Abstract Background Antimicrobial stewardship programs (ASPs) are essential to reduce antimicrobial resistance, but small hospitals often face challenges in securing ASP expertise. A collaborative network model may help overcome this limitation. We analyzed the impact of changes in ASP expertise and implementation on antimicrobial utilization (AU) trends in small community hospitals (less than 100 beds) supported by the Duke Antimicrobial Stewardship Outreach Network (DASON). Methods We assessed the status of ASP expertise and implementation in hospitals with fewer than 100 beds who are members of the 48 hospital DASON network based on the 2021 and 2023 National Healthcare Safety Network (NHSN) annual surveys. AU data were obtained from the DASON database. Hospital were clustered into six groups in 2021 based on the composition of ASP expertise and implementation. Using the same clustering algorithm, hospitals were re-clustered in 2023. Within-hospital differences in implementation and expertise were categorized into worsened, no-change, and improved groups based on changes in their cluster assignments. A mixed-effects model was used to compare AU trends between groups, followed by post hoc analysis of slope changes from 2021 to 2023. Results Of the 15 DASON member hospitals with fewer than 100 beds, 7 had complete AU and implementation and expertise data for analysis. Two had an infectious diseases (ID) physician, one had an ID pharmacist and six received ID tele-services in 2021. Regarding ASP expertise changes, three , two , and two hospitals were categorized into worsened, no-change, and improved groups, respectively. For ASP implementation, four, one and two hospitals were categorized into worsened, no-change, and improved groups. Linezolid and carbapenem use significantly decreased in the improved expertise group compared to the worsened and no-change groups. In the improved implementation group, AU for hospital-onset infections and Gram-positive organisms decreased significantly. Additionally, use of antifungal agents, carbapenems, linezolid, and vancomycin significantly decreased. Conclusion Strengthening ASP implementation through a collaborative, consultative model may improve antimicrobial use even in small hospitals where securing expertise is challenging. Disclosures Elizabeth Dodds Ashley, PharmD, MHS, HealthtrackRx: Advisor/Consultant|UpToDate, Inc.: Author Royalties Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed technology, method to detect fungal infection|Biomeme: Licensed technology, method to detect fungal infection|Scynexis: Grant/Research Support|Scynexis: Grant/Research Support|UpToDate: Author Royalties|UpToDate: Author Royalties

Given the global threat of antimicrobial-resistant organisms, an effective antimicrobial stewardship program (ASP) is essential. Infectious disease (ID) physicians and ID-trained pharmacists are prioritized as critical core members of ASP in hospital settings, but securing these ID-trained professionals in all settings is challenging. Alternative champions and personnel for implementation may be needed. This narrative review highlights the efficacy of ASP when non-ID-trained physicians and pharmacists are engaged in ASP, showcasing various studies demonstrating significant improvements in antimicrobial utilization, cost, and patient outcomes. Additionally, it discusses the impact of network-based models, such as the Duke Antimicrobial Stewardship Outreach Network, which provides structured support and resources to lower-resourced hospitals to ensure the successful implementation of ASP. Ultimately, this narrative review provides insights into how to structure accountability and pharmacy/stewardship expertise in establishing and expanding ASP nationwide in Korea, where ASP is still in its early stages. In addressing this issue, government initiatives to actively support this effort are essential, and striving to develop evidence-based policies is necessary.

ST235 (7 isolates, 11.1%). Overall susceptibility to ceftazidime/avibactam was only 17.5%, and none of the carbapenemase-producing isolates were susceptible to it. All ST644 strains were also resistant to aztreonam.

