivery was the most common mode of delivery, and rates of cesarean delivery were similar between groups. Most patients had a negative group B Streptococcus screen. Timely receipt of antimicrobials within 60–90 minutes of order entry occurred in significantly more patients in the cefoxitin group compared to combination therapy group (69.3% vs 4.7%, P < .001). Time to recommended therapy was significantly shorter in the cefoxitin group (76.4 ± 93.3 vs 183.7 ± 228.9 min, P < .001). There were no differences in mortality, 30-day infection-related readmission, or need for additional surgical/procedural intervention.

Cefoxitin for IAI significantly improves timeliness of recommended antibiotic treatment, aligning with current guideline recommendations for prompt therapy. The absence of differences in secondary outcomes supports the clinical efficacy of cefoxitin and its consideration as a first-line agent in the management of IAI.

To assess and compare the incidence, timing, and severity of hepatotoxicity associated with prophylactic isavuconazole and posaconazole in patients with hematologic malignancies or a history of hematopoietic stem cell transplant (HSCT).

Retrospective cohort study.

Large academic tertiary-care center.

Hospitalized adult patients with hematologic malignancies or a history of HSCT who received posaconazole or isavuconazole for antifungal prophylaxis between August 2015 and August 2024.

The primary outcome was the incidence of hepatotoxicity, defined by elevations in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), or bilirubin. Secondary outcomes included time to hepatotoxicity, severity grading per Common Terminology Criteria for Adverse Events (CTCAE) v5.0., and causality assessment using the Naranjo Adverse Drug Reaction Probability Scale.

A total of 154 patients were included (100 receiving posaconazole, 54 receiving isavuconazole). Hepatotoxicity occurred in 17% of the isavuconazole group and 7% of the posaconazole group (P = .06), with all events classified as mild. The median time to hepatotoxicity was longer for isavuconazole (96 vs. 15 days, P = .16). Survival analysis showed no significant difference in time to hepatotoxicity between groups (P = .07). Most hepatotoxic events were classified as “possible” according to the Naranjo Scale.

In this retrospective analysis, no statistically significant difference in hepatotoxicity incidence was observed between isavuconazole and posaconazole for prophylaxis. Larger prospective studies are needed to confirm these findings and further define the hepatic safety profiles of these antifungal agents.

To evaluate the practices, barriers, and facilitators related to antimicrobial stewardship (AMS) in community pharmacies (CPs).

Cross-sectional study

CPs in Uyo, Akwa Ibom State, Nigeria

One hundred and twelve pharmacists working in CPs, who had been practicing for at least six months and gave informed consent to participate, were surveyed.

Potential participants were approached at their CPs during working hours and the study’s objectives explained to them. Data were collected using a 31-item self-administered questionnaire from October to November 2023 and analyzed with SPSS version 25.0.

Participants were predominantly male (61.6%). Eighty-seven (77.7%) indicated that they often/always encourage patients to run a culture/sensitivity test before taking antibiotics. Most (95.5%) indicated that their choice of antibiotics is based on such results. The most frequently cited barriers to implementing AMS in CPs were limited access to patient records (93.8%), unrestricted patient access to antimicrobials without a prescription (90.1%), and physicians’ resistance to pharmacists intervening in antibiotic selection (58.0%) or the dose/duration of prescribed antibiotics (50.9%). The most commonly reported facilitators of AMS were increased availability of pharmacy education programs on AMS (92.9%), improved access to patients’ clinical/laboratory data (88.4%), improved collaboration with physicians in hospitals (85.7%), and public awareness initiatives emphasizing the role of community pharmacists in AMS (85.7%).

Participants reported generally favorable AMS practices. However, tailored AMS education programs for pharmacists and the general public, along with stronger collaboration between pharmacists and physicians and between CPs and hospitals are recommended.

(1) identify risk factors for extended-spectrum beta-lactamase Klebsiella pneumoniae (ESBL-KP) acquisition in the neonatal intensive care unit (NICU) and (2) evaluate the clinical impact of ESBL-KP acquisition on neonatal outcomes at NICU discharge.

This retrospective case–control study (Aug 2022–Sept 2025) compared neonates who acquired ESBL-KP in the NICU (cases) with those who did not (controls).

600 neonates admitted to a Kuwaiti NICU located in a general hospital.

Data included clinical, demographic, antibiotic, and laboratory records. The primary outcome was ESBL-KP acquisition. The secondary outcome was status at NICU discharge. Regression analysis was used to evaluate associations for the primary and secondary outcomes.

