{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:18:57Z","timestamp":1793531937926,"version":"4.5.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Certain antibiotic exposures have been associated with increased rates of acute graft-vs-host disease (aGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT). Since antibiotic exposure can both affect and be affected by infections, analyzing time-dependent exposure in the presence of multiple potential confounders, including prior antibiotic exposures, poses specific analytical challenges, necessitating both a large sample size and unique approaches.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify antibiotics and antibiotic exposure timeframes associated with subsequent aGVHD.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study assessed allo-HCT at a single center from 2010 to 2021. Participants included all patients aged at least 18 years who underwent their first T-replete allo-HCT, with at least 6 months of follow-up. Data were analyzed from August 1 to December 15, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Antibiotics between 7 days before and 30 days after transplant.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was grade II to IV aGVHD. The secondary outcome was grade III to IV aGVHD. Data were analyzed using 3 orthogonal methods: conventional Cox proportional hazard regression, marginal structural models, and machine learning.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 2023 patients (median [range] age, 55 [18-78] years; 1153 [57%] male) were eligible. Weeks 1 and 2 after HCT were the highest-risk intervals, with multiple antibiotic exposures associated with higher rates of subsequent aGVHD. In particular, exposure to carbapenems during weeks 1 and 2 after allo-HCT was consistently associated with increased risk of aGVHD (minimum hazard ratio [HR] among models, 2.75; 95% CI, 1.77-4.28), as was week 1 after allo-HCT exposure to combinations of penicillins with a \u03b2-lactamase inhibitor (minimum HR among models, 6.55; 95% CI, 2.35-18.20).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of allo-HCT recipients, antibiotic choices and schedules in the early course of transplantation were associated with aGVHD rates. These findings should be considered in antibiotic stewardship programs.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.17188","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T15:06:42Z","timestamp":1686150402000},"page":"e2317188","source":"Crossref","is-referenced-by-count":42,"title":["Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation"],"prefix":"10.1001","volume":"6","author":[{"given":"Armin","family":"Rashidi","sequence":"first","affiliation":[{"name":"Fred Hutchinson Cancer Center, Seattle, Washington"},{"name":"Division of Medical Oncology, Department of Medicine, University of Washington,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Gao","sequence":"additional","affiliation":[{"name":"Biostatistics, Bioinformatics and Epidemiology Program, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 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