Stewardship Practices Research Articles

Antimicrobial use in lactating sows, piglets, nursery, and grower-finisher pigs on swine farms in Ontario, Canada during 2017 and 2018

BackgroundData on antimicrobial use (AMU) in pig production are needed for the development of good antimicrobial stewardship practices to reduce the risk of antimicrobial resistance in bacteria that can cause illness in animals and humans. In Canada, there is a lack of quantitative data on AMU in the farrowing and nursery stages of pig production. This study aimed to determine which antimicrobial active ingredients are currently used in farrowing, nursery, and grower-finisher herds in the province of Ontario, Canada, and to quantify AMU using various metrics. We collected data on herd demographics, biosecurity, health status, and AMU during one production cycle from 25 farrowing and 25 nursery herds in Ontario, between May 2017 and April 2018, and obtained data from 23 Ontario grower-finisher herds during the same time frame from the Public Health Agency’s Canadian Integrated Program for Antimicrobial Resistance Surveillance. We applied frequency measures, and weight-, and dose-based metrics to the data.ResultsIn all pigs, the highest quantity of AMU was administered in-feed. By all routes of administration and compared to other production stages, nursery pigs used more antimicrobials in mg/kg biomass and the number of Canadian defined daily doses per 1000 pig-days (doseCA rate), while grower-finisher pigs used more antimicrobials in total kilograms and the number of Canadian defined daily doses per pig. In suckling pigs in some herds, there was routine disease prevention use of ceftiofur, an antimicrobial active ingredient categorized as very highly important in human medicine by Health Canada. The top antimicrobial used in each stage of pig production often varied by the metric used. There was producer-reported growth promotion use of antimicrobials in suckling and grower-finisher feed.ConclusionsThe results of this study provide a current picture of AMU in pigs in Ontario and can be used as a basis for further research on AMU in farrowing and nursery herds in Canada. Our findings confirm that it would be useful to include farrowing and nursery herds in routine AMU surveillance in Canada. A future analysis using data from this project will examine factors that affect the quantity of AMU.

Entrepreneurial Leadership in Austrian Family SMEs: A Configurational Approach

This article explores the role of stewardship practices related to entrepreneurial leadership in turning entrepreneurial orientation (EO) into family firm performance while considering its environmental context. Family business research has not fully investigated how the EO–financial performance relationship depends on configurations of internal and external factors which establish strategic fit. We argue that family firms can overcome the often-highlighted paternalism-entrepreneurship paradox by employing stewardship practices related to entrepreneurial leadership (internal factor), which in turn can help them leverage strategic fit between EO and dynamic environments (external factor). The results of a survey of 162 Austrian small and medium-sized family enterprises (family SMEs) show that family SMEs can only profit from EO under certain configurations of internal and external factors. Employing stewardship practices related to entrepreneurial leadership turns out to be an efficient and necessary condition for transforming EO into performance. Environmental dynamism is, furthermore, a double-edged sword facilitating and impeding the transformation of EO into performance. These findings contribute to existing research by shedding light on the role of stewardship practices in establishing strategic fit in entrepreneurial family firms.

The first nationwide surveillance of carbapenem-resistant Enterobacterales in the United Arab Emirates – increased association of Klebsiella pneumoniae CC14 clone with Emirati patients

ObjectivesTo assess the current prevalence, distribution, and main clonal types of carbapenem-resistant Enterobacterales (CRE) in the United Arab Emirates. MethodsA total of 504 CRE collected over a 9-month period in 15 hospitals were studied. Antibiotic susceptibility and the presence of common carbapenemase, 16S methylase, and mobile colistin resistance genes were assessed. Selected strains forming larger clusters by pulsed field gel electrophoresis were subjected to whole genome sequencing to identify their sequence types and core genome MLST. ResultsStrains expressing OXA and NDM type carbapenemases and 16S methylases were present in all major hospitals. Considerable interhospital differences were noticed, suggesting the role of specific clones. A total of three major Klebsiella pneumoniae clones (CC14, ST231, and CC147) were identified, accounting for 48.6% of all CRE. All clones were significantly more resistant than sporadic isolates. CC14 strains exhibited a significant association with Emirati patients. ConclusionsNearly half of CRE infections in the country are due to a limited number of clones. The data indicate the possibility of interhospital transmission, combined in some hospitals with inadequate stewardship practices. The study also revealed an association of the largest, most resistant clone (CC14) with Emirati patients. The specific reasons for it should be clarified by further investigations.

