Breakpoints

Small hospitals bring unique stewardship challenges, but also unique opportunities. Dr. Tina Khadem and Dr. Ashley Cubillos join host Dr. Whitney Buckel to discuss the realities of antimicrobial stewardship in small and critical access hospitals. From navigating competing priorities and limited resources, to building strong provider relationships in close-knit communities, we have you covered! Join us as we unpack real-world strategies, challenge common perceptions, and highlight the practical pearls you can apply in your own setting.

References:

Implementation of Core Elements at Small and Critical Access Hospitals: https://www.cdc.gov/antibiotic-use/media/pdfs/core-elements-small-critical-508.pdf

Stenehjem E, Hyun DY, Septimus E, Yu KC, Meyer M, Raj D, Srinivasan A. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clin Infect Dis. 2017 Aug 15;65(4):691-696.

Veillette JJ, May SS, Gabrellas AD, Gelman SS, Albritton J, Lyons MD, Stenehjem EA, Webb BJ, Dalto JD, Throneberry SK, Stanfield V, Grisel NA, Vento TJ. A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals. Open Forum Infect Dis. 2022 Oct 14;9(11):ofac549.

Cubillos AL, Fortier K, Hoang A. P-920. Impact of Positive Blood Culture Antimicrobial Stewardship on Staphylococcus aureus Bloodstream Infection Management across Critical Access, Small, and Medium Community Hospitals. Open Forum Infect Dis. 2026 Jan 11;13(Suppl 1):ofaf695.1126.

Smith LM, Ahern JW. Establishing Antibiotic Stewardship Programs in Rural Hospitals to Decrease Fluoroquinolone Prescribing: The Vermont Experience. Infect Prev Pract. 2021 Jan 21;3(1):100121.

Kassamali-Escobar Z, et al. Antimicrob Steward Healthc Epidemiol 2024. doi: 10.1017/ash.2024.458. Imlay H, Ciarkowski CE, Bryson-Cahn C, et al Infect Control Hosp Epidemiol 2025. 46: 150–155, doi: 10.1017/ice.2024.206

Ciarkowski CE, Imlay HN, Bryson-Cahn C, et al. Infect Control Hosp Epidemiol 2025. 46: 143–149, doi: 10.1017/ice.2024.171

Stenehjem E, et al. JAMA Netw Open. 2023;6(5):e2313011. doi:10.1001/jamanetworkopen.2023.13011

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About

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SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

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Professor Mical Paul and Professor Jesús Rodríguez-Baño join Professor Josh Davis and Dr Erin McCreary for a special Breakpoints and Communicable podcast collaboration. This episode discusses the ‘Trials Run’ session at ESCMID Global, where two randomized, clinical trials are presented in great depth. This year, both trials focused on treatment of cephalosporin-resistant Enterobacterales bacteremia. Listen to the authors describe why they performed these trials, results, and implications for clinical practice.

References:

1.      Paul, M., & Rodríguez-Baño, J. (2026, April 20). The trial run: treatment of ESBL bacteraemia[LW1]  - off to never-never land. [Presentation]. ESCMID Global 2026, Munich, Germany. ESCMID Global Virtual Platform.

2.      Bitterman R, Koppel F, Mussini C, et al. Piperacillin-tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen). BMJ Open. 2021;11(2):e040210. Published 2021 Feb 8. doi:10.1136/bmjopen-2020-040210

3.      Marín-Candón A, Rosso-Fernández CM, Bustos de Godoy N, et al. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): protocol for a randomised, pragmatic trial [Internet]. BMJ Open. 2021 Sep 27;11(9):e049481. Available from: bmj.com doi: 10.1136/bmjopen-2021-049481

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About

Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en

Facebook: https://www.facebook.com/sidprx

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SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Climate change in the context of healthcare can feel overwhelming but it doesn’t have to be paralyzing. We’re diving into the intersection of climate change and antimicrobial resistance with a focus on practical, actionable steps healthcare organizations can take.   Drs. Shreya Doshi, Andrea Pallotta and Preeti Jaggi join Dr. Whitney Buckel to talk about what’s real, what matters for healthcare, and where stewardship teams can make a meaningful impact.