Abstract Background Antimicrobial stewardship programs (ASPs) are essential to reduce antimicrobial resistance, but small hospitals often face challenges in securing ASP expertise. A collaborative network model may help overcome this limitation. We analyzed the impact of changes in ASP expertise and implementation on antimicrobial utilization (AU) trends in small community hospitals (less than 100 beds) supported by the Duke Antimicrobial Stewardship Outreach Network (DASON). Methods We assessed the status of ASP expertise and implementation in hospitals with fewer than 100 beds who are members of the 48 hospital DASON network based on the 2021 and 2023 National Healthcare Safety Network (NHSN) annual surveys. AU data were obtained from the DASON database. Hospital were clustered into six groups in 2021 based on the composition of ASP expertise and implementation. Using the same clustering algorithm, hospitals were re-clustered in 2023. Within-hospital differences in implementation and expertise were categorized into worsened, no-change, and improved groups based on changes in their cluster assignments. A mixed-effects model was used to compare AU trends between groups, followed by post hoc analysis of slope changes from 2021 to 2023. Results Of the 15 DASON member hospitals with fewer than 100 beds, 7 had complete AU and implementation and expertise data for analysis. Two had an infectious diseases (ID) physician, one had an ID pharmacist and six received ID tele-services in 2021. Regarding ASP expertise changes, three , two , and two hospitals were categorized into worsened, no-change, and improved groups, respectively. For ASP implementation, four, one and two hospitals were categorized into worsened, no-change, and improved groups. Linezolid and carbapenem use significantly decreased in the improved expertise group compared to the worsened and no-change groups. In the improved implementation group, AU for hospital-onset infections and Gram-positive organisms decreased significantly. Additionally, use of antifungal agents, carbapenems, linezolid, and vancomycin significantly decreased. Conclusion Strengthening ASP implementation through a collaborative, consultative model may improve antimicrobial use even in small hospitals where securing expertise is challenging. Disclosures Elizabeth Dodds Ashley, PharmD, MHS, HealthtrackRx: Advisor/Consultant|UpToDate, Inc.: Author Royalties Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed technology, method to detect fungal infection|Biomeme: Licensed technology, method to detect fungal infection|Scynexis: Grant/Research Support|Scynexis: Grant/Research Support|UpToDate: Author Royalties|UpToDate: Author Royalties

Given the global threat of antimicrobial-resistant organisms, an effective antimicrobial stewardship program (ASP) is essential. Infectious disease (ID) physicians and ID-trained pharmacists are prioritized as critical core members of ASP in hospital settings, but securing these ID-trained professionals in all settings is challenging. Alternative champions and personnel for implementation may be needed. This narrative review highlights the efficacy of ASP when non-ID-trained physicians and pharmacists are engaged in ASP, showcasing various studies demonstrating significant improvements in antimicrobial utilization, cost, and patient outcomes. Additionally, it discusses the impact of network-based models, such as the Duke Antimicrobial Stewardship Outreach Network, which provides structured support and resources to lower-resourced hospitals to ensure the successful implementation of ASP. Ultimately, this narrative review provides insights into how to structure accountability and pharmacy/stewardship expertise in establishing and expanding ASP nationwide in Korea, where ASP is still in its early stages. In addressing this issue, government initiatives to actively support this effort are essential, and striving to develop evidence-based policies is necessary.

ST235 (7 isolates, 11.1%). Overall susceptibility to ceftazidime/avibactam was only 17.5%, and none of the carbapenemase-producing isolates were susceptible to it. All ST644 strains were also resistant to aztreonam.

In this observational study conducted in 2022, 12.3% of patients who shared a room with a patient positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) also had a positive polymerase chain reaction (PCR) test, either at initial screening or during a 5-day quarantine. Therefore, screening and quarantine are still necessary within hospitals for close-contact inpatients during the SARS-CoV-2 omicron-variant dominant period.

BACKGROUND/AIMS: Infection remains the second leading cause of mortality in patients with end-stage renal disease (ESRD). Despite the direct relationship between hemodialysis vascular access-related infections (HD-VARI) and both prognosis and mortality in ESRD patients, there is a paucity of research in this area. METHODS: This retrospective study was performed at a tertiary care hospital in Seoul, Korea, from 2009 to 2020. Medical records of adult patients diagnosed with HD-VARI were assessed. We analyzed the distribution of microorganisms, clinical characteristics according to vascular access type, and evaluated risk factors for treatment failure. RESULTS: Data from a total of 367 patients were included over the 12-year study period. Based on vascular access type, 293 (79.8%) had arteriovenous graft infections, 29 (7.9%) had arteriovenous fistula infections, and 45 (12.3%) had tunneled cuffed catheter infections. Thirty-one (8.4%) patients experienced treatment failure within 90 days. Multivariate analysis identified male sex (odds ratio [OR], 2.343; 95% confidence interval [CI], 1.041-5.274) and metastatic infection (OR, 4.297; 95% CI, 1.516-12.178) as independent predictors of 90-day infection-related treatment failure. Subtotal or total excision (removal) of the infected vascular access significantly decreased the risk of 90-day infection-related treatment failure (OR, 0.337; 95% CI, 0.129-0.876). CONCLUSION: Removal of infected vascular access played a crucial role in reducing infection-related deaths or relapses within 90 days. Management of vascular access infection should be individualized based on patient-specific factors.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in millions of deaths worldwide and has now become a major respiratory infectious disease. Beyond the direct effects of the viral infection, one of the most significant and concerning issues to emerge is the exacerbated threat of antimicrobial resistance (AMR) by the indirect impacts of COVID-19. Early in the pandemic, widespread empirical antibiotic prescribing occurred despite low bacterial co-infection rates. In addition, azithromycin, whose antiviral effect remains unproven, was frequently used. This high, often unnecessary consumption, coupled with disrupted antimicrobial stewardship (AMS) and infection prevention and control (IPC) programs, created conditions favoring the emergence and spread of AMR. In patients with severe COVID-19, multidrug-resistant organisms were frequently implicated in secondary infections, particularly in intensive care units (ICUs). Nevertheless, previous studies analyzing AMR metrics before and during the COVID-19 pandemic have shown inconsistent results. Strategies to mitigate the COVID-19 pandemic, such as enhanced surveillance, social distancing resulting in lower respiratory infections, and strengthened IPC and targeted AMS interventions, could play protective roles to inhibit the development of AMR. Additionally, targeted interventions-such as prospective audit and feedback, biomarker-guided antibiotic discontinuation, diagnostic stewardship using a rapid molecular test to distinguish viral from bacterial infections, embedding AMS decision support into electronic medical records, and tailoring interventions to high-risk settings such as ICUs-demonstrated the feasibility of reducing unnecessary antimicrobial use (AMU) even during crisis conditions. Also, vaccination against SARS-CoV-2 may indirectly reduce AMU and AMR by lowering the incidence of severe disease and secondary bacterial infections. Future COVID-19-specific AMS frameworks must integrate these experiences during the pandemic. This review synthesizes current evidence on the interplay between COVID-19, AMR, and AMU, and outlines stewardship strategies to reduce AMR in COVID-19 management.

