Piperacillin-tazobactam (TZP) is widely used empirically in Danish hospitals despite guideline restrictions, making it an important target for antimicrobial stewardship (AMS). The aim of this study was to evaluate the impact of a multi-disciplinary AMS programme on TZP use, prescribing quality and clinical safety outcomes at a Danish university hospital. A prospective, quasi-experimental study using interrupted time series (ITS) and two hospital-wide point prevalence surveys (PPS; 2021 and 2023) was conducted from January 2022 to December 2024. The AMS programme, introduced in January 2023, included prospective audit and feedback, education and monthly department-level reports. Days of therapy (DOT)/1,000 bed-days assessed antimicrobial trends. Logistic regression analysed guideline adherence and prescribing quality indicators; Poisson regression assessed changes in proportional DOT. Among 156,035 admissions, 92,346 (59.2%) occurred in AMS-implementing departments. TZP use decreased by 19.5% (95% confidence interval [CI]: -25.5 to -13.5%; P < 0.001) but increased by 26.7% in non-AMS departments (95% CI: 18.6-34.9%; P < 0.001). Benzylpenicillin, ampicillin and aminoglycoside use increased by 14.2%, 20.2% and 36.4%, respectively, in AMS wards. PPS findings (N = 262) showed improved guideline adherence (odds ratio [OR]: 2.32, 95% CI: 1.38-3.90), documentation of indication (OR: 3.06), treatment planning (OR: 9.83) and reassessment within 72 h (OR: 2.52). Thirty-day readmission decreased from 11.6% to 10.2% (P = 0.0001), while in-hospital mortality remained unchanged (6.0% vs 6.1%; P = 0.962). A multi-disciplinary AMS programme was associated with reduced TZP use and improved prescribing quality in participating departments without adverse effects on safety indicators. These findings support AMS as an effective strategy to optimise antibiotic use.

Antimicrobial stewardship is essential to tackle antimicrobial resistance, particularly in veterinary practice where antimicrobials of high importance for human health require careful oversight. This study assessed prescribing patterns and concordance with FECAVA recommendations for prudent antimicrobial use across common clinical scenarios, providing a Europe-wide framework for responsible antimicrobial prescribing in companion animals. A cross-sectional survey was conducted among veterinarians in Portugal (October 2019-January 2020), covering 11 clinical scenarios and 18 therapeutic options, including 'no antimicrobial therapy'. Descriptive, inferential, and cluster analyses were performed. Among 416 respondents, amoxicillin-clavulanic acid (27.4%) and fluoroquinolones (13.8%) were most frequently chosen. Six prescribing clusters were identified: Cluster D (33.2%) was the largest, followed by Clusters C (23.3%) and F (22.1%). Younger veterinarians (<42years) were more likely to belong to Cluster A (p<0.001). Clusters A and F frequently selected 'no antimicrobials,' whereas Cluster B predominantly relied on amoxicillin-clavulanic acid and aminoglycosides. Concordance with FECAVA recommendations was highest in Cluster A and lowest in Cluster B. Importantly, consensus across clusters was observed for post-operative prophylaxis, wound treatment, and osteomyelitis, where prescription patterns aligned with FECAVA guidance. Limitations include potential recall and social desirability bias inherent to self-reported data, and the hypothetical scenarios did not account for case severity or previous antimicrobial exposure. Six distinct prescribing profiles were identified, with broad-spectrum antimicrobials frequently selected. The variability in antimicrobial prescription recommendation between the profiles underscores the need for targeted antimicrobial stewardship interventions to strengthen adherence to guidelines in companion animal practice.

