Bedside Snapshot

Use It For: Anaerobic coverage in intra-abdominal, pelvic and brain abscess infections (with an aerobic agent); fulminant C. difficile (IV, with oral vancomycin); trichomoniasis and bacterial vaginosis; amebiasis
Adult Dose: Anaerobic: 500 mg IV/PO every 8 hr (max 4 g/day). Differs from FDA label: 7.5 mg/kg every 6 hr
Fulminant C. diff: 500 mg IV every 8 hr + vancomycin
Trichomoniasis: 500 mg PO twice daily x 7 days (women); 2 g once (men)
Pediatric Dose: Children: 30–40 mg/kg/day IV divided every 8 hr (max 500 mg/dose); off-label from 4 months. Differs from FDA label: IV labeled under 4 months only. Under 4 months: 15 mg/kg IV load, then 7.5 mg/kg every 6–12 hr
Onset / Duration: IV: peak at end of 1-hr infusion / dosed every 6–8 hr; PO: peak 1–2 hr / dosed every 8–12 hr
Do Not Give / Hold If: Nitroimidazole allergy; disulfiram in the past 2 weeks; alcohol or propylene glycol during and 3 days after use (label; CDC differs); Cockayne syndrome. Stop for ataxia, confusion, seizure, neuropathy or blistering rash
Watch For: Encephalopathy or cerebellar signs (ataxia, dysarthria, nystagmus); seizures; peripheral neuropathy on long courses; rising INR with warfarin; SJS/TEN or DRESS
Reversal / Rescue: No antidote: stop the drug and give supportive care; benzodiazepine for seizures; hemodialysis removes metronidazole and its metabolites
Must Remember: Anaerobes and protozoa only: pair with an aerobic agent for mixed infection. For anaerobic coverage, do not add it to piperacillin-tazobactam or a carbapenem (fulminant C. difficile is a separate indication)

Indications

ED / ICU / Transport

Complicated intra-abdominal infection: perforation, abscess, peritonitis or complicated appendicitis. Anaerobes need coverage here, so pair it with an aerobic agent such as ceftriaxone
Fulminant Clostridioides difficile infection. Add IV metronidazole to oral or nasogastric vancomycin. It matters most with ileus
Community-acquired brain abscess. Start empiric therapy alongside a third-generation cephalosporin
Gynecologic infection: pelvic inflammatory disease (PID), tubo-ovarian abscess, endometritis and post-surgical vaginal cuff infection
Anaerobic skin and soft-tissue infection. Think of it for polymicrobial (type 1) necrotizing infection. It works as part of combination therapy
Other serious anaerobic infections: Bacteroides bacteremia, lung abscess or empyema, endocarditis, and bone and joint infection (adjunct)
Generalized tetanus. An antibiotic option, alongside wound debridement, tetanus immune globulin and supportive care. Some clinicians prefer it over penicillin, a GABA-A antagonist. Trials have not shown a clinical advantage
Colorectal surgical prophylaxis. Given with cefazolin before contaminated or clean-contaminated bowel surgery

Other Uses

Trichomoniasis. First-line for women and men. Treat the sex partners too
Bacterial vaginosis. Given orally or as an intravaginal gel
Amebiasis. Amebic dysentery and amebic liver abscess. A luminal agent follows
Giardiasis. An alternative agent, used off-label
Helicobacter pylori eradication. One piece of bismuth quadruple therapy, such as the Pylera combination capsule

Dosing & Administration

The doses below follow current guideline practice. Where the FDA label differs, the row says so.