Of 600 neonates, 30% acquired ESBL-KP. Among these, 12% had bloodstream infections (BSIs). Length of NICU stay (OR:1.02, 95% CI:1.01–1.03), intrauterine growth restriction (IUGR) (OR:2.59, 95% CI:1.08–6.24), extreme-prematurity (OR:2.89, 95% CI:1.29–6.47), previous hospital admission (OR:4.45, 95% CI:1.75–11.32), and prior ampicillin use (OR:3.51, 95% CI:2.12–5.82) were statistically significant risk factors for acquisition of ESBL-KP in the adjusted regression model. Moreover, ESBL-KP-positive neonates faced 12.83 times greater odds of death from sepsis (95 % CI: 2.41–68.22), than ESBL-KP negative neonates.

ESBL-KP acquisition was strongly linked to IUGR, extreme prematurity, previous admission, and ampicillin use. While a longer hospital stay correlated with acquisition, this relationship is prone to time-dependent bias and reverse causation. Acquisition also raised sepsis-related mortality risk, though small sample sizes require cautious interpretation. Targeted prevention is essential to improve neonatal outcomes.

Antibiotic overuse in community-acquired pneumonia (CAP) persists despite guidelines recommending 5-day treatment for uncomplicated cases. Our pilot quality improvement study aimed to address this problem via an antibiotic stewardship initiative.

Adults admitted to a tertiary care center with uncomplicated CAP were identified using database query and manual chart review, with exclusions for intensive care needs, lack of clinical improvement, or concurrent infections. A 3-month baseline period was compared to a 3-month post-intervention period after provider-targeted interventions were implemented—in-person and email-based provider education on eligibility for the 5-day antibiotic course and pharmacist-driven outreach on day 3 of treatment to encourage guideline-based prescribing. Mean antibiotic duration was compared using Mann–Whitney test. The primary goal was to decrease antibiotic overuse by 25%.

Of 647 baseline patients, 222 met criteria with a mean antibiotic duration of 6.75 ± 1.75 days. After the interventions, 170 of 570 patients met criteria with a reduced antibiotic duration of 6.24 ± 1.47 days (P = .001). The antibiotic overuse decreased by 28.7%. Prolonged courses were primarily due to habitual use of traditional longer regimens, unaccounted inpatient or emergency department doses at discharge, and discrepancies between documentation and medication orders.

Our pilot study showed that a provider-focused pharmacist-driven strategy can reduce unnecessary antibiotic use in uncomplicated CAP. The intervention encouraged shorter, guideline-driven courses and reduced antibiotic overuse by 28.7%, meeting our primary goal of 25% reduction. Nevertheless, there are opportunities for further improvement in guideline adherence through enhanced discharge prescription stewardship, documentation accuracy checks, and continued provider education.

To detail the impact of transitioning from intravenous piggyback (IVPB) to intravenous push (IVP) antibiotics on median time from sepsis identification to antibiotic administration (minutes), proportion of septic patients who received antibiotics within 60 and 180 minutes of sepsis identification, and Emergency Department (ED) length of stay (LOS).

Retrospective chart review.

Urban, acute-care hospital.

394 patients received IVPB antibiotics (June 2022–June 2023) and 421 patients received IVP antibiotics (June 2023–June 2024), identified through sepsis-related ICD-10 codes, systemic inflammatory response syndrome (SIRS) criteria, and other clinical indicators.

Chart reviews were conducted to obtain sepsis identification and antibiotic administration start times. Statistical process control was used to monitor trends and assess process consistency over time.

Following our intervention, median time from sepsis identification to antibiotic administration decreased from 132 minutes (IQR 70, 194) in the IVPB group to 99 minutes (IQR 56,164) in the IVP group (P < .001). The proportion of patients who received antibiotics within 60 minutes of sepsis identification increased from 20.3% to 28.0% (P = .01) and within 180 minutes increased from 70.8% to 79.8% (P = .003). ED LOS decreased from 397 minutes with IVPB to 369 minutes with IVP (P = .004). A sustained downward shift of twelve consecutive months of mean sepsis identification to antibiotic administration start time below the pre-intervention centerline was observed.

IVP antibiotics were associated with decreased median time from sepsis identification to antibiotic administration for septic patients, increased adherence to practice guidelines, and reduced ED LOS.