Early identification of high-risk individuals is essential to guide infection-prevention strategies and optimize antibiotic stewardship in this vulnerable population. To identify independent risk factors associated with hospital-acquired infections in elderly ICU patients following antibiotic use and to develop and internally validate a clinical risk prediction model for early infection detection. A retrospective cohort study was conducted in the ICU of Nanjing First Hospital, Nanjing Medical University. A total of 120 patients aged ≥65 years, with ICU stay >48 hours, no documented infection at ICU admission and antibiotic exposure within 48 hours before or at ICU admission were included. Demographic data, comorbidities, Sequential Organ Failure Assessment (SOFA) scores, antibiotic exposure characteristics, invasive device use and nutritional support were collected from electronic health records. Hospital-acquired infections occurred in 46 patients (38.3%). Independent predictors included advanced age (odds ratio [OR] 1.08 per year), higher SOFA score (OR 1.25 per point), diabetes mellitus (OR 1.45), chronic kidney disease (OR 1.65), use of central venous catheters (OR 1.75), mechanical ventilation (OR 1.85), Foley catheterization (OR 1.55), broad-spectrum antibiotic use (OR 1.50), longer antibiotic duration (OR 1.20 per day) and prolonged ICU stay (all p<0.05). The prediction model demonstrated good discrimination (AUC-ROC = 0.82), which improved slightly after variable refinement (AUC-ROC = 0.83). Cross-validated performance remained robust (AUC = 0.80). A multivariable risk prediction model using routinely available clinical parameters demonstrated good internal validity and may assist clinicians in early identification of high-risk patients, enabling targeted infection prevention and improved antibiotic stewardship.

Real-world laboratory functionality requirements and implementation considerations for fast phenotypic antimicrobial susceptibility testing.

A comprehensive review of resistome profiles in ocular pathogens: Insights into Pseudomonas aeruginosa and emerging resistance trends.

Modeling multidrug resistance in Campylobacter coli and Campylobacter jejuni isolated from swine at U.S. slaughter plants.

Antibiotic (AB) resistance is a global health threat, particularly in resource-limited settings like Yemen. Antibiotics misuse, especially in hospitals, is the most important risk for resistance development. Understanding empirical AB use and susceptibility patterns among inpatient settings is crucial for implementing effective antimicrobial stewardship. To evaluate Empirical Antibiotic Therapy (EAT), resistance patterns, and their impact on hospitalized patients' outcomes. A prospective cross-sectional study was conducted in medical and surgical wards in a tertiary hospital over 2 months, including 80 adult patients for analysis. The patient-level data on antibiotic prescriptions, culture results, patient demographics, clinical characteristics, and treatment outcomes, were collected manually and from computer records. An ethical approval was obtained, and SPSS app was used in analyzing the data. EAT was alarmingly high (98%), often mismatched susceptibility patterns, coupled with high percentage (68.3%) of negative culture results. The most commonly prescribed antibiotics were Ceftriaxone, Vancomycin, Levofloxacin, Meropenem, Imipenem/Cilastatin, and Metronidazole. Significant resistance (>50%) was observed against Moxifloxacin, Clindamycin, and all tested beta-lactam agents except Cefuroxime (42%). Appropriate EAT was associated with good prognosis, P=.029 (Fisher's Exact Test), and Ceftriaxone use was associated with poorer prognosis, P=.017 (X 2 Test). The study highlights a notable misuse of EAT coupled with high resistance rate in hospital. These findings underscore the need for effective interventions to optimize antibiotic use and mitigate the growing threat of resistance in Yemen. Strategies such as enhanced diagnostic capabilities, improved stewardship programs, and rational prescribing practices are essential to improve patient outcomes and preserve the effectiveness of antibiotics.

Molecular analysis of carbapenemase-producing Pseudomonas aeruginosa strains in a tertiary care hospital in Riyadh.

