Other specific DSP article suggested by Editorial Board
Clinical standards for antimicrobial stewardship in TB care.
Authors: Brehm TT, et al
Abstract
Background: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.
Methods: An international panel of 62 experts participated in a Delphi process. Using a 5-point Likert scale (5 = strong agreement; 1 = strong disagreement), participants evaluated 10 draft clinical standards developed by a core coordination team. A standard was adopted if ≥90% of respondents rated it three or higher, according to a predefined consensus threshold.
Results: All 10 standards reached the consensus threshold and were adopted: Standard 1, integration of TB into national AMR action plans; Standard 2, implementation of TB surveillance systems; Standard 3, education of health care providers, individuals affected by TB, and the public; Standard 4, integration of TB into AMS activities; Standard 5, establishment of expert consultation services; Standard 6, targeted testing and preventive treatment for individuals at risk for TB; Standard 7, access to timely and comprehensive drug susceptibility testing; Standard 8, prioritisation of efficacy, safety, and resistance prevention in TB treatment regimens; Standard 9, clinical and microbiological monitoring of treatment response; and Standard 10, assessment of adherence, drug exposure, and resistance in treatment failure.
Conclusion: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.
Other specific DSP article suggested by Editorial Board
Colistin use in neonates with multidrug-resistant Gram-negative infections: challenges in antimicrobial stewardship.
Authors: Mehmood MS, et al
Abstract
The resurgence of colistin as a last-resort antibiotic has become pivotal in managing multidrug-resistant (MDR) Gram-negative infections in neonatal intensive care units. Despite its life-saving potential, colistin use in neonates remains controversial due to limited pharmacokinetic data, variable dosing strategies, and substantial risks of nephrotoxicity and neurotoxicity. Globally, MDR Gram-negative infections account for nearly half of late-onset neonatal sepsis cases, contributing to high mortality and prolonged hospitalization. The emergence of mcr-mediated colistin resistance and inconsistent adherence to antimicrobial stewardship protocols further complicate management. Evidence reveals that a significant proportion of neonatal colistin use is empiric rather than culture-driven, underscoring the gap between guidelines and clinical practice. Strengthening stewardship frameworks, integrating therapeutic drug monitoring, and adopting real-time resistance surveillance are essential to safeguard colistin efficacy and mitigate resistance spread among vulnerable neonatal populations.
Other specific DSP article suggested by Editorial Board
Beyond the 9 to 5: A Cross-sectional Survey of Adult Antimicrobial Stewardship Programs in the United States on Their Initiatives and Resources Based on On-call Model Participation.
DOI: 10.1093/ofid/ofaf722
Authors: Brace S, et al
Abstract
Background: Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use through coordinated interventions that improve patient outcomes and reduce adverse events. While guidance exists from organizations including the Centers for Disease Control and Prevention and the Infectious Diseases Society of America, recommendations on effort allocation, working hours, and initiatives remain unclear.
Methods: This cross-sectional survey assessed the institutional structure, effort allocation, initiatives, and on-call participation of adult ASPs in the United States from September to October 2024. The survey was distributed via email to several ASP-related listservs. Respondents indicating on-call participation were also inquired about working hours, initiatives performed, participants, and compensation.
Results: Of 69 responses, most were from academic medical centers (59%) or community hospitals (35%), with 65% covering >500 beds. ASPs were often system-wide (78%) and primarily funded by their respective departments of pharmacy (87%). Common initiatives performed by all ASPs include answering ASP/infectious diseases questions, therapy de-escalation, and prospective audit and feedback. Twenty-four (69%) respondents indicated having an on-call model, with said programs reporting higher median inpatient full-time equivalents (FTEs) for physicians (0.5 vs 0.25) and pharmacists (2.9 vs 1.45) than those without. Commonly performed after-hours initiatives include preauthorization and answering microbiology inquiries. On-call coverage was generally performed during weekend daytimes and holidays, most often by pharmacists.
Conclusions: This survey highlights differences in structure, effort allocation, and initiatives of ASPs based on on-call participation. Institutions participating in on-call reported higher FTE assignments for physicians and pharmacists and were more likely to perform time-sensitive initiatives.
Other specific DSP article suggested by Editorial Board
Patient satisfaction with infection prevention and control interventions in acute hospitals: a systematic review and meta-analysis.
Authors: Skally M, et al
Abstract
Introduction: Infection prevention and control (IPC) interventions are multifactorial and are used to prevent healthcare-associated infections in healthcare facilities. However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.
Objectives: This systematic review aims to identify peer-reviewed publications reporting patient satisfaction outcomes in the context of IPC interventions, to document the methods used to assess patient satisfaction and to conduct a meta-analysis on reported satisfaction outcomes.
Design: Systematic review and meta-analysis following the Joanna Briggs Institute (JBI) methodology and the PRISMA statement, with oversight from a steering group including PPI partners. Studies in peer-reviewed journals were included based on eligibility criteria.
Data sources: MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, CINAHL and PsycINFO were searched in June 2024. Eligibility criteria: Included studies investigated satisfaction among hospitalised patients in acute care settings following IPC measures, including isolation, cohorting, screening, hand hygiene, antimicrobial stewardship, patient flagging, education, personal protective equipment use, visiting restrictions and treatment delays
DATA EXTRACTION AND SYNTHESIS: Titles and abstracts were screened independently by two reviewers; disagreements were resolved by a third. Study quality was assessed using the JBI manual for evidence synthesis. A meta-analysis was conducted where four or more studies used comparable designs and methods within the same areas of IPC, with heterogeneity evaluated using Cochran’s Q statistic and I2 and pooled estimates calculated with 95% CIs using the Wilson (score) method.
Results: Twenty-nine studies were identified. Among IPC measures, isolation precautions were the most commonly reported intervention (11 studies, 38%). The Likert scale was the predominant assessment method (13 studies, 45%). Patient satisfaction with IPC interventions ranged from 58.3% to 97.2%. Meta-analysis of four studies using the Hospital Consumer Assessment of Healthcare Providers and Systems survey showed substantial heterogeneity (I2, 55%, p=0.08) and a pooled patient satisfaction level of 69% (95% CI 63.6% to 74.4%) for isolation precautions.
Conclusion: Sixty-nine percent of isolated patients reported satisfaction with their care. Patient satisfaction with IPC interventions varies widely, highlighting limitations in current measurement approaches. Strengthening PPI in the design and evaluation of satisfaction measures is essential to capture meaningful data and improvements in IPC programmes.