{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T10:42:40Z","timestamp":1762425760285,"version":"build-2065373602"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X25102080_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The antibiotic spectrum index (ASI) outcome quantifies antibiotic exposure based on spectrum of activity. Our objective was to examine ASI as an exploratory outcome in the context of a recent stewardship-focused, clinical trial in childhood pneumonia that originally used a binary guideline-concordant outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25102080_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Secondary analysis of a randomized clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25102080_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Two tertiary pediatric hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25102080_as4\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Encounters were randomly assigned to clinical decision support (CDS) or usual care treatment arm. The ASI was calculated by summing daily ASI scores for each unique antibiotic administered. It was evaluated as a continuous and ordinal measure: No Antibiotics (ASI = 0), Narrow (1-2), Intermediate (3-4), Broad (5-7), and Very Broad (\u22658). Proportional odds regression modeled the ordinal ASI outcome in the first 24 hours by treatment arm and compared to the guideline-concordance outcome. Results were stratified by emergency department (ED) disposition. We also conducted a longitudinal, descriptive analysis of day-to-day ASI for those with in-hospital dispositions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25102080_as5\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 1027 encounters, 549 (53%) were randomized to CDS and 478 (47%) usual care respectively. ASI Category did not differ by treatment arm overall (Odds Ratio: 0.88[95% Confidence Interval: 0.70,1.09]), which mirrored binary guideline-concordance. Mean ASI\u00a0was lower for concordant encounters (2.1 vs 8.4,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) and across all ED dispositions. In the longitudinal analysis, there were 1137 day-to-day ASI comparisons, with only 7% representing spectrum escalations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25102080_as6\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The ASI outcome yielded similar results to a dichotomous concordance outcome. However, ASI provided more granular insights into antibiotic prescribing, suggesting ASI may be a useful outcome measure in future stewardship-focused trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2025.10208","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T06:01:14Z","timestamp":1750658474000},"page":"805-811","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the antibiotic spectrum index in a stewardship-focused clinical trial for childhood pneumonia"],"prefix":"10.1017","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9206-7477","authenticated-orcid":false,"given":"Sabrina E.","family":"Carro","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Gargurevich","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mert","family":"Sekmen","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1717-7593","authenticated-orcid":false,"given":"Srinivasan","family":"Suresh","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine and UPMC Children\u2019s Hospital of Pittsburgh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-1770","authenticated-orcid":false,"given":"Judith M.","family":"Martin","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine and UPMC Children\u2019s Hospital of Pittsburgh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0295-1240","authenticated-orcid":false,"given":"Derek J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"S0899823X25102080_ref6","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. children","volume":"372","author":"Seema","year":"2015","journal-title":"N Engl J Med"},{"key":"S0899823X25102080_ref10","first-page":"e210","article-title":"Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors","volume":"3","author":"Neuner","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol ASHE"},{"key":"S0899823X25102080_ref11","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.13101"},{"key":"S0899823X25102080_ref7","unstructured":"7. Emergency Department Management of Childhood Pneumonia in the United States Prior to Publication of National Guidelines - Neuman - 2013 - Academic Emergency Medicine - Wiley Online Library. Accessed June 9, 2024. https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.12088"},{"key":"S0899823X25102080_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s40506-019-00188-3"},{"key":"S0899823X25102080_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piz026"},{"key":"S0899823X25102080_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.94"},{"key":"S0899823X25102080_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piae014"},{"key":"S0899823X25102080_ref18","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04303-1"},{"key":"S0899823X25102080_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piz091"},{"key":"S0899823X25102080_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.12029"},{"key":"S0899823X25102080_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2023.106710"},{"key":"S0899823X25102080_ref21","first-page":"e48","article-title":"Cohort study of patients with advanced cancer: outcomes associated with duration of antibiotic therapy for non-ventilator hospital-acquired pneumonia","volume":"4","author":"Lee","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol ASHE"},{"key":"S0899823X25102080_ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S0899823X25102080_ref1","doi-asserted-by":"publisher","DOI":"10.1086\/673982"},{"key":"S0899823X25102080_ref19","first-page":"e181","article-title":"Lack of pathogen identification influencing antibiotic de-escalation in hospital-acquired pneumonia","volume":"2","author":"Bittmann","year":"2022","journal-title":"Antimicrob Steward Healthc Epidemiol ASHE"},{"key":"S0899823X25102080_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.17816"},{"key":"S0899823X25102080_ref24","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkad082"},{"key":"S0899823X25102080_ref23","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.467"},{"key":"S0899823X25102080_ref17","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v22.i29.6638"},{"key":"S0899823X25102080_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.151"},{"key":"S0899823X25102080_ref8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir531"},{"key":"S0899823X25102080_ref9","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1055\/s-0040-1715893","article-title":"Considerations for designing EHR-embedded clinical decision support systems for antimicrobial stewardship in pediatric emergency departments","volume":"11","author":"Ozkaynak","year":"2020","journal-title":"Appl Clin Inform"},{"key":"S0899823X25102080_ref5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2008"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X25102080","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T10:38:46Z","timestamp":1762425526000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X25102080\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["S0899823X25102080"],"URL":"https:\/\/doi.org\/10.1017\/ice.2025.10208","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"type":"print","value":"0899-823X"},{"type":"electronic","value":"1559-6834"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}