Available Forms

IV premixed bag: 5 mg/mL in 100 mL (500 mg) single-dose, ready-to-use, iso-osmotic buffered solution; contains 14 mEq sodium per bag.
Tablets: 250 mg and 500 mg
Capsules: 375 mg (Flagyl)
Oral suspension: 500 mg/5 mL (100 mg/mL) (Likmez); check the concentration before measuring pediatric doses
Vaginal gel: 0.75% (5 g applicator)

Adult Dosing

Indication	Dose & Route	Repeat / Max	Notes
Anaerobic or mixed infection (intra-abdominal, pelvic, skin, bacteremia)	500 mg IV/PO every 8 hr	Max 4 g/day; usual course 7–10 days	With an aerobic agent for mixed or polymicrobial infection (e.g. ceftriaxone or ciprofloxacin). Differs from FDA label: 15 mg/kg (about 1 g) load, then 7.5 mg/kg (about 500 mg) every 6 hr
Community-acquired brain abscess	500 mg IV every 6–8 hr	Max 4 g/day; usually 6–8 weeks total	With a third-generation cephalosporin; aspiration or excision whenever feasible
Fulminant C. difficile (shock, ileus or megacolon)	500 mg IV every 8 hr	Max 1.5 g/day; with vancomycin	Plus vancomycin 500 mg PO/NG every 6 hr; add rectal vancomycin if ileus
Nonsevere C. difficile, only if vancomycin and fidaxomicin are unavailable	500 mg PO 3 times daily for 10 days	Max 1.5 g/day	Less effective than vancomycin or fidaxomicin; avoid repeated or prolonged courses (cumulative neurotoxicity)
PID (with ceftriaxone and doxycycline)	500 mg PO/IV every 12 hr	Max 1 g/day; 14 days total	Inpatient: with ceftriaxone 1 g IV every 24 hr and doxycycline 100 mg every 12 hr; outpatient: ceftriaxone 500 mg IM once. Oral 24–48 hr after improvement
Trichomoniasis	Women: 500 mg PO twice daily for 7 days. Men: 2 g PO once	Max 2 g/day	Differs from FDA label: 250 mg PO three times daily for 7 days (women). CDC 2021: retest sexually active women about 3 months after treatment. Treat partners. Alternative: tinidazole 2 g PO once (avoid in pregnancy)
Bacterial vaginosis	500 mg PO twice daily for 7 days, or 0.75% gel 5 g intravaginally once daily for 5 days	Max 1 g/day PO	Treat every symptomatic pregnant patient
Amebiasis	Dysentery: 750 mg PO 3 times daily for 5–10 days. Liver abscess: 500–750 mg PO 3 times daily for 5–10 days	Max 2.25 g/day	Then a luminal agent (e.g. paromomycin)
Colorectal surgical prophylaxis	500 mg IV plus cefazolin 2 g (3 g if 120 kg or more), started within 60 min before incision	Single dose; metronidazole needs no routine redose (cefazolin every 4 hr in long cases)	SHEA/IDSA/APIC 2022: stop prophylaxis at incision closure; postoperative doses are not recommended. Differs from FDA label: the label regimen is 15 mg/kg about 1 hr before surgery, then 7.5 mg/kg at 6 and 12 hr after. Elective colorectal surgery also uses an oral antibiotic bowel preparation (commonly oral neomycin with oral metronidazole) per institutional protocol

Pediatric Dosing

Indication	Dose (per kg) & Route	Max Single / Max Total	Notes
Anaerobic or intra-abdominal infection (children)	Complicated intra-abdominal infection: 30–40 mg/kg/day IV divided every 8 hr (10–13 mg/kg/dose); same dose PO once absorbing	Max 500 mg/dose (adult dose)	With an aerobic agent. SIS/IDSA 2010 dose. Differs from FDA label: labeled IV use is for infants under 4 months only, so this is off-label from 4 months of age
Infants under 4 months: intra-abdominal infection	15 mg/kg IV load, then 7.5 mg/kg starting 24 hr later: every 12 hr (postmenstrual age 23 to under 34 weeks), every 8 hr (34–40 weeks), every 6 hr (over 40–48 weeks)	Load 15 mg/kg once; maintenance 7.5 mg/kg/dose	FDA-labeled
Nonsevere C. difficile	7.5 mg/kg PO every 8 hr for 10 days	Max 500 mg/dose	Oral vancomycin is preferred for severe disease
Amebiasis	35–50 mg/kg/day PO divided 3 times daily for 10 days	Max 750 mg/dose; 2,250 mg/day	FDA-labeled (cap stated on the Likmez label); then a luminal agent
Bowel surgery prophylaxis	15 mg/kg IV once, with cefazolin 30 mg/kg (max 2 g), started within 60 min before incision. Neonates under 1,200 g: 7.5 mg/kg once	Max 500 mg (adult dose)	ASHP doses; regimens vary by institution

Adolescents with trichomoniasis, bacterial vaginosis or PID get the adult regimens. Check your math against weight-based dosing.