Burn wound infections pose a major challenge in both critical care and surgical settings, owing to the complex interplay of host immune dysfunction, altered pharmacokinetics, surgical wound dynamics, and the high prevalence of multidrug-resistant (MDR) organisms. This review summarizes current evidence on diagnosis, antimicrobial therapy, and multidisciplinary management of burn wound infections, highlighting common pitfalls and strategies to mitigate them. Burn patients display a distinct microbiological profile that evolves over time: Gram-positive cocci initially predominate, whereas nonfermenting Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter baumannii become increasingly prevalent during hospitalization. Differentiating colonization from infection remains a major diagnostic challenge. Although tissue biopsy is the gold standard for confirming wound infection, it is not uniformly implemented across centers. Therefore, a comprehensive clinical and microbiological evaluation involving infectious disease specialists, intensivists, and surgeons is essential for accurate interpretation of wound status. Antimicrobial stewardship interventions, including pharmacokinetic/pharmacodynamic optimization, therapeutic drug monitoring, carbapenem-sparing regimens, shorter antibiotic courses, and avoidance of redundant combination therapies, are key components of burn infection management. New agents, such as β-lactam/β-lactamase inhibitor combinations and novel tetracyclines, show promise against MDR nonfermenting Gram-negative pathogens. A structured, multidisciplinary team offers the most effective framework for improving outcomes in burn wound infections. Optimizing diagnostics, individualizing antimicrobial therapy, and aligning surgical timing with infection control measures are fundamental pillars. Future research should focus on prospective validation of integrated care pathways and on evaluating the real-world effectiveness of novel antimicrobial agents in burn-injured patients.

Prevalence and dynamics of quinolone and macrolide resistance in hospital wastewater: insights from Kathmandu Valley, Nepal.

Blinatumomab has transformed the treatment of pediatric B-acute lymphoblastic leukemia (B-ALL). However, it presents distinct operational challenges for administration given it is delivered as a continuous infusion and has unique toxicities. The objective of this project was to develop, implement, and evaluate a standardized institutional protocol for blinatumomab administration to optimize safety, efficiency, and patient experience. This quality improvement (QI) initiative was conducted at The Hospital for Sick Children, Toronto, Canada. A multidisciplinary Blinatumomab Working Group developed harmonized standards across five domains: (1) caregiver education, (2) fever management, (3) nursing-led assessments, (4) infusion interruption management, and (5) use of 7-day infusion bags. Patients receiving blinatumomab for upfront therapy or for relapsed disease between July 2024 and August 2025 were included. Demographic and clinical data were extracted from the institutional data warehouse. Outcomes included rates of caregiver education completion, antibiotic use during blinatumomab initiation, and completion of nursing-led assessments. Fifty-three patients received standard of care blinatumomab. All eligible caregivers (100%) completed standardized education. The rate of empiric antibiotic use during blinatumomab initiation decreased from 68% to 22% following adoption of selective antibiotic initiation without increased readmission, or prolonged stay. Nursing assessment completion was 95% for inpatients and 81% for outpatients. Infusion interruptions were managed using a standardized, risk-based algorithm without observed safety events. Implementation of multidisciplinary, standardized blinatumomab administration protocols was feasible and safe. These processes improved antibiotic stewardship, empowered nursing-led care, and reduced practice variability. This framework may inform best practices for the safe and efficient delivery of blinatumomab in other pediatric oncology centers.

Background: Pathogenic Escherichia coli (PEC) is a leading cause of acute diarrhea worldwide. With increasing antibiotic use, antimicrobial resistance in PEC has become a significant public health concern. In this study, we investigated the distribution and antimicrobial susceptibility patterns of PEC isolated from patients with acute diarrhea in the Busan and Gyeongnam regions of South Korea. Methods: In this retrospective cross-sectional laboratory-based study, 272 PCR-positive residual stool or rectal swab specimens collected between October 2023 and June 2024 were screened; after exclusion of 80 specimens without recoverable or confirmable isolates, 192 pathogenic E. coli isolates were included for pathotype identification and antimicrobial susceptibility testing. Pathotypes were identified using multiplex real-time polymerase chain reaction, and antimicrobial susceptibility was tested against 18 agents using the VITEK II system. Results: Enteroaggregative E. coli (EAEC) was the most prevalent pathotype (44.8%), followed by enteropathogenic E. coli (34.9%). High resistance rates were observed for ampicillin (77.1%), cefazolin (55.2%), and amoxicillin/clavulanic acid (44.3%). EAEC demonstrated the highest multidrug resistance (MDR) rate (34.9%). Pediatric patients (&lt; 18 years) exhibited significantly higher resistance rates and MDR frequencies compared with adults, particularly against β-lactam antibiotics. Conclusion: EAEC was identified as the predominant and most resistant pathotype in this region. The elevated resistance levels in children and the prevalence of MDR EAEC underscore the need for continuous local surveillance and appropriate antibiotic stewardship.

