Other specific DSP article suggested by Editorial Board
Integrated iPRISM Direct-on-Urine Platform for Rapid UTI Diagnosis in a Double-Blind Clinical Trial.
Authors: Jiang X, et al
Abstract
Rapid point-of-care (POC) diagnostics for urinary tract infections (UTIs) are critical for targeted therapy and antibiotic stewardship. We report the first double-blind study of a POC diagnostic system for UTI detection and phenotypic antimicrobial susceptibility testing (AST), using the label-free, real-time iPRISM platform (intensity-based phase-shift reflectometric interference spectroscopic measurement), which traps and grows bacteria on photonic silicon chips. In this near-patient study, unprocessed urine samples were tested in a single-use microfluidic device that integrates both infection screening and AST. Infection screening achieved 97% sensitivity and 60% specificity within 90 min; threshold optimization at 75 min improved performance to 81% specificity and 82% sensitivity. For AST, iPRISM correctly classified 100% of gentamicin-exposed samples in just 30 min and achieved 62% sensitivity and 87% specificity for ciprofloxacin within 90 min. Notably, our preliminary data also demonstrate the potential to differentiate between fungal and bacterial infections, thereby broadening its diagnostic applicability. iPRISM delivers clinically actionable results within a relevant time frame, enabling single-visit prescriptions and supporting personalized, data-driven UTI management.
Other specific DSP article suggested by Editorial Board
Precision antibiotic treatment in intensive care unit-acquired lower respiratory tract infections (ICU-LRTIs): contemporary concepts and future directions.
Authors: Martín-Loeches I, et al
Abstract
Introduction: Intensive care unit-acquired lower respiratory tract infections (ICU-LRTIs), including ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), and hospital-acquired pneumonia (vHAP) requiring invasive ventilation, remain among the most frequent and complex infections in critical care. Their management is challenged by diagnostic uncertainty, overlapping syndromes, and rising antimicrobial resistance. Despite advances in diagnostic and therapeutic tools, empirical broad-spectrum antibiotics remain the cornerstone of treatment, often started without microbiological confirmation. Areas covered: This narrative review examines current approaches to ICU-LRTIs, with a focus on the growing role of bronchoscopy, molecular diagnostics, host biomarkers, and therapeutic drug monitoring (TDM). The need for harmonized definitions, such as ventilator-associated lower respiratory tract infection (VA-LRTI), is discussed to address diagnostic variability. The review also considers combined therapies, including nebulized antibiotics, novel antimicrobials targeting multidrug-resistant pathogens, and real-time TDM to optimize treatment in complex ICU cases. Expert opinion: Management of VA-LRTIs is moving toward precision-guided care. Integrating bronchoscopy, molecular testing, and host-response profiling into routine practice can enable earlier, targeted therapy. Real-time TDM and local resistance surveillance should be standard to optimize antimicrobial use and prevent resistance. A shift from rigid syndromic classifications toward phenotype-driven management is needed to improve patient outcomes.
Other specific DSP article suggested by Editorial Board
Non-prescription antibiotic dispensing and counselling practices in Iraqi community pharmacies: implications for Antimicrobial stewardship and resistance containment.
Authors: Darweesh O, et al
Abstract
Background: To assess the prevalence, characteristics, dispensing practices, and counseling behavior of non-prescription antibiotic dispensing among Iraqi community pharmacies to inform antimicrobial stewardship (AMS) policy. Research design and methods: A cross-sectional simulated client study was conducted in 696 pharmacies across five Iraqi provinces. Standardized scenarios of upper respiratory tract infection were used to evaluate dispensing behavior, counseling quality (defined as whether staff provided key counseling components including enquiry about symptoms, allergy status, dosage instructions, and treatment duration), and antibiotic class distribution according to the WHO-AWaRe framework. Data were analyzed using descriptive and multivariable logistic regression. Results: Antibiotics were dispensed without prescription in 80.6% (95%CI:77.6-83.5%) of visits. Access agents accounted for 60.8% (95%CI:56.9-65.0%) and Watch agents for 39.2% (95%CI:34.9-43.1%), with amoxicillin-(26.4%), amoxicillin – clavulanate-(30.7%), and azithromycin-(25.5%) most common. Counseling was poor, only 15% (95%CI:12.3-18.3%) of providers asked any clinical question and 7.7% (95%CI:5.5-9.9%) enquired about allergy history. Non-pharmacist staff (nurses) were significantly more likely to dispense antibiotics without prescription compared with pharmacists (OR =5.7; 95%CI:3.2-10.1). Conclusions: Non-prescription antibiotic dispensing and minimal counseling remain widespread in Iraqi pharmacies. Effective AMS in Iraq will require phased, system-level approaches, including strengthened regulatory enforcement, workforce support addressing all pharmacy personnel, and integration of community pharmacies into national AMR strategies.