Global resilience and new strategies needed for antimicrobial stewardship during the COVID-19 pandemic and beyond.

Resilience is having the ability to respond to adversity proactively and resourcefully. The coronavirus disease 2019 (COVID‐19) pandemic's profound impact on antimicrobial stewardship programs (ASP) requires clinicians to call on their own resilience to manage the demands of the pandemic and the disruption of ASP activities. This article provides examples of ASP resilience from pharmacists and physicians from seven countries with different resources and approaches to ASP—The United States, The United Kingdom, Canada, Nigeria, Lebanon, South Africa, and Colombia. The lessons learned pertain to providing ASP clinical services in the context of a global pandemic, developing new ASP paradigms in the face of COVID‐19, leveraging technology to extend the reach of ASP, and conducting international collaborative ASP research remotely. This article serves as an example of how resilience and global collaboration is sustaining our ASPs by sharing new “how to” do antimicrobial stewardship practices during the COVID‐19 pandemic.

The ‘quiet hunt’: the significance of mushroom foraging among Russian-speaking immigrants in New York City

ABSTRACT Urban foraging provides city dwellers with numerous ecosystem services, but this human-nature interaction is largely missing from the urban ecosystem services scholarship. This exploratory study aims to address this gap in the literature and examines the benefits and values associated with foraging in New York City, United States. We focus on Russian-speaking mushroom foragers, a previously unstudied community. Data from 10 interviews reveals that for some groups, foraging is primarily about cultural ecosystem services, with a provisioning attribute. Foraging supports multiple benefits, most notably contributions to social relations, cultural heritage, and recreational experiences; these nonmaterial contributions often intertwine with material benefits. Our findings further demonstrate the mutual exchange of benefits between humans and nature, including services to ecosystems and species. Participants reported engagement in multiple stewardship practices and actively maintained and enhanced ecosystem services. We encourage future ecosystem services assessments to recognize foraging as an urban activity and consider the bi-directional exchange of benefits between humans and ecosystems. To some participants, foraging was an integral part of their relationship with the natural world, intertwined with relational values of connection to nature, kinship, love, and care. Our results suggest that relational values can be central for understanding the value of ecosystem services. Our study further illustrates that some ecosystem services may be associated with practices, rather than places, and future work should examine these links in more detail.

Effect of a virtual simulated participant experience on antibiotic stewardship knowledge among pre-licensure baccalaureate nursing students: A pilot study

BackgroundAntibiotic resistant infections are a growing global public health threat poised to render antibiotics ineffective in treating even the most common infectious diseases. It is essential that future nurses have the knowledge and skills to keep patients safe from antibiotic harm in all health care settings, however, studies indicate that there is limited education provided in nursing schools regarding antibiotic use, antibiotic resistance, and antibiotic stewardship nursing practices. ObjectiveEvaluate the effect of a virtual, scenario-based simulation experience using simulated participants on pre-licensure baccalaureate nursing students' antibiotic, antibiotic resistance, and antibiotic stewardship nursing practice knowledge. MethodsA quasi-experiential repeated measure pre-posttest design was used with a convenience sample of 165 pre-licensure baccalaureate nursing students enrolled in a health promotion course at a private university in the northeast region of the United States. The NLN Jeffries Simulation Theory guided the virtual simulation experience and used simulated participants methodology. ResultsAll students participated in the simulation experience. Statistically significant increases were noted (p < 0.005) in antibiotic, antibiotic use, and antibiotic resistance knowledge between the pre and post surveys. The most significant changes were in knowledge of antibiotic stewardship nursing practices. ConclusionIntegration of virtual, scenario-based simulations provided students an active learning opportunity to practice antibiotic stewardship assessment and practice skills through real life-like situational experiences with simulated participants, resulting in improved antibiotic, antibiotic resistance, and antibiotic stewardship knowledge.