Preparation & Administration

Dilution: none; the premixed bag is ready to use. Do not add other drugs to the bag
Rate: slow IV infusion only, never IV push; treatment doses over 1 hr per label, prophylaxis doses over 30–60 min
Piggyback: stop the primary fluid during the metronidazole infusion
Equipment: do not use needles or cannulae containing aluminum (precipitate forms)
Air embolism: never connect bags in series, pressurize a bag with residual air or use a vented administration set with the vent open
IV to oral: switch once the patient takes and absorbs oral medication; same dose

Dosing Notes:

In practice, adult doses stay fixed. The label's mg/kg regimen works out to about 500 mg for a 70 kg adult.
Look in Special Populations for hepatic and dialysis adjustments.

Contraindications & Precautions

Contraindications

Prior hypersensitivity to metronidazole or another nitroimidazole (e.g. tinidazole); IgE-mediated allergy with trichomoniasis: desensitize with an allergy specialist
Disulfiram taken within the past 2 weeks (psychotic reactions)
Alcohol or propylene glycol-containing products during therapy and for at least 3 days after (labeled; see Interactions for the CDC view)
Cockayne syndrome (fatal acute liver failure, onset as early as 2 days)
First trimester of pregnancy for trichomoniasis on current generic tablet labels (e.g. Teva 2024); CDC 2021 treats trichomoniasis at any stage of pregnancy

Precautions

Seizure disorder or CNS disease: encephalopathy, cerebellar toxicity and seizures can all happen
Severe hepatic impairment or hepatic encephalopathy: the drug builds up. CNS effects get worse
Severe renal impairment or ESRD: metabolites build up. Watch for adverse effects
Blood dyscrasia: agranulocytosis, leukopenia and neutropenia reported
Heart failure, edema, sodium restriction or corticosteroids: each 500 mg bag adds 14 mEq sodium
QT-prolonging drugs: QT prolongation has been reported with the combination

Hold / Reassess If

Ataxia, dysarthria, nystagmus, confusion, seizure or new numbness or paresthesia: stop
Rash with blisters, mucosal lesions, fever or eosinophilia (SJS/TEN, DRESS, AGEP): stop
New neutropenia on CBC: reassess and consider an alternative

FDA Boxed Warning: In mice and rats, metronidazole has caused cancer. Avoid unnecessary use. Save it for infections that call for it.

Adverse Effects & Toxicity

Common

Nausea, vomiting, abdominal pain, diarrhea, reduced appetite
Metallic or altered taste
Headache, dizziness and vertigo
Dark or reddish-brown urine (harmless)
Vaginal candidiasis
Infusion-site reactions

Serious / Life-Threatening

Effect	Recognition	Management
Encephalopathy and cerebellar toxicity	Confusion, reduced consciousness; ataxia, dysarthria, nystagmus; MRI T2/FLAIR lesions in the dentate nuclei	Stop; supportive care; usually reverses within days to weeks
Seizures	New convulsions	Stop; benzodiazepine per protocol
Peripheral and optic neuropathy	Symmetric numbness or paresthesia of the extremities; vision change	Stop; may persist after the drug is stopped
Aseptic meningitis	Headache, fever, neck stiffness within hours of a dose	Stop; resolves after discontinuation
Severe cutaneous reactions (SJS/TEN, DRESS, AGEP)	Rash with blisters, mucosal lesions, fever, eosinophilia	Stop immediately; burn or dermatology care
Acute liver failure in Cockayne syndrome	Jaundice, rising transaminases within days of starting	Contraindicated; stop and give hepatic support
Agranulocytosis, neutropenia, thrombocytopenia	Fever, infection, bleeding or bruising; falling neutrophil or platelet count	Stop; CBC; seek an alternative
Pancreatitis	Epigastric pain radiating to the back, vomiting, raised lipase	Stop; usually resolves after withdrawal
Jaundice or raised liver enzymes	Yellow skin or sclerae; rising AST/ALT	Check liver tests; stop if drug-related
Ototoxicity	Tinnitus, hearing impairment or hearing loss	Stop and reassess
Anaphylaxis	Hypotension, wheeze, urticaria during or after a dose	Stop; epinephrine IM, airway and fluids