Other specific DSP article suggested by Editorial Board
Clinician awareness, attitudes and prescribing practices relating to doxycycline post-exposure prophylaxis (DoxyPEP) in Ireland: Cross-sectional survey of sexual health professionals.
Authors: Gilmore J, et al
Abstract
Background: Doxycycline post-exposure prophylaxis (DoxyPEP) has emerged as a biomedical strategy to reduce bacterial sexually transmitted infections (STIs), yet implementation remains contested due to antimicrobial resistance concerns and limited clinical guidance in many European settings. Evidence on clinician readiness to prescribe DoxyPEP is limited. This study examined awareness, attitudes and prescribing practices among sexual health clinicians in the Republic of Ireland.MethodsA cross-sectional anonymous online survey was conducted among sexual health clinicians in early 2026. Survey items were informed by the Theoretical Framework of Acceptability (TFA). Descriptive statistics summarised responses. Group differences were assessed using χ2 tests, independent-samples t-tests, one-way ANOVA and non-parametric tests where appropriate. Pearson correlations explored relationships between implementation constructs.Results101 clinicians participated (60 doctors, 33 nurses, 8 other professionals). Awareness of DoxyPEP was high (95%) and 64% of doctors and nurses reported prior prescribing or recommendation. Current local guidance was variable, with only 28% reporting formal guidance, but willingness to prescribe with national guidance was high (82%) and did not differ between professional groups or specialties.No significant differences were observed between doctors and nurses across knowledge or acceptability domains. Among doctors, implementation perceptions varied by specialty: GU/HIV clinicians reported higher knowledge, perceived effectiveness, intervention coherence and self-efficacy than infectious diseases clinicians and general practitioners.Self-reported knowledge was strongly associated with intervention coherence (r = -0.601, p < .001) and self-efficacy (r = 0.600, p < .001). Ethicality emerged as the only independent predictor of willingness to prescribe (OR = 5.77, 95% CI 2.47-13.47). Concern about antimicrobial resistance was widespread (81%).ConclusionIrish clinicians demonstrate high awareness and substantial readiness to prescribe DoxyPEP. Implementation readiness appears shaped more by ethical acceptability and professional confidence than knowledge alone. National guidance, education and antimicrobial stewardship frameworks will be essential to support safe and equitable integration of DoxyPEP into sexual health services.
Other specific DSP article suggested by Editorial Board
Strategies and outcomes of CDSS implementation for antimicrobial stewardship in hospital settings: a systematic review.
Authors: Giordano L, et al
Abstract
Objectives: Optimal implementation strategies and clinical outcomes of Clinical Decision Support Systems (CDSS) for antimicrobial prescribing in hospital settings have not been systemically evaluated. This review explores how CDSS for antimicrobial stewardship (AMS) have been implemented in secondary and tertiary care, focusing on strategies used, clinical and implementation outcomes.
Methods: A systematic search was conducted including studies published up to December 2022. Primary studies describing CDSS implementation strategies in secondary and tertiary care were included. Strategies were analysed using the Expert Recommendations for Implementing Change (ERIC) framework. Implementation outcomes reported in the studies were extracted and categorized according to Proctor’s framework. Quality assessment was performed using the Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS).
Results: Screening of 2,189 papers identified 12 studies meeting inclusion criteria, all focusing on antimicrobial prescribing in high-income countries. Most CDSS were expert systems (n = 11), primarily designed for infectious disease physicians (n = 7). Pre-implementation assessments, such as workflow analysis, user surveys and multidisciplinary meetings, were conducted in only five of the 12 studies. Studies used a median of 11 out of 73 ERIC implementation strategies. The most frequently reported strategies belonged to the following ERIC categories: developing stakeholder interrelationships (n = 11), training and educating users (n = 11), evaluative strategies (n = 10), provision of interactive assistance (n = 5), adaptation and tailoring to context (n = 5). In contrast, strategies aimed at supporting clinicians (n = 3) and changing infrastructure (n = 2) were less commonly used. No study reported strategies related to patient and service user engagement or financial strategies. Clinical outcomes were considered effective in two studies and partially effective in four, while the remaining studies did not evaluate them. A median of three implementation outcomes was reported per study, with appropriateness (n = 10), adoption (n = 9) and acceptability (n = 9) being the most examined. Overall, initial adoption was slow but improved over time, enhancing compliance with policy indicators.
Conclusions: The implementation strategies of CDSS for AMS in hospital settings are variably reported, with many studies providing limited detail on strategy selection, application, or outcomes, highlighting the need for more systematic and comprehensive evaluation in future research.