Rapid molecular testing for antimicrobial resistance (AR) provides an indication of resistance faster than phenotypic antimicrobial susceptibility testing. We summarize the adoption of molecular testing for AR among US acute care hospitals and discuss the potential impact on National Healthcare Safety Network’s surveillance for AR.

A systemwide electronic clinical decision support (CDS) tool for blood culture ordering reduced utilization by 12% across three hospitals (IRR 0.88, P < .01), but the effect waned over time. Low-yield ordering persisted, and contamination rates increased. Sustained diagnostic stewardship likely requires multimodal strategies beyond CDS alone.

We evaluated large language model (LLM)-based agents integrated with the electronic medical record to assess blood culture appropriateness. While sensitivity was high, specificity remained low. Performance was shaped by prompt phrasing, sycophantic behavior, and semantic triggers, reflecting both the potential and limitations of LLMs in real-world clinical decision support.

Respiratory virus surveillance varies widely between nursing homes (NHs) and is shaped by differences in staffing capacity, provider training, diagnostic resources, and facility-level protocols. CLIA-waived, point-of-care molecular testing devices were implemented as routine respiratory virus surveillance in 23 Medicare-certified U.S. NHs to evaluate feasibility.

Guidelines urge that infected fluid or tissue obtained during surgery be submitted for microbiologic study directly rather than via swab. A prospective study of operative specimens showed concordance in 64.7% of cases with better yield from abscess fluid, but swab cultures sometimes identified important pathogens missed by fluid culture.

The emergency department (ED) is a common site for respiratory viral surveillance, but air sampling has not been thoroughly explored in this setting. In this study, we observed a significant association between COVID-19, influenza A, and RSV detection via air sampling in an ED waiting room and clinical viral testing.

Across 13 surveys of 590 residents in seven ventilator-capable SNFs, residents in ventilator-designated beds had markedly higher ESBL (48.1% vs 28.2%; aOR = 1.64) and C. auris (38.6% vs 15.2%, aOR = 2.89), but lower MRSA colonization (35.2% vs 45.5%; aOR = 0.47), supporting the need for MDRO prevention beyond current Enhanced Barrier Precautions.

South Korean CRE notifications more than doubled between 2020 and 2024, with no inflection in the trajectory. Imipenem resistance in long-term care facilities reached 52.3% for Klebsiella pneumoniae and a 12.93-fold higher risk ratio than small/medium hospitals for Escherichia coli. Current surveillance cannot identify individual facility reservoirs, requiring structural reform.

Following a global 2024 blood culture bottle shortage, we implemented a multidisciplinary stewardship intervention to reduce utilization. Upon supply normalization in 2025, a durable 34.8% reduction in utilization was maintained without increasing sepsis-related mortality, demonstrating that crisis-driven shifts can successfully establish a sustainable “new steady state.”

Implementation of a 24-hour antimicrobial prophylaxis guideline for patients with delayed sternal closure significantly reduced broad-spectrum post-operative antimicrobial use without increasing surgical site infection risk in 75-patient cohort. The median duration of prophylaxis decreased from 120 to 45 hours, and surgical site infection rates were 3% pre-intervention versus 0% post-intervention.

This single center retrospective observational study of serial plasma metagenomic next-generation sequencing testing shows that >95% of serial testing was without meaningful clinical impact. Only 5/173 cases were adjudicated as having significant clinical impact.

By 2022, 96% of U.S. acute care hospitals reported having water management programs (WMPs). Hospitals with more ICU beds and greater infection prevention expertise were more likely to conduct water infection control risk assessments (WICRAs). Smaller, rural hospitals showed lower adoption of both WMPs and WICRAs, suggesting resource-based disparities in WMP implementation.

We describe an outbreak of hospital-acquired Legionella pneumonia in a hematology ward; a cold drinking water dispenser was identified as the source. Regular surveillance and provision of appropriate water quality to high-risk patients are critical, and hospitals should be aware of the risks associated with the use of these devices.

Timely blood cultures (BCx) are required by SEP-1. The recent BCx bottle shortage necessitated enhanced BCx stewardship. At two hospitals during the shortage, SEP-1 metric compliance declined related to BCx utilization. Review of cases where BCx were not obtained demonstrated most BCx were safely avoided without demonstrable patient harm.

Our quasi-experimental study at four Veterans Affairs Medical Centers evaluates whether clinician-centered education, audit, and feedback could reduce unnecessary preoperative urine cultures in asymptomatic neurosurgical, orthopedic, and vascular surgery patients. Urine culture rates decreased from 20.7% to 12.9% (P < .01), with orthopedic surgery showing the largest improvements (18.7% to 7.4%; P < .01).

We evaluated an endoscope surveillance culture program at a tertiary academic center from 2019–2024. Postreprocessing culture positivity was highest for esophagogastroduodenoscopy (25.9%). Carbapenem-resistant organism matches between endoscope and patient isolates occurred in 5% of positive cultures.

Approximately 30% of U.S. outpatient antibiotic prescriptions are unnecessary. Using 2016–2022 MarketScan data, this study assessed Missouri outpatient prescribing. Among several bacterial infections, 62.4% were inappropriate; antibiotics were prescribed for 18.3% of viral infections. Inappropriate prescribing was higher in rural areas. This method can assess regional condition-specific antibiotic stewardship targets.

Candida auris is an emerging, multidrug-resistant pathogen with limited perioperative prevention guidance. A poll of U.S. infectious diseases professionals revealed C. auris perioperative guidelines, preoperative screening, and antifungal prophylaxis was uncommon. 19% of respondents had encountered postoperative C. auris infections, highlighting a need for research and standardized prevention strategies.