Ensure Timely and Proper Expenditure of Gifts

The Major Gifts ReportVolume 24, Issue 5 p. 3-3 Essential Stewardship Practices Ensure Timely and Proper Expenditure of Gifts First published: 04 April 2022 https://doi.org/10.1002/mgr.31910Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume24, Issue5May 2022Pages 3-3 RelatedInformation

Stewardship practice and the performance of citizenship: Greening tree-pits in the streets of Berlin

Hands-on activities of shaping and maintaining urban public green spaces, in short, “stewardship,” have become a flourishing field of civic engagement. It is the aim of this article to find out how citizenship is enacted in the everyday practice of stewardship, and how such an analysis can benefit from theories of “material participation” and “practice.” It explores this theme through a case study of the greening of tree-pits in Berlin. The article asks: (1) how people, through their doing of stewardship, engage with the tangible places that they take care of, and (2) how connections between stewardship, its focal places, and other practices shape and sustain wider public concerns. Thereby, it identifies three intersecting and materially grounded “civic nexuses of practices,” which each imply specific constructions of citizenship: civic neighboring, managed volunteering, and political mobilization. It explores how each of these nexuses emerges from the convergence of practices around the tree-pit, and probes the tensions and conflicts that they entail. In contrast to authors who have either cherished stewardship as a form of citizen empowerment, or, in line with Foucauldian governmentality studies, as the formation of governable citizen-subjects, the article emphasizes the politically ambiguous dynamics through which stewards practice their citizenship.

Roll Up Your Sleeves: Servant Leadership as a Paradigm for the Challenging South African School Context?

The South African educational system has challenges regarding learner outcomes of previously disadvantaged schools. New thinking is mandatory, and school leadership needs to play an significant role to improve the status quo. The servant leadership paradigm may be a substantial factor to counter the challenges. A quantitative approach measured the covariation between the servant leadership paradigm and its influence on the organizational climate of private schools to learn implementable lessons. The construct of servant leadership was explored via the Servant Leadership Survey (SLS) of Van Dierendonck and Nuijten. According to Castro and Martins’s Climate Survey Questionnaire (CSQ), the organizational climate was analyzed. A total of 249 respondents, all permanently employed as educators from primary and secondary private schools, completed the survey questionnaires. It was found that private schools’ leadership exhibits the characteristics of the servant leadership practices of empowerment, stewardship, accountability, and humility. It was confirmed that private school leadership displays the organizational climate groupings of organizational image, teamwork, work environment, and leadership as priorities that increase constructive organizational climate in the school setting. Recommendation about the implication of these results to improve the disadvantaged school environment is discussed.

In vitro Activity of Isavuconazole and Comparators Against Clinical Isolates of Molds from a Multicenter Study in China.

PurposeMonitoring antifungal susceptibility patterns for new or established antifungals is imperative. Antifungal resistance is frequent in molds, frequently leading to invasive mold infections (IMIs) in immunocompromised patients with high morbidity and mortality. Limited availability of effective antifungals for treatment of IMIs in China is an enormous challenge. The purpose of this study was to monitor in vitro antifungal resistance profiles of mold isolates from China, with a particular focus on evaluating in vitro isavuconazole (ISA) activity against these isolates, contributing to the treatment guidance in clinics.MethodsWe evaluated the in vitro activity of ISA and its comparators (voriconazole [VOR] and amphotericin B [AMB]) against 131 clinical isolates of Aspergillus spp. (n = 105) and Mucorales order (n = 26) collected between 2017 and 2020 from China.ResultsISA and VOR exhibited similar in vitro activity against Aspergillus spp., with minimum inhibitory concentration (MIC)50 of 1 µg/mL and MIC90 of 2 µg/mL, respectively. Overall, AMB was less active than azoles against Aspergillus spp. (MIC50: 4 µg/mL, MIC90: 8 µg/mL). Against the Mucorales order, ISA demonstrated MIC50 of 0.5 µg/mL and MIC90 of 1 µg/mL; however, one strain each of Mucor circinelloides and Syncephalastrum racemosum were resistant to ISA (MICs: >8 µg/mL). VOR exhibited little or no activity (MIC50: 8 µg/mL, MIC90: >8 µg/mL) against the Mucorales order, whereas AMB had MIC50 and MIC90 of 1 µg/mL.ConclusionThis was the first multicenter, in vitro study conducted in China and demonstrated the excellent activities of ISA against most species of the Mucorales order. MIC indicated an advantage over currently available azole antifungals, positioning ISA as a potential alternative to VOR for clinical management of IMIs. As with other antimicrobials, clinicians should employ stewardship and best practices in relation to potential resistance to new azole antifungals.