References:

1.       Sustainabil‑ID. https://sustainabil-id.com/

2.       National Academy of Medicine. Climate Collaborative.https://nam.edu/our-work/programs/climate-and-health/climate-collaborative/

3.       Medicine for a Changing Planet. https://www.medicineforachangingplanet.org

4.       Cascades Canada. https://cascadescanada.ca/

5.       EcoRxChoice. https://ecorxchoice.com

6.       Rx for Climate. https://www.rxforclimate.org/

7.       Practice Greenhealth. https://practicegreenhealth.org

8.       Healthcare Without Harm. https://healthcarewithoutharm.org

9.       Healthcare Sustainability and Infectious Diseases. _J Pediatric Infect Dis Soc._https://academic.oup.com/jpids/pages/healthcare-sustainability-and-infectious-diseases

10.    PubMed. PMID: 40434281. https://pubmed.ncbi.nlm.nih.gov/40434281/

11.    PubMed Central. PMC12616928. https://pmc.ncbi.nlm.nih.gov/articles/PMC12616928/

12.    Sustainable Healthcare Networks. Scale and spread quality improvement initiative promoting metronidazole IV‑to‑oral switch.https://networks.sustainablehealthcare.org.uk/resources/scale-and-spread-quality-improvement-initiative-promoting-metronidazole-iv-oral-switch-

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About

Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en

Facebook: https://www.facebook.com/sidprx

LinkedIn: https://www.linkedin.com/company/sidp/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Episode Notes

Complicated UTIs just got a whole lot less complicated—or did they? Dr. Dana Bowers and Kyle Molina (@kcmolinaID) join Dr. Whitney Buckel to break down what’s new, what’s controversial, and what this means for your day‑to‑day antimicrobial decisions. Join us as we dig into the biggest updates, the evidence behind them, and the clinical pearls you won’t want to miss.

References:

Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2024 Nov 4;7(11):e2444495.

Trautner BW, Cortes-Penfield NW, Gupta K, et al. Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. Published July 17, 2025. https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/

Kadry N, Natarajan M, Bein E, Kim P, Farley J. Discordant Clinical and Microbiological Outcomes Are Associated With Late Clinical Relapse in Clinical Trials for Complicated Urinary Tract Infections. Clin Infect Dis 2023;76(10:1768-1775. https://academic.oup.com/cid/article/76/10/1768/6980780

USCAST Oral cephalosporin STIC against S. aureus and E. coli meeting recording. https://www.youtube.com/watch?v=HieaVFAC08s

MacDougall C. A Cloudy Crystal Ball: Critically Assessing and Rethinking the Antibiogram. Clin Infect Dis. 2023;77(11):1501-1503. doi:10.1093/cid/ciad468

Koehl J, Spolsdoff D, Negaard B, et al. Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. Ann Emerg Med. 2025;85(3):240-248. doi:10.1016/j.annemergmed.2024.10.013

Dunne MW, Aronin SI, Das AF, et al. Sulopenem for the Treatment of Complicated Urinary Tract Infections Including Pyelonephritis: A Phase 3, Randomized Trial. Clin Infect Dis. 2023;76(1):78-88. doi:10.1093/cid/ciac704

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About

Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en

Facebook: https://www.facebook.com/sidprx

LinkedIn: https://www.linkedin.com/company/sidp/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

In this third collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite two veteran authors of guidelines and guidances, Pranita Tamma (Philadelphia, USA) and Benedikt Huttner (WHO, Geneva, Switzerland) [1-3]. Together, they deconstruct the complex landscape of developing and implementing guidelines into digestible components: they discuss why different organizations develop guidelines and what need they hope to fulfil, the framework including the GRADE methodology under which guidelines are written, and major barriers in the uptake of guidelines. The conversation also details the distinction between guideline and guidance as well as the art and science behind formulating recommendations or suggestions, with a few anecdotal cases sprinkled in from the panel.

References

1. WHO handbook for guideline development, 2nd Edition, https://www.who.int/publications/i/item/9789241548960

2. The WHO AWaRe (Access, Watch, Reserve) antibiotic book https://www.who.int/publications/i/item/9789240062382

3. IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections, https://www.idsociety.org/practice-guideline/amr-guidance/

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About

Twitter: @SIDPharm (https://twitter.com/SIDPharm)

Instagram: @SIDPharm (https://www.instagram.com/sidpharm/)

Facebook: https://www.facebook.com/sidprx

LinkedIn: https://www.linkedin.com/company/sidp/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/