{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:46:12Z","timestamp":1792118772457,"version":"4.4.0"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"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":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X25103590_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Shorter antibiotic courses and transition to oral therapy for uncomplicated gram-negative bloodstream infections (GN-BSI) are evidence-supported yet remain challenging to implement. Here we report our experience with a GN-BSI antimicrobial stewardship (AS) quality improvement initiative in a large health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103590_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We implemented two sequential AS interventions in adult patients hospitalized with uncomplicated GN-BSI: (1) mandatory AS review of patients discharging on intravenous (IV) antibiotics (\u201cOPAT review\u201d) and (2) a clinical guideline informing oral antibiotic transition and duration, in our 22-hospital system. We evaluated the initiative from January 2018 to September 2024. Pre- and postimplementation rates of (1) IV antibiotics at discharge and (2) total length of antibiotic therapy were calculated across the following periods: preintervention, after OPAT review, and after guideline implementation. Secondary outcomes included duration &lt;10 days, oral antibiotic prescribing, and guideline-recommended dosing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103590_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      3,231 patients (preintervention: 666, postOPAT review: 1,357, postguideline: 1,208) were included. We observed decreases in IV antibiotics at discharge (22.7% preintervention, 10.7% postOPAT review, and 9.2% postguideline,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and median length of treatment (13.5 days preintervention to 10.7 days postguideline,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). We also observed improvement in durations &lt;10 days (19.1% vs 45%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), oral antibiotic prescriptions, and appropriate dosing (2.8% vs 33.5%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), but no difference in rates of BSI recurrence, mortality, or\n                      <jats:italic>C. difficile<\/jats:italic>\n                      infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X25103590_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>After implementing GN-BSI-focused AS initiatives in our large health system, we observed a shift toward more frequent oral rather than IV antibiotics at discharge, and shorter overall antibiotic durations, without obvious changes in adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2025.10359","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T09:28:50Z","timestamp":1763630930000},"page":"180-188","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Interventions to optimize duration of antibiotic therapy and encourage oral transition for uncomplicated gram-negative blood stream infections across a health system"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3281-9614","authenticated-orcid":false,"given":"Jared","family":"Olson","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03r0ha626","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Utah"},{"name":"Primary Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0148-046X","authenticated-orcid":false,"given":"Adam","family":"Hersh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03r0ha626","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7662-7609","authenticated-orcid":false,"given":"John","family":"Veillette","sequence":"additional","affiliation":[{"name":"Intermountain Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4500-9810","authenticated-orcid":false,"given":"C. Dustin","family":"Waters","sequence":"additional","affiliation":[{"name":"McKay-Dee Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-3315","authenticated-orcid":false,"given":"Brandon J","family":"Webb","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7573-432X","authenticated-orcid":false,"given":"Nick","family":"Tinker","sequence":"additional","affiliation":[{"name":"Intermountain Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"May","sequence":"additional","affiliation":[{"name":"Intermountain Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1757-457X","authenticated-orcid":false,"given":"Michelle","family":"Matheu","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6209-1740","authenticated-orcid":false,"given":"Nora","family":"Fino","sequence":"additional","affiliation":[{"name":"University of Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Foster","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6397-7511","authenticated-orcid":false,"given":"Mary","family":"Hutton","sequence":"additional","affiliation":[{"name":"Utah Valley Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Stahl","sequence":"additional","affiliation":[{"name":"Intermountain Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7961-9081","authenticated-orcid":false,"given":"Jena","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Primary Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6065-9964","authenticated-orcid":false,"given":"Edward","family":"Stenehjem","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Pavia","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03r0ha626","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Utah"},{"name":"University of Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-7313","authenticated-orcid":false,"given":"Payal","family":"Patel","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8142-3405","authenticated-orcid":false,"given":"Allan","family":"Seibert","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9505-2572","authenticated-orcid":false,"given":"Whitney","family":"Buckel","sequence":"additional","affiliation":[{"name":"Intermountain Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"S0899823X25103590_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz364"},{"key":"S0899823X25103590_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2017.12.007"},{"key":"S0899823X25103590_ref20","doi-asserted-by":"publisher","DOI":"10.7861\/fhj.2022-0076"},{"key":"S0899823X25103590_ref16","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1Q240"},{"key":"S0899823X25103590_ref1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy1054"},{"key":"S0899823X25103590_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix767"},{"key":"S0899823X25103590_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.70041"},{"key":"S0899823X25103590_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2016.07.013"},{"key":"S0899823X25103590_ref23","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.40"},{"key":"S0899823X25103590_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.480"},{"key":"S0899823X25103590_ref22","doi-asserted-by":"publisher","DOI":"10.1177\/1062860617716541"},{"key":"S0899823X25103590_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab434"},{"key":"S0899823X25103590_ref15","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200508000-00002"},{"key":"S0899823X25103590_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-8579(09)70567-9"},{"key":"S0899823X25103590_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.20166"},{"key":"S0899823X25103590_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxac202"},{"key":"S0899823X25103590_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2024.395"},{"key":"S0899823X25103590_ref14","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.2011.110180"},{"key":"S0899823X25103590_ref6","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae193"},{"key":"S0899823X25103590_ref12","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01515-20"},{"key":"S0899823X25103590_ref17","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq257"},{"key":"S0899823X25103590_ref19","unstructured":"19. Trautner, BW et al. Complicated urinary tract infections (cUTI): clinical guidelines for treatment and management. IDSA. 2025. (https:\/\/www.idsociety.org\/practice-guideline\/complicated-urinary-tract-infections)."},{"key":"S0899823X25103590_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad657"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X25103590","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:38:59Z","timestamp":1792118339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X25103590\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["S0899823X25103590"],"URL":"https:\/\/doi.org\/10.1017\/ice.2025.10359","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]},"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"}]}}