Overdose & Toxicity Management

Signs: nausea, vomiting, ataxia, confusion, disorientation, seizures and peripheral neuropathy
Management: stop the drug; supportive and symptomatic care; treat seizures with a benzodiazepine per protocol
No antidote: hemodialysis clears a meaningful amount of metronidazole and its metabolites

Monitoring

Parameter	When / How Often	Target / Act If
Clinical: neurologic status	Every assessment; closer with long courses, liver disease or ESRD	Ataxia, slurred speech, confusion, seizure or numbness: stop; consider MRI
Clinical: infection response	Temperature, heart rate, BP, mental status, WBC	No improvement: review source control and aerobic coverage
Clinical: fluid and sodium load	Daily weight and edema in heart failure or sodium restriction	Edema or rising weight: account for 14 mEq sodium per bag
Clinical: nasogastric suction	Continuous gastric suction during IV therapy	Suction can lower serum levels: watch the clinical response
Laboratory: CBC	Before, during and after prolonged or repeated courses	Neutropenia or agranulocytosis: reassess (CBC)
Laboratory: liver function	Baseline in known liver disease; recheck if jaundice or symptoms of liver injury develop	Child-Pugh C: halve the dose (liver panel)
Laboratory: PT/INR	At start, during and after stopping in warfarin users	INR rising: adjust warfarin; check for bleeding (PT/INR)
Laboratory: lithium and creatinine	Frequently in patients on lithium	Level rising: adjust lithium (lithium)
Drug levels: phenytoin and CYP3A4 substrates	During and after therapy in patients on phenytoin, tacrolimus, cyclosporine or carbamazepine	Level rising or signs of toxicity (e.g. nystagmus, ataxia with phenytoin): adjust the interacting drug
Laboratory: assay interference	AST, ALT, LDH, triglyceride and hexokinase glucose results	Can read falsely low: question unexpected lows
ECG: QTc	Baseline and after starting when combined with QT-prolonging drugs	QTc lengthening: review interacting drugs

Interactions & Compatibility

Clinically Significant Interactions

Drug / Class	Effect	What To Do
Alcohol and propylene glycol-containing products	Labeled disulfiram-like reaction: cramps, vomiting, headache, flushing, tachycardia	Label: avoid during and for 3 days after; CDC 2021 calls abstinence unnecessary. Counsel per local practice, including that some liquid medicines and mouthwashes contain alcohol or propylene glycol
Disulfiram	Psychosis and confusion	Do not give if disulfiram was taken in the past 2 weeks
Warfarin and other coumarins	INR rises; bleeding	Check INR closely; adjust the warfarin dose
Lithium	Raised lithium levels and toxicity	Monitor lithium and creatinine frequently
Busulfan; 5-fluorouracil	Reduced clearance: busulfan toxicity (sinusoidal obstruction); 5-fluorouracil toxicity	Avoid with busulfan (if essential, monitor busulfan levels); monitor for 5-fluorouracil toxicity
CYP3A4 substrates (amiodarone, tacrolimus, cyclosporine, carbamazepine, phenytoin, quinidine)	Substrate levels rise	Monitor drug levels
Phenytoin (two-way), phenobarbital; cimetidine	Phenytoin and phenobarbital speed metronidazole clearance (possible treatment failure); metronidazole can impair phenytoin clearance. Cimetidine slows metronidazole clearance	Check phenytoin levels and watch for phenytoin toxicity; watch for treatment failure, or metronidazole toxicity with cimetidine
Vecuronium	Prolonged neuromuscular blockade	Monitor train-of-four; anticipate longer paralysis

IV Compatibility

Supplied ready to use: no further dilution; add nothing to the bag unless compatibility is known
Labeled incompatibilities: aztreonam, cefamandole, cefoxitin and penicillin G (list not exhaustive)
Piggyback: stop the primary infusion while metronidazole runs
Look it up in your institutional compatibility resource. Don't assume.

