Study highlights stewardship initiative in Massachusetts nursing homes

News brief

Nurse checking pulse of elderly woman — AlexRaths / iStock

A statewide antimicrobial stewardship program launched in Massachusetts offers insights into how stewardship can be operationalized in nursing homes, researchers reported late last week in Clinical Infectious Diseases.

The voluntary program, launched in 2018 by the Massachusetts Department of Health in collaboration with Tufts Medical Center, created a standardized mechanism for tracking antibiotic initiation in the state's long-term care (LTC) facilities. Antibiotics are among the most commonly prescribed medications in nursing homes, with at least half of residents receiving one or more antibiotic courses annually. But up to 75% of those antibiotic prescriptions have been found to be unnecessary. The statewide antibiotic start (AS) benchmarking initiative, implemented alongside other stewardship interventions (including educational outreach and structured office hours), aimed to promote data transparency and guide improvement efforts.

"Although well established in hospital settings, benchmarking remains underutilized in LTC despite its potential to support both facility- and system-level improvements," the study authors wrote.

Increase in guideline-concordant prescribing

Using an online platform, 217 Massachusetts LTC facilities submitted at least one month of AS data from 2018 through 2024. The median number of facilities reporting per month was 53, and participation increased from 18.8% to 24.2% of all LTC statewide facilities over the study period.

The overall AS rate rose 7%, from 7.22 to 7.70 starts per 1,000 resident-days. Penicillin/beta-lactamase inhibitors, first- and third-generation cephalosporins, fluoroquinolones, and tetracycline were the most frequently prescribed antibiotics, accounting for 62.7% of all starts. An interrupted time series analysis showed fluoroquinolone starts declined 36% over the study period, while beta-lactam starts increased 26%.

Despite the increase in AS, which could reflect shifts in the composition of participating facilities, the authors say the decline in fluoroquinolone use and concurrent increase in beta-lactam prescribing is "consistent with the intended stewardship outcomes reflecting safer, guideline-concordant prescribing practices."

"In summary, the Massachusetts Antibiotic Start Reporting Program demonstrates that antimicrobial stewardship in LTC is feasible through sustained public health-academic collaboration and a multicomponent approach," they concluded. "Its success derives from the combined impact of benchmarking, feedback, education, and recognition implemented over time, rather than from any single discrete intervention."

NIAID staffers ordered to remove biodefense, pandemic preparedness language on website

News brief

Mary Van Beusekom, MS

Working with pathogen in lab — *US National Guard, Ben Houtkooper / Flickr cc*

Staff members at the US National Institute of Allergy and Infectious Diseases (NIAID) have been told to delete the words “biodefense” and “pandemic preparedness” from the institute’s website, a move that experts say will hobble the United States’ ability to respond to future infectious disease threats, Nature reported late last week.

The journal said the directives were outlined in emails it obtained, but it didn’t name the person who sent them. It said four NIAID staffers spoke to Nature on the condition of anonymity because the institute didn’t authorize them to speak to media.

The staffers told Nature that NIAID, one of 27 institutes at the centers at the National Institutes of Health (NIH), likely will deprioritize its traditional research pillars of HIV, biodefense, and pandemic preparedness as part of a broader reorganization.

Just because we say we’re going to stop caring about these issues doesn’t make the issues go away—it just makes us less prepared.

Nahid Bhadelia, MD

Rather, the NIAID will now “address the most impactful infectious diseases that Americans currently face with evidence from gold standard science and … support innovative research to address fundamental studies in immunology and allergic and autoimmune diseases to improve patient outcomes,” Bhattacharya and colleagues wrote in a January 16 commentary in Nature Medicine.

Nahid Bhadelia, MD, director of Boston University’s Center on Emerging Infectious Diseases, told Nature that the deprioritization of biodefense and pandemic preparedness will weaken the United States’ ability to respond to pathogens that are constantly evolving in wildlife and spilling over into people. “Just because we say we’re going to stop caring about these issues doesn’t make the issues go away—it just makes us less prepared,” she said.

Shrinking investment in US readiness

Today, about a third of the institute’s $6.6 billion budget supports studies on pathogens of concern and developing ways to protect Americans from emerging infectious diseases and threats such as radiation and chemical threats, and $1.5 billion funds HIV/AIDS research projects.

Since President Donald Trump took office in January 2025, the NIH workforce has been reduced by roughly 20% through layoffs or resignations. In June 2025, officials also idled the Office of Pandemic Preparedness and Response Policy, which was launched in 2023 to maintain readiness to respond to biological threats and pathogens, including development of new vaccines and treatments.

Cambodia reports first H5N1 human case this year

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Stephanie Soucheray, MA

Cambodia’s Ministry of Health (MOH) has announced the country’s first highly pathogenic avian influenza (HPAI) H5 human infection since last November. This is the first case detected in 2026.

The case occurred in a 30-year-old man from Kampot Province. The patient is fully recovered and at home, and it is not clear from the MOH report how long he was hospitalized. The man had fever, abdominal pain, and cough.

The MOH said investigators found a dead chicken in the man’s house that was cooked roughly 3 days before he became ill.

Cambodia has reported 36 human H5 infections since 2023, and the case-fatality rates of these infections are high, at greater than 40%. Most recent cases in Cambodia have involved a reassortant (2.3.2.1e) between an older H5N1 clade that has circulated in Cambodia since 2014 and the newer clade 2.3.4.4b virus that is circulating globally.