Carbapenems are essential antibiotics used to treat severe nosocomial infections. However, the misuse of these antibiotics has led to the emergence of carbapenem-resistant organisms (CROs), posing significant public health threats. This study aims to determine the prevalence and phenotypic profile of carbapenem resistance (CR) in multidrug-resistant Gram-negative bacteria (MDR-GNB) in selected healthcare facilities in the United Arab Emirates (UAE). A retrospective study was conducted across 65 healthcare facilities in Dubai and the Northern Emirates (NE) from January 2018 to June 2021. Results from GNB isolates - including Enterobacterales, Acinetobacter, and Pseudomonas aeruginosa- obtained from various clinical samples were collected and assessed for CR using CLSI guidelines at all locations. MDR-CRO prevalence was calculated within each bacterial group using total isolates of that group as the denominator at each time point. Of the 77,228 GNB collected, 3,829 (5%) MDR-CROs were identified. Within the MDR-CROs subset, Enterobacterales accounted for 65.8% (48.7% of which were Klebsiella pneumoniae), P. aeruginosa 28.6%, and Acinetobacter 5.6%. In contrast, period prevalence calculated within total isolates of each organism group was highest for MDR-CR Acinetobacter (22.8%), followed by MDR-CR P. aeruginosa (12.9%), and MDR-CR Enterobacterales (5.6%). A significant increase in MDR-CR Acinetobacter was observed in the NE in mid-2021, which coincided with the COVID-19 pandemic. Hospitals were the primary source of MDR-CR isolates, accounting for more than 90% of Acinetobacter and P. aeruginosa cases, and 62.6% of Enterobacterales cases. Carbapenems nonsusceptibility varied among bacterial species. This study highlights the increasing CR burden of Acinetobacter, P. aeruginosa, and K. pneumoniae in the UAE. Regional variations in resistance, particularly the MDR-CR Acinetobacter surge in the NE during the COVID-19 pandemic, stress the need for tailored infection control measures and antimicrobial stewardship.

Antimicrobial resistance (AMR) poses a rapidly growing threat to global health, with low- and middle-income countries (LMICs) bearing a disproportionate burden. These LMICs face challenges such as weak health system governance, limited diagnostic capacity, undertrained workforces, and poorly regulated antibiotic markets that drive inappropriate antimicrobial use and accelerate AMR. In settings where over-the-counter antibiotic sales remain widespread and empirical treatment is a routine, AMR undermines treatment effectiveness and increases preventable morbidity and mortality. If left unaddressed, AMR is predicted to result in 10 million deaths per year by 2050. Combating AMR in LMICs requires a comprehensive approach: strengthening healthcare systems, enforcing prescription-only policies, raising public health awareness, and fostering collaboration between governments, non-governmental organisations, and international stakeholders. Priority actions include regulating informal pharmaceutical markets, embedding antimicrobial stewardship within primary care, expanding access to basic diagnostics, and using digital health tools to support prescribers and patients. Drawing on regional LMIC experiences, this viewpoint highlights practical pathways for aligning health system reform with AMR containment.