Clinico-Epidemio-Microbiological Exploratory Review Among COVID-19 Patients with Secondary Infection in Central India.

PurposeSecondary infections (SI) in COVID-19 have been documented from 3.6% to 72% in various studies with mortality ranging from 8.1% to 57.6%. There is a gap in knowledge for clinico–epidemio-microbilogical association among COVID-19 patients with concomitant SI.Patients and MethodsThis is a retrospective chart review, in central India. The study was undertaken for hospitalized adult patients during 1st June 2020 to 30th November 2020, with laboratory proven COVID-19 infection and secondary infection.ResultsOut of the total 2338 number of patients, only 265 (11.3%) patients were investigated for microbiological identification of SI. Male gender was predominant (76.8%) and the mean age was 53.7 ± 17.8 years. Only 3.5% (82/2338) of patients were having microbiologically confirmed (bacterial or fungal) SI. The overall mortality was 50.9% (54/82) with a differential mortality of 88.8% (48/54) in high-priority areas and 21.4% (6/28) in low-priority areas. Blood was the most commonly investigated sample (56%) followed by urine (20.7%) and respiratory secretion (15.8%). A. baumanii complex (20/82, 24.3%) was the most common bacteria isolated followed by K. pneumonia (12/82, 14.6%) and E. coli (11/82, 13.4%). Candida spp. (20/82, 24.3%) was the most common fungal pathogen isolated. Sixty percent (12/20) of Acinetobacter spp. were carbapenam-resistant and 70.3% of Enterobacterales were carbapenam-resistant. Fluconazole resistant Candida spp. was isolated only in 10% (2/20) of cases. Diabetes was the most common co-morbidity 54.8% (45/82) followed by hypertension (41.4%) and chronic heart disease (13.4%). The negative predictors of secondary infections are urinary catheterization, placement of central line and mechanical ventilation (invasive and non-invasive).ConclusionThere is an urgent need of better anti-microbial stewardship practices in India (institutional and extra institutional) for curtailment of secondary infection rates particularly among COVID-19 patients.

Kaili Chun: The Native Artist as Storyteller and Steward of the Land and the Water

This Research Note proceeds from an interview with Native Hawaiian artist Kaili Chun following her presentation at the “Pacific Island Worlds: Oceanic Dis/Positions” symposium, which took place at the University of California, Santa Cruz, in 2018. The conversation delved into Chun’s interactive installation practice through a discussion of three of her artworks: Veritas (2012), Hulali i ka lā (2017), and Uwē ka lani, ola ka honua (2021). Each of these pieces celebrates the importance and value of water in Native ecologies, and proposes to view Native practices of stewardship of the land as pathways towards a more sustainable future. Ultimately, the conversation draws a portrait of the Native artist as a storyteller and steward of the land.

Toward the development of an antibiotic stewardship competency in dental education.

Antimicrobial resistance was recently described by the World Health Organization (WHO) as "a clear and present danger to global health." It is well documented that this resistance is significantly driven by the overuse and inappropriate use of antibiotics. Impactful change can only come from the adoption of antibiotic stewardship practices in all aspects of health care. With dentistry responsible for approximately 10% of all prescribed antibiotics in the United States, there is a potential to be acutely impactful with adequate interventions. After extensively reviewing the most current national and international literature on the topic, we identified that predoctoral dental education provides a potentially impactful opportunity to introduce and support the development of responsible antibiotic practices. To that extent, we developed a detailed framework of antibiotic stewardship competencies to promote responsible best practices among dental students.

Add These Stewardship Practices to Your Toolbox

Add These Stewardship Practices to Your Toolbox

Impacts of purple martin landlord stewardship activities on nest box occupancy

AbstractThe eastern subspecies of purple martins (Progne subis; hereafter martins) nests almost exclusively in human‐made cavity nest boxes. Martin landlords manage nest boxes with varying levels of engagement and methods, but little research has evaluated the effectiveness of management on martin occupancy. In the fall of 2019, based on interviews with 31 martin landlords in Camrose, Alberta, Canada, we compared martin occupancy in nest boxes during 3 years with 8 management practices. Nest boxes whose landlords cleaned nests, removed blowfly larvae, frequently checked nests, removed competitor nests, and added nest material had higher martin occupancy rates than nest boxes without stewardship practices. Our results help affirm and prioritize future martin landlord practices.

