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Background/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher’s exact test substituted where expected cell counts were below 5, with significance set at p < 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher’s exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher’s exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice.
Background Disease-modifying therapies have improved physical symptoms for many people with cystic fibrosis (PwCF), yet reported quality of life impairments remain high. Primary and specialist palliative care (SPC) are recommended for PwCF, but there are limited data on how SPC can best meet patient needs. Methods We conducted a multisite, randomized controlled trial of specialist palliative care vs regular CF care for adult PwCF.1 We analyzed interventionists’ checklists following SPC visits in a multisite, randomized clinical trial comparing SPC vs usual care alone for PwCF. Using qualitative software (Nvivo 15), we analyzed transcripts of audio recorded visits. Using standardized definitions of the National Consensus Guidelines’ eight palliative care domains, four analysts coded transcripts to analyze the time spent per domain. Results We analyzed checklists for 359 encounters and coded transcripts for 329 encounters for which audio recording was available, representing 113 unique patients. Median visit length was 38 minutes (range 7-115). Physical symptoms occupied 36% of visit time; social issues 23.5%, and psychological issues 14.5%. Advance care planning occupied16% of total time, and 6% was related to existential/spiritual issues. SPC interventionists’ logs indicate recommendations to add or change a therapy to address physical symptoms in 38% of visits, and to address psychological symptoms in 12%. Among all visits, 22% included referral to physical therapy, counseling, or other specialties. More than half of visits addressed coping and social roles; 27% addressed financial concerns. There were no significant differences between people taking or not taking modulator therapy; people with higher self-reported symptom burden spent significantly greater time on physical (p=.004) and psychological (p=.013) concerns. Discussion Complex, multidimensional challenges of living with chronic illness persist for PwCF even as physical health and life expectancy improve with new therapies. Understanding how PwCF use SPC suggests opportunities to enhance whole-person care over the CF lifespan.
BACKGROUND:Reports of ceftriaxone serious adverse events (SAEs), including deaths, from multiple jurisdictions during December 2024-January 2025 prompted a nationwide investigation to evaluate product safety, characterize SAEs, and assess for changes in baseline adverse event occurrence via national databases. METHODS:In February 2025, CDC issued a national call for cases, defined as SAEs involving death or CPR within six hours of ceftriaxone injection, not otherwise explained and occurring in non-ICU settings during September 2024-August 2025. Epidemiologic and clinical data were collected by health departments and reported to CDC. Laboratory testing of ceftriaxone and lidocaine diluent was performed at FDA. Temporal trends in adverse events (2016-2019 vs 2020-2024) were assessed via Medicare claims and National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance System analyses. RESULTS:Among 31 cases identified from 27 healthcare facilities (65% outpatient) across 18 states during September 2024-August 2025, all involving death or CPR, 12 (39%) persons died, 23 (74%) had anaphylaxis-type presentations (65% without skin/mucosal involvement), 21 (68%) had previous ceftriaxone exposure, and 24 (77%) had cardiac comorbidities. Median age was 67 years (IQR: 60-81). Antihypertensive use was common (n=19/28, 68%). Product testing revealed no evidence of tampering, adulteration, endotoxin, or purity/potency issues. National adverse event trends were stable across 2016-2019 and 2020-2024. CONCLUSIONS:SAEs, including deaths, can occur after ceftriaxone receipt. Product testing and trend analyses did not identify evidence of a new safety issue. This investigation highlights the need for ongoing vigilance for ceftriaxone SAEs and reporting to FDA MedWatch.
West Nile virus (WNV; Flaviviridae) and Eastern Equine Encephalitis virus (EEEV; Togaviridae) represent the two most significant mosquito-borne zoonoses in the southeastern United States. While both viruses utilize avian amplifying hosts and mosquito vectors, it is unclear if they occur within distinct ecological niches. This study assessed the cumulative effects of both landscape composition and weather variables on the spatial-temporal distribution of WNV and EEEV outbreaks in Georgia over a twenty-four-year period (2001-2025). We used a modeling framework that directly accounts for both spatial and temporal effects but additionally integrates key EO variables (Earth observation). These environmental effects were investigated using Bernoulli generalized linear mixed-effects models (GLMMs) and executed with an integrated nested Laplace approximation (INLA). Our findings revealed disproportional distribution ranges of Culex quinquefasciatus, Aedes albopictus and Culiseta melanura in highly urbanized Georgian counties such as Chatham, Dekalb, and Fulton. Results showed that WNV transmission was heavily influenced by urban land cover (Posterior Mean: +0.78, 95% CrI: [0.61,0.95]) but negatively associated with lagged precipitation (Posterior Mean: −0.18, 95% CrI: [−0.29, −0.07]), confirming drought-driven amplification. Conversely, EEEV transmission was strongly influenced by wetland cover (Posterior Mean: +1.12, 95% CrI: [0.94,1.30]) and precipitation (Posterior Mean: +0.51, 95% CrI: [0.39,0.63]). These results underscore the need for improved mosquito surveillance across all Georgian counties in the face of growing vector-borne disease risks.