Special Populations

Pediatrics: labeled only for IV use in infants under 4 months (intra-abdominal infection) and for oral amebiasis. Other dosing follows guideline references. The Pediatric Dosing table has the numbers.
Neonates: the half-life runs from 109 hr at 28 weeks' gestation down to 22.5 hr at term. Set the interval by postmenstrual age.
Pregnancy: it crosses the placenta. Across more than 5,000 exposed pregnancies, many in the first trimester, no consistent rise in birth defects shows up. CDC treats trichomoniasis and bacterial vaginosis at any stage. Don't withhold it for a serious infection.
Lactation: milk levels match maternal plasma. The label offers pump and discard during therapy and for 24 hr (IV) to 48 hr (oral) after. CDC sees lower doses as compatible with breastfeeding. Some clinicians wait 12–24 hr after a 2 g dose before feeding.
Older Adults: after age 70 the active hydroxy metabolite runs 40–80% higher. Watch for neurotoxicity.
Renal Impairment: mild to moderate impairment needs no adjustment. In severe impairment or ESRD, metabolites build up, so monitor. Hemodialysis strips out 40–65% of a dose. Dose after dialysis, or supplement. Peritoneal dialysis (CAPD) needs no dose adjustment, but watch for toxicity as metabolites accumulate.
Hepatic Impairment: Child-Pugh C: cut the dose by 50%. Child-Pugh A or B: no adjustment. Keep monitoring.
Obesity / Dosing Weight: adult doses stay fixed, usually at 500 mg. The label names no dosing weight. Max 4 g/day.
Cockayne Syndrome: contraindicated because of rapid, fatal liver failure.

Field & Transport Considerations

Scope: most EMS agencies don't carry it. Critical-care transport crews (Paramedic/RN/CCT) may keep a running infusion going on an interfacility transfer. That varies by state and agency protocol.
Storage & Stability: store at room temperature, 25°C (77°F), protected from light, in the overwrap until use; do not refrigerate.
Carried Concentration: one IV strength, 500 mg/100 mL. A pediatric dose is a partial volume. Confirm it is drawn or programmed that way, not as the whole bag.
Infusions in Transport: run on a pump over 1 hr; never pressurize the bag or use a vented set with the vent open.
Handoff Essentials: hand over the time of the last dose and when the next is due (every 6–12 hr by regimen). Include the companion aerobic antibiotic, source-control status, the baseline neurologic exam and any warfarin, lithium or phenytoin use.

Clinical Pearls

New Ataxia on Metronidazole: Slurred speech, nystagmus, an unsteady gait or confusion during a long course points to metronidazole encephalopathy or cerebellar toxicity. The MRI lesions sit in the dentate nucleus. Stop the drug. Most patients recover in days to weeks.

Who Already Covers Anaerobes:

Metronidazole covers anaerobes and protozoa. It covers no aerobes.
Piperacillin-tazobactam and carbapenems are used alone for intra-abdominal infection. Adding metronidazole is redundant.
Ceftriaxone, cefotaxime and ciprofloxacin need metronidazole added for anaerobes.

Exam Discriminator, Fulminant C. difficile: Oral metronidazole is no longer first-line for C. difficile. IV metronidazole earns its place in fulminant disease. When ileus stops oral vancomycin from getting to the colon, IV metronidazole can still reach the inflamed colon.

Aspiration Pneumonia: ATS/IDSA advise against adding anaerobic coverage as routine for suspected aspiration pneumonia. Save it for lung abscess or empyema.

