Sixty-one percent of intravenous drug users (IVDUs) who received outpatient parenteral antibiotic therapy (OPAT) failed treatment. Hospital readmission and adverse drug reactions occurred in 25%. By multivariate analysis, time since last IVDU was associated with failure (P = .04). Intravenous drug users requiring OPAT are at high risk for failure; additional studies are needed to explore alternatives.

To the Editor-Routine feedback of surgeon-and procedurespecific rates of surgical site infections (SSIs) reduces subsequent SSI rates. 1-3 In fact, SSI surveillance and feedback are cornerstones of SSI prevention. 4 Most hospitals in the United States use National Healthcare Safety Network (NHSN) surveillance definitions for SSI, which include 3 categories: superficial incisional, deep incisional, and organ-space infections. 5,6 Practical SSI surveillance definitions are integral to collecting data and providing meaningful feedback. Hospital infection prevention programs most commonly use culture-based surveillance for SSI. Deep incisional and organ-space SSIs are relatively easy to identify because they usually lead to hospital readmission, return trips to the operating room, and the use of intravenous antibiotics. 7 In contrast, accurate and complete surveillance data on superficial incisional SSIs are harder to collect due to surveillance bias and because they are commonly diagnosed in outpatient settings. Because wound cultures are not routinely obtained from many patients with superficial incisional SSIs, most infection prevention programs fail to detect many superficial incisional SSIs. Although the NHSN recommends the reporting of superficial incisional SSIs, only 1 of 3 standardized infection ratio (SIR) models used by the NSHN include superficial SSIs cases. Additionally, SSI data reported to CMS do not include superficial incisional SSI cases. 8 Superficial incisional SSIs vary widely in severity and clinical importance to both patients and their surgeons. 9,10 Some superficial incisional SSIs lead to serious morbidity, including readmission, surgical debridement in operating rooms, and long-term antibiotic therapy. We believe that including patients with serious superficial incisional SSIs (SSISSIs) in standard SSI surveillance could enhance and improve the benefit of surveillance and feedback of data to surgeons and better estimate the risk of harm when informing patients who are weighing the benefits and risks of surgery. The objectives of this study were to describe this group of patients and to outline our rationale for proposing a new category of SSIs.

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Financial support. No financial support was provided relevant to this article. Conflicts of interest. All authors report no conflicts of interest relevant to this article.

Staphylococcus aureus rarely causes prostatic abscess. We report five cases of S. aureus prostatic abscess in the setting of bacteremia at our institution that occurred between 12/2018 and 05/2019. Three of the cases were caused by MRSA, and four of the patients underwent drainage of the prostatic abscess. All five patients received a minimum of six weeks of antibiotic therapy. One of the five patients died during the course of their infection. S. aureus prostatic abscess with bacteremia is an uncommon but serious disease. Treatment should consist of a combination of prolonged antibiotic therapy and surgical drainage when feasible.

The 2021 focused update to the Infections Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines for management of Clostridioides difficile infection (CDI) prioritizes the use of fidaxomicin over vancomycin for the treatment of initial and recurrent CDI. These recommendations have significant clinical and financial ramifications for hospitals and patients with CDI. Antimicrobial stewardship programs must balance the needs, goals, and barriers faced by patients and health systems when determining the best treatment strategy for CDI. In this commentary, we provide antimicrobial stewardship programs with a decision-making framework that acknowledges the fundamental principles of ethics to provide equitable patient care.

Background Urinary tract infections (UTIs) are often misdiagnosed or treated with exceedingly broad-spectrum antibiotics, leading to negative downstream effects. We aimed to implement antimicrobial stewardship (AS) strategies targeting UTI prescribing in the emergency department (ED). Methods We conducted a quasi-experimental prospective AS intervention outlining appropriate UTI diagnosis and management across three EDs, within an academic and two community hospitals, in North Carolina, United States. The study was divided into three phases, a baseline period and two intervention phases. Phase 1 included introduction of an ED-specific urine antibiogram and UTI guideline, education, and department-specific feedback on UTI diagnosis and antibiotic prescribing. Phase 2 included re-education and provider-specific feedback. Eligible patients included adults with an antibiotic prescription for UTI diagnosed in the ED from 11/13/18 to 3/1/21. Admitted patients were excluded. The primary outcome was guideline-concordant antibiotic use, assessed using an interrupted time series regression analysis with 2-week intervals. Results Overall, 8,742 distinct patients with 10,426 patient encounters were included. Ninety-two percent of all encounters (n=9,583) were diagnosed with cystitis and 8.1% with pyelonephritis (n=843). There was an initial 15% increase in guideline-concordant antibiotic prescribing in Phase 1 compared to the pre-intervention period (incidence rate ratio [IRR] 1.15; 95% confidence interval [CI] 1.03 to 1.29). A significant increase of guideline-concordant prescriptions was seen with every two-week interval during Phase 2 (IRR 1.03; 95% CI 1.01 to 1.04). Conclusions This multifaceted AS intervention involving a guideline, education, and provider-specific feedback increased guideline-concordant antibiotic choices for treat-and-release patients in the ED.