Wednesday, October 22, 2025: 11:30 AM Background: Serious adverse events (SAEs) related to ceftriaxone, a widely used cephalosporin antibiotic, are considered rare. After a 2024 SAE cluster in Alabama, the Centers for Disease Control and Prevention (CDC), with state/local partners and the US Food and Drug Administration (FDA), conducted a nationwide investigation of SAEs, including deaths, among patients who received ceftriaxone.Table.Clinical summary of serious adverse event cases (n=26), September 2024–June 2025Abbreviations: SAE: serious adverse event, ACH: acute care hospital, ED: emergency department, OP: outpatient clinic, F: female, M: male, Pt: patient (used when sex not reported); NR: not reported, NOS: not otherwise specified, EKG: electrocardiogram, PEA: pulseless electrical activity, IV: intravenous, IM: intramuscular, N/A: not applicable, PMH: past medical history, CA: cancer, CAD: coronary artery disease, CHF: congestive heart failure, CKD/ESRD: chronic kidney disease or end stage renal disease; COPD: chronic obstructive pulmonary disease, DM: diabetes mellitus, HTN: hypertension, HLD: hyperlipidemia, dx: disease CPR: cardiopulmonary resuscitation.Figure 1a-b.Epidemic curve: Frequency of reported serious adverse event cases following ceftriaxone administration from September 2024 to June 2025, by event month and US region (a) or ceftriaxone manufacturer (b), n=26Figure includes SAEs meeting CDC case definition: Adverse events following injectable ceftriaxone exposure, occurring after September 1, 2024, which: 1) occurred within 6 hours after receipt of injectable ceftriaxone in a non-ICU setting, 2) resulted in death or required cardiopulmonary resuscitation (CPR), and 3) were not attributed by the treating provider(s) to a cause other than ceftriaxone administration (such as known infection, other underlying medical condition, or exposure to a medication or medical product other than ceftriaxone). Figure 1a (left) displays epidemic curve by US Census Bureau region, reflecting case-patient state of residence. Southern region includes AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV. Figure 1b (right) displays epidemic curve by the ceftriaxone product reported as administered to case-patient or present in the facility at the time of adverse event. Abbreviations: NR: not reported, US: United States. (R Core Team, 2024). Methods: CDC issued a national call for cases, defined as death or cardiopulmonary resuscitation within 6 hours of ceftriaxone receipt in non-intensive care settings without other apparent cause, occurring after Sep 1, 2024. Health departments collected clinical data for analysis at CDC. We further classified cases as anaphylaxis-type if determined by treating provider to be allergic or if involved two or more of: hypotension, respiratory compromise, cutaneous manifestations, and gastrointestinal symptoms. For SAEs reported Dec 2024-Jan 2025, FDA collected available ceftriaxone/diluent for testing and requested internal product investigations by manufacturers.Figure 2.Medications (other than ceftriaxone) prescribed proximal and prior to serious adverse event, by individual case-patient, n=23Abbreviations: ARB: angiotensin receptor blocker, ACE: angiotensin-converting enzyme, NSAID: non-steroidal anti-inflammatory drugs. Results: We report 26 cases (65% outpatient; 35% inpatient), including 12 deaths, from 22 healthcare facilities across 15 states from Sep 1, 2024 to Jun 30, 2025 (Figure 1a). Case-patients had a median age of 70 years (IQR: 60-81) and received 1g (n=15, 58%), 2g (n=9, 35%), or unspecified (n=2, 7%) ceftriaxone doses via intravenous (IV) push (n=15, 58%), IV infusion (n=9, 35%), or intramuscular injection (n=2, 7%). Presentations varied (Table); 69% (n=18) were anaphylaxis-type. Prior ceftriaxone exposure (n=16, 62%), cardiac comorbidities (n=20, 77%), and/or concurrent use of antihypertensives (n=17, 65%, Figure 2) were common. Product exposures included 22 lots from 6 ceftriaxone manufacturers (Figure 1b). FDA testing of ceftriaxone (5 lots, 4 manufacturers) and lidocaine diluent (3 lots, 2 manufacturers) found no evidence of tampering, adulteration, endotoxin, or purity/potency issues. Manufacturers (n=4) did not report product anomalies. Conclusion: SAEs, including deaths, can occur after ceftriaxone use. This investigation did not identify a common-source etiology, nor a link to a specific ceftriaxone product. Providers in all settings should monitor for SAEs, including anaphylaxis, and report to the FDA MedWatch Program. Disclosures: All Authors: No reported disclosures
