{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T18:25:07Z","timestamp":1788114307865,"version":"build-2803163510"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T00:00:00Z","timestamp":1600128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Ontario Ministry of Health and Long-Term Care Alternative Funding Plan Innovation Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A patient\u2019s prior cultures can inform the subsequent risk of infection from resistant organisms, yet prescribers often fail to incorporate these results into their empiric antibiotic selection. Given that timely initiation of adequate antibiotics has been associated with improved outcomes, there is an urgent need to address this gap.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In order to better incorporate prior culture results in the selection of empiric antibiotics, we performed a pragmatic, prospective, hospital-wide intervention: (1) empiric antibiotic prescriptions were assessed for clinically significant discordance with the most recent methicillin-resistant Staphylococcus aureus (MRSA) surveillance swab, previous cultures for extended-spectrum beta-lactamases (ESBLs), and the most recent culture for a Gram-negative (GN) organism; and (2) if discordant, an antimicrobial stewardship pharmacist provided recommendations for alternative therapy. The impact was analyzed using a quasi-experimental design comparing two 9-month periods (pre- and postintervention) at a large academic, tertiary care institution.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Clinically significant discordance was identified 99 times in the preintervention period and 86 times in the intervention period. The proportion of patients that received concordant therapy increased from 73% (72\/99) in the control group to 88% (76\/86) in the intervention group (P = .01). The median time to concordant therapy was shorter in the intervention group than the control group (25 vs 55 hrs, respectively; P &amp;lt; .001; adjusted hazard ratio = 1.95 [95% confidence interval {CI}, 1.37\u20132.77; P &amp;lt; .001]). The median duration of unnecessary vancomycin therapy was reduced by 1.1 days (95% CI, .5\u20131.6 days; P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This intervention improved prescribing, with a shorter time to concordant therapy and an increased proportion of patients receiving empiric therapy concordant with prior culture results. The use of unnecessary vancomycin was also reduced.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1397","type":"journal-article","created":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T19:12:06Z","timestamp":1599851526000},"page":"e630-e638","source":"Crossref","is-referenced-by-count":17,"title":["Using Prior Culture Results to Improve Initial Empiric Antibiotic Prescribing: An Evaluation of a Simple Clinical Heuristic"],"prefix":"10.1093","volume":"72","author":[{"given":"Marion","family":"Elligsen","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada"},{"name":"Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruxandra","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Population Health, Sunnybrook Health Sciences Centre, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome A","family":"Leis","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Toronto, Toronto, Canada"},{"name":"Centre of Quality Improvement and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A N","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada"},{"name":"Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek R","family":"MacFadden","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Toronto, Toronto, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2021051810394874700_CIT0001","doi-asserted-by":"crossref","first-page":"4851","DOI":"10.1128\/AAC.00627-10","article-title":"Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis","volume":"54","author":"Paul","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2021051810394874700_CIT0002","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit Care Med"},{"key":"2021051810394874700_CIT0003","volume-title":"Antimicrobial resistance in common hospital pathogens in Ontario: annual laboratory and hospital survey report 2016","author":"Ontario Agency for Health Protection and Promotion (Public Health Ontario), Institute for Quality Management in Healthcare","year":"2018"},{"key":"2021051810394874700_CIT0004","volume-title":"When antibiotics fail","author":"Finlay","year":"2019"},{"key":"2021051810394874700_CIT0005","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1136\/bmj.c2096","article-title":"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","volume":"340","author":"Costelloe","year":"2010","journal-title":"BMJ"},{"key":"2021051810394874700_CIT0006","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1086\/510393","article-title":"Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship","volume":"44","author":"Dellit","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0007","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1128\/AAC.02176-12","article-title":"Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection","volume":"57","author":"Brown","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"2021051810394874700_CIT0008","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1017\/ice.2017.308","article-title":"The role of negative methicillin-resistant Staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients","volume":"39","author":"Chotiprasitsakul","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021051810394874700_CIT0009","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s10096-017-3100-y","article-title":"Clinical predictors of methicillin-resistant Staphylococcus aureus in nosocomial and healthcare-associated pneumonia: a multicenter, matched case-control study","volume":"37","author":"Torre-Cisneros","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2021051810394874700_CIT0010","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1155\/2015\/212184","article-title":"Usefulness of previous methicillin-resistant Staphylococcus aureus screening results in guiding empirical therapy for S. aureus bacteremia","volume":"26","author":"Bai","year":"2015","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2021051810394874700_CIT0011","doi-asserted-by":"crossref","first-page":"e1100","DOI":"10.1097\/MD.0000000000001100","article-title":"Risk