Oral Works as Well as IV: Oral and IV metronidazole reach similar blood levels. Once the gut works, switch to oral. You skip a line and 14 mEq of sodium per dose.

Paralysis Lasting Longer: Metronidazole can potentiate vecuronium. Ventilated ICU patient on both? Check train-of-four before you redose the paralytic.

Pharmacology

Mechanism of Action

A prodrug. It slips into cells by passive diffusion, then gets reduced by low-redox electron carriers (e.g. ferredoxin) found in anaerobes and protozoa
The reduced nitro radicals damage DNA and block its synthesis. The organism dies (bactericidal)
Aerobic and facultative bacteria can't activate it. That is why it has no clinically useful aerobic activity
Resistance comes from reduced uptake or activation, efflux and DNA repair

Pharmacokinetics

Route	Onset	Peak	Duration
IV	Therapeutic levels during the infusion	End of 1-hr infusion	6–8 hr dosing interval
PO	Well absorbed; disposition similar to IV	1–2 hr	8–12 hr dosing interval

Half-life: about 8 hr in healthy adults. It runs longer in neonates and in severe hepatic impairment
Metabolism: hepatic side-chain oxidation and glucuronidation
Active metabolites: the hydroxy metabolite still has antimicrobial activity. It builds up in ESRD and in older adults
Elimination: 60–80% in urine (about 20% unchanged), 6–15% in feces
Protein binding / distribution: under 20% bound. CSF and breast milk levels track plasma. It reaches bactericidal levels in abscess pus

Names & Classification

Generic Name: Metronidazole
Brand Names: Flagyl (375 mg capsules); Likmez (oral suspension); Pylera (combination with bismuth subcitrate potassium and tetracycline); generic tablets, IV bags and vaginal gel
Pharmacologic Class: Nitroimidazole antibiotic
Therapeutic Class: Antibacterial (anaerobic) and antiprotozoal
Controlled Substance: Not controlled
ISMP High-Alert: No
Look-Alike / Sound-Alike: metroNIDAZOLE / metFORMIN (ISMP confused drug names and tall-man lists)

References

Baxter Healthcare Corporation. (2025). Metronidazole Injection, USP in plastic container: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9d762edb-12ac-429d-b1f0-7af5d3b909d4
Teva Pharmaceuticals USA, Inc. (2024). Metronidazole Tablets, USP: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=291a45f6-ed27-4dcc-8364-358d08623797
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., et al. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70(3), 195–283. https://doi.org/10.2146/ajhp120568
Solomkin, J. S., Mazuski, J. E., Bradley, J. S., et al. (2010). Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clinical Infectious Diseases, 50(2), 133–164. https://doi.org/10.1086/649554
McDonald, L. C., Gerding, D. N., Johnson, S., et al. (2018). Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases, 66(7), e1–e48. https://doi.org/10.1093/cid/cix1085
Workowski, K. A., Bachmann, L. H., Chan, P. A., et al. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1
Bodilsen, J., D'Alessandris, Q. G., Humphreys, H., et al. (2024). European Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clinical Microbiology and Infection, 30(1), 66–89. https://doi.org/10.1016/j.cmi.2023.08.016
Bishop, E. J., & Tiruvoipati, R. (2023). Management of Clostridioides difficile infection in adults and challenges in clinical practice: Review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines. Journal of Antimicrobial Chemotherapy, 78(1), 21–30. https://doi.org/10.1093/jac/dkac404
Rodrigo, C., Fernando, D., & Rajapakse, S. (2014). Pharmacological management of tetanus: an evidence-based review. Critical Care, 18, 217. https://doi.org/10.1186/cc13797
Saptalis Pharmaceuticals, LLC. (2025). Likmez (metronidazole) oral suspension: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e20c14eb-5361-4a93-ab46-a7bd9aeb9b98
Metlay, J. P., Waterer, G. W., Long, A. C., et al. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST
Calderwood, M. S., Anderson, D. J., Bratzler, D. W., et al. (2023). Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 44(5), 695–720. https://doi.org/10.1017/ice.2023.67

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