Antibiotic Stewardship Related to Delayed Diagnosis and Poor Prognosis of Critically Ill Patients with Vancomycin-Resistant Enterococcal Bacteremia: A Retrospective Cohort Study

PurposePatients with septicemia caused by vancomycin-resistant Enterococcus (VRE) bacteremia have higher mortality rates than patients infected by VSE. Vancomycin or teicoplanin is selected as the antibiotic stewardship intervention to cover methicillin-resistant Staphylococcus aureus infections before blood culture reveals VRE bacteremia in critically ill patients with Gram-positive cocci (GPC) bacteremia; this may require linezolid or daptomycin treatment instead. We thus evaluated antibiotic stewardship practices, such as appropriate timing of antibiotic use in GPC bacteremia, and clinical outcomes of critically ill patients with VRE infection.Patients and MethodsThis retrospective study enrolled 191 critically ill patients with enterococcal bacteremia at the Taipei Tzu Chi Hospital during January 1, 2019–December 31, 2020. Demographic and clinical characteristics, as well as disease outcomes and appropriate antibiotic use after GPC bacteremia diagnosis, were compared between the VRE and VSE groups.ResultsOf 191 patients, 55 had VRE bacteremia (case group) and 136 had VSE bacteremia (control group). The rate of antibiotic change after initial antibiotic use for GPC bacteremia was higher in the VRE bacteremia group (100% vs 10.3%; p<0.001). The time to appropriate antibiotic administration after GPC bacteremia diagnosis was longer in the VRE bacteremia group (3.3±2.1 vs 1.5±1.8 days; p<0.001). Patients with VRE bacteremia had higher 28-day mortality rates (relative risk, 1.997; 95% confidence interval [CI], 1.041–3.83). Multivariate Cox regression analysis showed that delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis increased the risks of 28-day all-cause mortality (adjusted hazard ratio, 2.045; 95% CI, 1.089–3.84; p=0.026) in patients with VRE infection.ConclusionPatients with VRE bacteremia with delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis had increased 28-day mortality risks. New strategies for early VRE detection in GPC bacteremia may shorten the time to administer appropriate antibiotics and lower mortality rates.

Cost-minimisation analysis of oritavancin for the treatment of acute bacterial skin and skin structure infections from a United Kingdom perspective

BackgroundEarly discharge (ED) from hospital and outpatient parenteral antibiotic therapy (OPAT) are effective approaches for the management of a range of infections, including acute bacterial skin and skin structure infections (ABSSSI). Strategies that facilitate ED, thereby reducing complications such as healthcare-acquired infection whilst enhancing patient quality of life, are being increasingly adopted in line with good antimicrobial stewardship practice. This study presents a cost-minimisation analysis for the use of oritavancin at ED versus relevant comparators from a National Health Service (NHS) and personal and social services United Kingdom perspective.MethodsA cost-minimisation model considering adult patients with ABSSSI with suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection, was developed based on publicly available NHS costs, practice guidelines for ABSSSI and clinical expert’s opinion. Cost of treatment and treatment days were compared for oritavancin at ED to dalbavancin, teicoplanin, daptomycin and linezolid.ResultsFollowing the empiric use of either flucloxacillin or vancomycin in the inpatient setting, oritavancin was compared to OPAT with dalbavancin, teicoplanin and daptomycin, and oral linezolid from day 4 of treatment. Oritavancin at ED reduced treatment duration by 0.8 days and led to cost savings of £281 in comparison to dalbavancin. In comparison to teicoplanin, daptomycin and linezolid, oritavancin reduced treatment duration by 5 days, with marginally higher costs (£446, £137, and £1,434, respectively).ConclusionOritavancin, used to support ED, is associated with lower costs compared with dalbavancin and reduced treatment duration relative to all comparators. Its use would support an ED approach in MRSA ABSSSI management.

Antimicrobial Stewardship in the ICU.

