{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:49:52Z","timestamp":1787759392537,"version":"build-2784847793"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"unspecified","delay-in-days":77,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S2732494X24000263_as1\"><jats:title>Objective:<\/jats:title><jats:p>To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel \u03b2-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU).<\/jats:p><\/jats:sec><jats:sec id=\"S2732494X24000263_as2\"><jats:title>Design:<\/jats:title><jats:p>Retrospective, multicenter, cohort.<\/jats:p><\/jats:sec><jats:sec id=\"S2732494X24000263_as31\"><jats:title>Setting:<\/jats:title><jats:p>Ten hospitals in the southeastern United States.<\/jats:p><\/jats:sec><jats:sec id=\"S2732494X24000263_as32\"><jats:title>Methods:<\/jats:title><jats:p>GNB with DTR including Enterobacterales,<jats:italic>Pseudomonas aeruginosa<\/jats:italic>, and<jats:italic>Acinetobacter<\/jats:italic>spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel \u03b2-lactams including ceftolozane\/tazobactam, ceftazidime\/avibactam, meropenem\/vaborbactam, imipenem\/cilastatin\/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel \u03b2-lactams.<\/jats:p><\/jats:sec><jats:sec id=\"S2732494X24000263_as33\"><jats:title>Results:<\/jats:title><jats:p>The overall prevalence of GNB with DTR was 0.85% (1,223\/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (<jats:italic>P<\/jats:italic>= .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%,<jats:italic>P<\/jats:italic>= .023) and DTR<jats:italic>Acinetobacter<\/jats:italic>spp. (4.2% to 18.8%,<jats:italic>P<\/jats:italic>= .002). Cumulative AU of novel \u03b2-lactams was 1.91 \u00b1 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT\/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden.<\/jats:p><\/jats:sec><jats:sec id=\"S2732494X24000263_as3\"><jats:title>Conclusions:<\/jats:title><jats:p>The overall prevalence of GNB with DTR and the use of novel \u03b2-lactams remain low. However, the uptrend in the use of novel \u03b2-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ash.2024.26","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T10:11:30Z","timestamp":1710756690000},"source":"Crossref","is-referenced-by-count":4,"title":["The prevalence of gram-negative bacteria with difficult-to-treat resistance and utilization of novel \u03b2-lactam antibiotics in the southeastern United States"],"prefix":"10.1017","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0551-4508","authenticated-orcid":false,"given":"Y. Vivian","family":"Tsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4409-0963","authenticated-orcid":false,"given":"P. 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