Antimicrobial resistance represents a major global health challenge, and hospital-based antimicrobial stewardship programs (ASPs) are essential for promoting appropriate antibiotic use. This study aimed to introduce and implement an ASP in a university hospital and to assess its impact on antibiotic prescribing patterns and patient outcomes. We conducted a single-center study including infectious disease (ID) consultations performed before ASP introduction (2023), during implementation (2024), and after full implementation (December 2024–February 2025). Primary outcomes were carbapenem prescriptions and antimicrobial stewardship interventions, while secondary outcomes included in-hospital mortality, 30-day in-hospital mortality, and length of hospital stay (LOS). A total of 1673 ID consultations involving 975 patients in pre- and post-interventional phases were analyzed. Carbapenem prescriptions progressively and significantly declined over the study phases (from 32.1% to 18.6%; adjusted OR 0.57 [95% CI 0.35–0.92] in Phase II and 0.39 [95% CI 0.22–0.70] in Phase III compared to Phase I). Antimicrobial stewardship interventions increased significantly over time (reaching 54.0% in Phase III; adjusted OR 1.94, 95% CI 1.40–2.69). No significant differences in 30-day in-hospital mortality or LOS were detected across the study phases. In conclusion, a structured ASP was associated with improved antibiotic prescribing practices, supporting its role as a key strategy for optimizing antimicrobial use in hospital settings.

We report the case of an HIV-positive man from the Peruvian Amazon presenting with a massive, exophytic perianal lesion progressively enlarging over one year. Despite preserved immune status and antiretroviral adherence, the lesion reached an unusually large size (approximately 17 × 13 cm in vertical and horizontal dimensions, respectively), exceeding dimensions typically reported in the literature for anal lesions of this entity (1). Microbiological investigation revealed Proteus mirabilis superinfection, while histopathological and molecular workup identified high-risk HPV type 16 using the GeneXpert® HPV assay applied directly to tissue — a diagnostic approach rarely reported. Notably, most existing literature describes the use of GeneXpert® and other molecular assays primarily on swab-based specimens (cervical, vaginal, urine, or anal canal). This case illustrates the potential off-label utility of GeneXpert® for rapid molecular confirmation of HPV directly from solid tissue samples in resource-limited settings where conventional pathology infrastructure may be delayed or unavailable.

Background: Human papillomavirus (HPV)-associated anal squamous cell carcinoma (SCC) is strongly linked to persistent infection with high-risk HPV genotypes, particularly in people living with human immunodeficiency virus (HIV), who experience higher rates of viral persistence and oncogenic progression. The burden of HPV-related malignancies is disproportionately higher in low-resource settings, where limited access to screening, histopathology, and specialist care contributes to delayed diagnosis and advanced-stage presentation. In such contexts, rapid molecular diagnostic tools may help overcome diagnostic delays and support earlier clinical decision-making. Case presentation: We describe an atypically presenting HPV-associated anal squamous cell carcinoma in a man living with HIV from the Peruvian Amazon, a region characterized by geographic and structural barriers to healthcare access. The patient presented with a large exophytic perianal lesion measuring 16 × 7 × 4 cm ³ , exceeding sizes typically reported in the literature and reflecting prolonged disease progression. High-risk HPV type 16 was detected using a GeneXpert® assay applied to solid tissue, an approach rarely described, as most available evidence and current guidelines focus on swab-based specimens. Histopathological confirmation of HPV-associated squamous cell carcinoma was delayed due to limited local pathology services. In the interim, molecular HPV testing contributed to early diagnostic orientation and clinical planning. Imaging findings raised suspicion for advanced disease, although definitive metastatic staging could not be established due to incomplete diagnostic workup. Conclusions: This case highlights the potential utility of tissue-based GeneXpert HPV testing as a rapid adjunctive diagnostic tool in resource-limited settings where access to histopathology is delayed. Early molecular identification of high-risk HPV may support timely clinical decision-making and facilitate linkage to care. However, its clinical impact remains constrained in the context of advanced disease at presentation, underscoring the importance of addressing structural barriers to early diagnosis and sustained HIV and cancer care in underserved regions.