Smallpox, caused by the variola virus, remains a potential biosecurity threat despite its eradication. This study develops a mathematical model to evaluate outbreak scenarios and the effectiveness of reactive intervention strategies in controlling transmission, with application to the Republic of Korea. The model incorporates age-stratified contact patterns, contact tracing, and vaccination strategies, including targeted vaccination and mass vaccination. Our simulations demonstrate that early outbreak recognition and rapid intervention are critical in mitigating smallpox spread. In scenarios where vaccination rollout was slow or outbreak recognition was delayed, severe patient numbers exceeded healthcare capacity, highlighting the need for preemptive preparedness. Sensitivity analyses revealed that outbreak recognition timing and contact tracing effectiveness were the most influential factors in determining outbreak severity, with later recognition leading to up to 3.5 times more cumulative cases. Furthermore, we compared different vaccination prioritization strategies and found that prioritizing high-transmission age groups was more effective in reducing total mortality than prioritizing high-risk groups based solely on disease severity. This contrasts with COVID-19 vaccination strategies, which focused on protecting vulnerable populations. These findings underscore the importance of early detection, strategic vaccination, and non-pharmaceutical interventions in mitigating a potential smallpox outbreak. Our model provides a quantitative framework for policymakers to evaluate intervention effectiveness and optimize outbreak response strategies.

BACKGROUND: This study aimed to analyze the coronavirus disease-19 (COVID-19) response in long-term care hospitals (LTCHs) and establish a preparedness and management framework for addressing novel infectious diseases. METHODS: A national survey was conducted in Korea between June 19 and June 30, 2023. Using an anonymous online questionnaire, the survey gathered information on the general characteristics of participating hospitals, preparedness for infectious diseases in LTCHs prior to the COVID-19 pandemic, preparedness for in-house outbreaks during the COVID-19 pandemic, experiences of in-house COVID-19 outbreaks, and a section related to vaccines and treatments. RESULTS: Of the 1,425 domestic LTCHs, 201 (14.1%) completed the survey. Of the 201, before the COVID-19 pandemic, 24.9% of LTCHs had a disaster preparedness team and 27.9% had conducted training for infectious disease disaster preparedness. During the COVID-19 pandemic, 99.0% of the institutions established response teams for preparedness against COVID-19, and 89.1% of the 201 institutions experienced in-house outbreaks. Most institutions had experienced shortages of materials (78.8%), staff (96.1%), and caregivers (88.3%). The COVID-19 treatments prescribed at the LTCFs were: nirmatrelvir/ritonavir (86.6%), molnupiravir (36.8%), and remdesivir (22.4%). Independent vaccination was administered in 99% of the institutions. CONCLUSIONS: Despite the establishment of response systems, most LTCHs experienced in-house outbreaks during the COVID-19 pandemic. These institutions commonly faced challenges such as staffing shortages and supply constraints. To ensure better preparedness for future outbreaks, infection control systems should be regularly evaluated and maintained through ongoing training, even during non-outbreak periods.