Background and Aim: Escherichia coli is a common intestinal commensal in poultry, but avian pathogenic E. coli (APEC) strains can cause colibacillosis and pose zoonotic risks due to genetic similarities with human extraintestinal pathogenic E. coli (ExPEC). Quails sold in traditional markets may serve as reservoirs for multidrug-resistant (MDR) and virulent strains, yet data from Indonesia are limited. Iron acquisition systems, such as the iroN gene encoding the salmochelin siderophore receptor, are critical virulence determinants in APEC, enabling survival in iron-limited host environments and potentially linking to antimicrobial resistance (AMR). This cross-sectional laboratory-based study aimed to detect MDR E. coli from quail cloacal swabs in Surabaya's traditional markets and screen MDR isolates for the iroN gene, highlighting market level risks within a One Health framework. Materials and Methods: From November to December 2024, 150 cloacal swabs were collected from quails across five traditional markets (Turi, Bratang, Cemara Pabean, Kupang, and Benowo) in Surabaya, Indonesia. Samples were enriched in buffered peptone water, streaked on eosin methylene blue agar and MacConkey agar, and confirmed as E. coli via Gram staining and biochemical tests (Triple Sugar Iron Agar, Simmons Citrate Agar, Sulfide Indole Motility, and Methyl Red–Voges Proskauer). Antibiotic susceptibility was assessed using the Kirby–Bauer disk diffusion method on Mueller–Hinton agar against aztreonam (ATM 30 μg), ciprofloxacin (CIP, 5 μg), tetracycline (TE, 30 μg), kanamycin (K, 30 μg), and chloramphenicol (C, 30 μg), interpreted per Clinical and Laboratory Standards Institute M100 (2023) guidelines. MDR was defined as resistance to ≥3 antibiotic classes. MDR isolates underwent polymerase chain reaction for iroN detection. Results: E. coli was isolated from 148/150 samples (98.7%), with 100% positivity in Turi, Bratang, and Cemara Pabean markets. Resistance rates were highest to C (33.1%), followed by TE (22.3%), ATM (13.5%), K (6.1%), and C (4.7%). Four isolates (2.7%) were MDR, distributed in Turi (1), Cemara Pabean (2), and Kupang (1). MDR patterns included ATM/CIP/TE (two isolates), ATM/CIP/K (one), and ATM/CIP/TE/K/C (one). All four MDR isolates were positive for iroN, indicating a 100% association in this subset. Conclusion: Quails in Surabaya's traditional markets harbor prevalent E. coli with notable AMR, including MDR strains carrying the iroN virulence gene, underscoring their role as potential APEC reservoirs. This convergence of resistance and virulence highlights zoonotic and public health risks, necessitating enhanced AMR surveillance, market hygiene, and antibiotic stewardship under One Health principles. Future studies should explore genomic mechanisms and transmission pathways. Keywords: antimicrobial resistance, avian pathogenic Escherichia coli, E. coli, traditional markets, iroN virulence gene, polymerase chain reaction, public health.

Mycoplasma pneumoniae (MP) and respiratory syncytial virus (RSV) contribute to 15%-30% of pneumonia cases in China, yet lack rapid diagnostics. We evaluated a molecular point-of-care testing (mPOCT) system for detecting these pathogens versus RT-qPCR. Oropharyngeal swabs from 549 patients (269 MP-suspected, 280 RSV-suspected) collected prospectively (Dec 2023-Aug 2024) were tested by RT-qPCR and mPOCT (EasyNAT). RT-qPCR positivity was defined as Ct ≤ 40, as per the kit manufacturer's instructions. Diagnostic accuracy was assessed via sensitivity, specificity, and Cohen's kappa. For MP detection (n = 269), mPOCT showed 97.25% sensitivity (95% CI: 91.57%-99.29%) and 98.75% specificity (95% CI: 95.09%-99.78%) with kappa = 0.96. For RSV (n = 280), sensitivity was 96.72% (95% CI: 91.31%-98.94%) and specificity 100% (95% CI: 97.04%-100%) with kappa = 0.97. Age-stratified analysis (pediatric/adult) maintained kappa > 0.90 for both pathogens. Co-infections occurred in 12.8% (14/109) of MP-positive and 17.2% (21/122) of RSV-positive samples, with > 95% mPOCT concordance except one influenza A-discordant case. The mPOCT system demonstrated high diagnostic accuracy comparable to RT-qPCR for MP/RSV detection, with rapid results (< 30 min). Its reliability across age groups and complex co-infections supports clinical utility for timely treatment decisions and antibiotic stewardship.

