Decades of biomarker research in sepsis have not translated into consistent changes in practice for hospital-acquired pneumonia (HAP). HAP remains among the most consequential healthcare-associated infections, contributing substantially to morbidity, mortality, and antimicrobial pressure in hospitalized patients. Its management is complicated by diagnostic imprecision and by pathogen heterogeneity, including a disproportionate burden of multidrug-resistant organisms. In this clinical setting, biomarkers have been introduced in clinical practice as adjunctive tools to support diagnostic frameworks and antibiotic stewardship, yet their integration into routine care remains variable and their limitations are frequently underappreciated. Moreover, most of the supporting evidence derives from ventilator-associated pneumonia (VAP), severe community-acquired pneumonia, or mixed sepsis populations, whereas most HAP occurs in non-ventilated patients, in whom biomarker-guided strategies remain largely unstudied. This narrative review argues that the clinical value of procalcitonin and C-reactive protein in HAP lies not in point-in-time diagnosis but in serial kinetic monitoring. We further argue that the value of biomarker-guided treatment-duration strategies specifically is context-dependent, diminishing as baseline antibiotic prescribing improves. We examine the evidence across the full spectrum of HAP management, diagnostic adjunction, treatment monitoring, de-escalation, and discontinuation, applying a clinical function-based framework derived from the NIH/FDA BEST taxonomy. We critically appraise the conditions under which biomarker guidance adds clinical value, specifically where empirical antibiotic courses are prolonged beyond recommended standards, and the contexts in which it does not. We critically appraise landmark trials, including PASS and ADAPT-SEPSIS, where biomarker-guided strategies paradoxically increased antibiotic exposure or failed to outperform already-adequate standard care, and contrast these with kinetic-guided discontinuation protocols, including double-trigger models embedded within digital clinical decision support, that meaningfully shortened treatment without compromising safety. The central message is not a dismissal of biomarkers but a conditional endorsement: their benefit depends on baseline prescribing habits, kinetic rather than threshold-based interpretation, and integration with clinical trajectory rather than substitution for it. Whether these principles extend to non-ventilated HAP requires dedicated evaluation. The immediate clinical priority is not measuring existing biomarkers less often but interpreting and integrating them more correctly within the clinical trajectory.
Antimicrobial stewardship (AMS) tools have been widely developed to support safe and effective antimicrobial prescribing in nursing homes (NHs). However, access to AMS tools developed and provided by AMS organisations might be hindered by the wide range of stakeholders involved in their development in France. This study aimed to develop an inventory method to systematically review AMS tools that we applied to the NH settings. Organisations involved in AMS at national, regional and local levels in France were mapped using an inductive approach. Their websites were searched until February 2025 to include AMS tools defined as materials used by healthcare professionals (HCPs) and other stakeholders to initiate or expand AMS activities in NHs. We used a tailored TIDieR checklist to characterise the selected tools. For each item of the checklist, characteristics were generated using the constant comparative method, and the CDC core elements of antibiotic stewardship for NHs were integrated as part of the checklist. A network analysis was performed to assess the collaborations between organisations that developed the selected tools. Of 541 AMS tools identified across 238 organisation websites, 96 were AMS tools for NHs and were included in the inventory. Most tools addressed the CDC core elements “Education” (n = 58, 60.4
The emergence or clonal dissemination of pathogenic bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), particularly those with enhanced virulence or infectivity, represents a major global concern. In our institution, we have implemented a continuous epidemiological surveillance strategy to detect and characterize all MRSA strains responsible for infection or identified during screening. Our group has developed molecular assays based primarily on PCR and real-time PCR, enabling rapid characterization of S. aureus and MRSA strains, including the detection of unusual genomic features. Our long-term surveillance strategy, conducted over the past 22 years, has revealed the replacement of previously prevalent hospital clones by strains exhibiting diverse genomic profiles associated with specific clinical clonal complexes. We also observed a shift among community-acquired isolates, from highly diverse profiles to a predominance of USA300 strains. More recently, assays targeting the SCCmec element showed an increasing number of MRSA strains that could not be typed. Whole-genome sequencing identified isolates harboring novel SCCmec elements. Sustained epidemiological surveillance is essential to monitor the ongoing evolution of MRSA genomic diversity and to detect emerging clones.
One of the significant issues in healthcare is the irrational prescription of antibiotics (IRAP). Rational antibiotic prescription (RAP) faces numerous barriers that may vary across different communities. The objective of this study was to identify barriers to the RAP in hospitals of a developing country and to propose appropriate solutions. This qualitative study was conducted in 2023 and 2024, involving 38 stakeholders in antibiotic prescription within five public hospitals in Zanjan, Abhar, and Kashan, Iran. The participants included physicians, administrators, pharmacologists, pharmacists, the secretary of the stewardship committee, microbiologists, laboratory managers, ICU nurses, nurse managers, quality improvement managers, infection control officers, and information technology (IT) managers. Participants were recruited using a purposive sampling method. Data were collected through semi-structured interviews, lasting between 25 and 50 min (mean duration: 37.5 min), and analyzed using conventional content analysis techniques with the aid of MAXQDA 2020 software for data organization. RAP barriers were categorized into five main categories, and 15 subcategories as follows: (1) prescribers’ characteristics, concerns and commitment (e.g. physicians concerns and fears for patients, physicians knowledge, attitude and behavior) (2), governance (e.g. poor guideline development and uptake, no clear lines of responsibility for a collaborative program, lack of integration of antibiotic stewardship program (ASP) into quality improvement program, post–prescription review for corrective interventions and improvement) (3), supporting structures and services (e.g. shortcomings in medication management, poor decontamination procedure for equipment, challenges for preventing and controlling healthcare-associated infections, poor diagnostics laboratory services, poor IT support) (4), health system policy and governance (e.g. poor understanding, knowledge, and interventions at local context, medicolegal aspects) (5), economic, social and cultural factors (e.g. pharmaceutical companies pressure and interventions, poor care seeking behavior). This study highlights the multiplicity and diversity of barriers to RAP in a developing country. Some of these barriers are hospital-level barriers, while others are health system–level or governance-related. Attention to legal aspects, continuous education for physicians, enhancements to structural and support services, and development and implementation of local clinical guidelines are among the most significant methods in resolving the issue of IRAP in hospitals. To address the barriers to RAP, implementing ASP, providing performance feedback to physicians, and enhancing IT infrastructure in hospitals are recommended.
Implementation of the infection control link nurse (ICLN) role could be a promising strategy to enhance infection prevention and control (IPC) in nursing homes. Yet, little is known about how this role is enacted in practice. This study therefore examines the implementation of the ICLN role in nursing homes, how ICLNs enact their role in practice, and the factors influencing role enactment. In this multimethod study, we administered two questionnaires (Q1: organizational implementation; Q2: local enactment), and conducted semi structured interviews with ICLNs working in nursing homes. Respondents were recruited via snowball sampling, from initial contacts identified through broad outreach and professional networks. Quantitative data were analyzed descriptively while qualitative data were analyzed using a thematic analysis-informed approach. Between June 2024 and January 2025, 118 questionnaires were completed and 21 semi-structured interviews were conducted with ICLNs. The questionnaire administered on organizational level (Q1) indicated that within most nursing home organizations ICLNs were appointed (30/36, 83.3