Increasing rates of infection and multidrug-resistant pathogens, along with a high use of antimicrobial therapy, make the intensive care unit (ICU) an ideal setting for implementing and supporting antimicrobial stewardship efforts. Overuse of antimicrobial agents is common in the ICU, as practitioners are challenged daily with achieving early, appropriate empiric antimicrobial therapy to improve patient outcomes. While early antimicrobial stewardship programs focused on the financial implications of antimicrobial overuse, current goals of stewardship programs align closely with those of critical care providers-to optimize patient outcomes, reduce development of resistance, and minimize adverse outcomes associated with antibiotic overuse and misuse such as acute kidney injury and Clostridioides difficile-associated disease. Significant opportunities exist in the ICU for critical care clinicians to support stewardship practices at the bedside, including thoughtful and restrained initiation of antimicrobial therapy, use of biomarkers in addition to rapid diagnostics, Staphylococcus aureus screening, and traditional microbiologic culture and susceptibilities to guide antibiotic de-escalation, and use of the shortest duration of therapy that is clinically appropriate. Integration of critical care practitioners into the initiatives of antimicrobial stewardship programs is key to their success. This review summarizes key components of antimicrobial stewardship programs and mechanisms for critical care practitioners to share the responsibility for antimicrobial stewardship.

Factors Associated with Antimicrobial Stewardship Practices on California Dairies: One Year Post Senate Bill 27.

Background: The current study is aimed at identifying the factors associated with antimicrobial drug (AMD) use and stewardship practices on conventional California (CA) dairies a year after CA Senate Bill 27. Methods: Responses from 113 out of 1282 dairies mailed a questionnaire in 2019 were analyzed to estimate the associations between management practices and six outcomes including producer familiarity with medically important antimicrobial drugs (MIADs), restricted use of MIADs previously available over the counter (OTC), use of alternatives to AMD, changes in on-farm management practices, changes in AMD costs, and animal health status in dairies. Results: Producers who reported having a veterinarian–client–patient relationship (VCPR) and tracking AMD withdrawal intervals had greater odds of being familiar with the MIADs. Producers who began or increased the use of preventive alternatives to AMD in 2019 had higher odds (OR = 3.23, p = 0.04) of decreased use of MIADs previously available OTC compared to those who did not. Changes in management practices to prevent disease outbreak and the use of diagnostics to guide treatment were associated with producer-reported improved animal health. In addition, our study identified record keeping (associated with familiarity with MIADs), use of alternatives to AMD (associated with management changes to prevent diseases and decreased AMD costs), and use of diagnostics in treatment decisions (associated with reported better animal health) as factors associated with AMD stewardship. Conclusions: Our survey findings can be incorporated in outreach education materials to promote antimicrobial stewardship practices in dairies.

Predictors of Fecal Microbiota Transplant Failure in Clostridioides difficile Infection : An Updated Meta-analysis.

Fecal microbiota transplantation (FMT) is an effective treatment for recurrent/refractory Clostridioides difficile infection (CDI) with a 10% to 20% risk of recurrence after a single FMT. In this meta-analysis, we aimed to evaluate the predictors of FMT failure. A comprehensive search of MEDLINE, Embase, Cochrane, and Web of Science databases through July 2021 was performed. All studies that evaluated risk factors associated with FMT failure in a multivariate model were included. We calculated pooled odds ratios with 95% confidence intervals for risk factors reported in ≥3 studies using a random-effects model. Twenty studies involving 4327 patients (63.6% females) with recurrent/refractory CDI who underwent FMT were included. FMT failed in 705 patients (16.3%) with 2 to 3 months of follow-up in most studies. A total of 12 different risk factors were reported in a multivariate model in ≥3 studies. Meta-analysis showed that advanced age, severe CDI, inflammatory bowel disease, peri-FMT use of non-CDI antibiotics, prior CDI-related hospitalizations, inpatient status, and poor quality of bowel preparation were significant predictors of FMT failure. Charlson Comorbidity Index, female gender, immunosuppressed status, patient-directed donor, and number of CDI recurrences were not associated with FMT failure. Adequate bowel preparation at the time of FMT and optimizing antibiotic stewardship practices in the peri-FMT period can improve the success of FMT. Patients with nonmodifiable risk factors should be counseled about the risk of FMT failure. Our results may help develop a risk stratification model to predict FMT failure in CDI patients.