To compare clinical outcomes for patients with a positive urine culture who were prescribed antibiotics vs those who were not prescribed antibiotics, as determined by pharmacist-conducted symptom evaluation via an outpatient culture follow-up program. This retrospective cohort study included adult female patients with a positive urine culture collected at an emergency department (ED) or urgent care (UC) visit who were contacted by a pharmacist for follow-up and symptom assessment. Patients with urinary symptoms had antibiotic therapy initiated or changed (standard of care [SOC]); however, patients without symptoms did not receive a new antibiotic prescription (intervention). The primary objective was to compare treatment for symptomatic urinary tract infection within 30 days of follow-up between the groups. Secondary objectives included evaluating pharmacist workload and comparing adverse events and Clostridioides difficile infection within 30 days between the groups. A total of 214 patients were included (97 in the SOC group and 117 in the intervention group). At their initial visit, 83.5% of patients in the SOC group reported urinary symptoms vs 53% of patients in the intervention group (P < 0.001). Empiric antibiotic prescribing was similar between the groups (SOC, 37.1%; intervention, 25.6%; P = 0.392). There was no difference in treatment of symptomatic urinary tract infection within 30 days of follow-up (SOC, 14.4%; intervention, 11.1%; P = 0.466). Follow-up occurred on average 2.5 days after discharge, requiring a median of 1 contact attempt and 15 minutes to conduct the call and documentation. Our findings support nonprescribing of antibiotics at follow-up for asymptomatic patients, despite a positive urine culture, as an appropriate stewardship intervention for ED and UC patients to prevent unnecessary antibiotic exposure.

Community-acquired pneumonia (CAP) remains a significant global health challenge. This review summarizes the major advances in clinical research or CAP between October 1, 2024, and September 30, 2025. Given the high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in China, PCR test for MRMP was recommended in pediatric patients to guide appropriate antibiotic selection. Increased attention is warranted for respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) due to their increasing prevalence and poor prognosis. PSI and CURB-65 scores remain the reliable tools for assessing the severity of CAP, while the SOFA-2 score may offer a promising approach for identifying patients requiring intensive care unit (ICU) admission. Although multiplex PCR (mPCR), targeted next-generation sequencing (tNGS), and metagenomic next-generation sequencing (mNGS) have been widely adopted in clinical practice, current evidence does not demonstrate sufficient benefits in improving patient survival or optimizing antibiotic stewardship. A rational, empirical antibiotic strategy should be individualized according to local pathogen epidemiology, risk of antimicrobial resistance and aspiration, and patient's clinical presentation. Short-course antibiotic therapy guided by "clinical stability" criteria is reliable, yet achieving stability requires more time in elderly patients and cases with comorbidities. Cefpirome and lefamulin are new antimicrobial agents on the market, but further clinical data are needed to support their use in severe cases and elderly patients. Suraxavir marboxil (GP681), a newly antiviral agent drug targeting the polymerase acidic protein of the influenza virus RNA polymerase, has recently been approved in China. Extending the administration of steroids to severe CAP without septic shock should be approached with extreme caution. High level of C-reactive protein may serve as a potential indicator for identifying cases who could benefit from steroids. In addition, RSV vaccines and monoclonal antibodies will emerge as important strategies for preventing RSV pneumonia in high-risk populations.

FTIR spectroscopy of peripheral blood mononuclear cells and machine learning: Spectral biomarkers for bacteremia, focal bacterial, and viral infections.

Informatics for Infection Prevention and Control.