factors of methicillin-resistant Staphylococcus aureus infection and correlation with nasal colonization based on molecular genotyping in medical intensive care units: a prospective observational study","volume":"94","author":"Kao","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"2021051810394874700_CIT0012","doi-asserted-by":"crossref","first-page":"E725","DOI":"10.1503\/cmaj.130364","article-title":"Utility of prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections","volume":"185","author":"MacFadden","year":"2013","journal-title":"CMAJ"},{"key":"2021051810394874700_CIT0013","doi-asserted-by":"crossref","first-page":"e02432-16","DOI":"10.1128\/AAC.02432-16","article-title":"Nasal methicillin-resistant Staphylococcus aureus (MRSA) PCR testing reduces the duration of MRSA-targeted therapy in patients with suspected MRSA pneumonia","volume":"61","author":"Baby","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2021051810394874700_CIT0014","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jcrc.2016.11.008","article-title":"Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia","volume":"38","author":"Smith","year":"2017","journal-title":"J Crit Care"},{"key":"2021051810394874700_CIT0015","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.2146\/ajhp160964","article-title":"Impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus surveillance protocol","volume":"74","author":"Willis","year":"2017","journal-title":"Am J Health Syst Pharm"},{"key":"2021051810394874700_CIT0016","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1017\/ice.2019.17","article-title":"A methodological comparison of risk scores versus decision trees for predicting drug-resistant infections: a case study using extended-spectrum beta-lactamase (ESBL) bacteremia","volume":"40","author":"Goodman","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021051810394874700_CIT0017","doi-asserted-by":"crossref","first-page":"e0201688","DOI":"10.1371\/journal.pone.0201688","article-title":"Relationship between digestive tract colonization and subsequent ventilator-associated pneumonia related to ESBL-producing Enterobacteriaceae","volume":"13","author":"Houard","year":"2018","journal-title":"PLoS One"},{"key":"2021051810394874700_CIT0018","doi-asserted-by":"crossref","first-page":"1\u20137","DOI":"10.1155\/2018\/8296720","article-title":"Infections caused by extended-spectrum \u03b2-lactamase producing Escherichia coli in systemic lupus erythematosus patients: prevalence, risk factors, and predictive model","volume":"2018","author":"Yu","year":"2018","journal-title":"Biomed Res Int"},{"key":"2021051810394874700_CIT0019","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1017\/ice.2016.292","article-title":"Clinical risk score for prediction of extended-spectrum \u03b2-lactamase\u2013producing Enterobacteriaceae in bloodstream isolates","volume":"38","author":"Augustine","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021051810394874700_CIT0020","doi-asserted-by":"crossref","first-page":"1\u20136","DOI":"10.1186\/s12879-017-2346-4","article-title":"Enterobacteriaceae producing extended-spectrum \u03b2-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: \u201cretrospective cohort study.\u201d","volume":"17","author":"Cheikh","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2021051810394874700_CIT0021","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1093\/ofid\/ofw172.231","article-title":"The predictive utility of screening extended-spectrum beta-lactamase swabs in selecting empiric antibiotics for sterile-site infections","volume":"3","author":"Brasg","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"2021051810394874700_CIT0022","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1093\/cid\/ciu588","article-title":"Predictive utility of prior positive urine cultures","volume":"59","author":"MacFadden","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0023","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.cmi.2017.07.032","article-title":"Utility of prior cultures in predicting antibiotic resistance of bloodstream infections due to Gram-negative pathogens: a multicentre observational cohort study","volume":"24","author":"MacFadden","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"2021051810394874700_CIT0024","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s15010-018-1147-z","article-title":"Risk factors for pneumonia due to beta-lactam\u2013susceptible and beta-lactam\u2013resistant Pseudomonas aeruginosa: a case-case-control study","volume":"46","author":"Al-Jaghbeer","year":"2018","journal-title":"Infection"},{"key":"2021051810394874700_CIT0025","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1093\/cid\/ciz524","article-title":"Personalized ertapenem prophylaxis for carriers of extended-spectrum \u03b2-lactamase\u2013producing Enterobacteriaceae undergoing colorectal surgery","volume":"70","author":"Nutman","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0026","first-page":"31","article-title":"Prospective audit and feedback of antimicrobial stewardship in critical care: program implementation, experience, and challenges","volume":"65","author":"Elligsen","year":"2012","journal-title":"Can J Hosp Pharm"},{"key":"2021051810394874700_CIT0027","doi-asserted-by":"crossref","first-page":"1\u201312","DOI":"10.1186\/cc12896","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis","volume":"17","author":"Phua","year":"2013","journal-title":"Crit Care"},{"key":"2021051810394874700_CIT0028","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.chest.2016.08.1460","article-title":"Culture-negative severe sepsis: nationwide trends and outcomes","volume":"150","author":"Gupta","year":"2016","journal-title":"Chest"},{"key":"2021051810394874700_CIT0029","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.jclinepi.2004.03.012","article-title":"New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality","volume":"57","author":"Sundararajan","year":"2004","journal-title":"J Clin Epidemiol"},{"key":"2021051810394874700_CIT0030","volume-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2019"},{"key":"2021051810394874700_CIT0031","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jhin.2016.01.007","article-title":"Clinical risk scoring system for predicting extended-spectrum \u03b2-lactamase\u2013producing Escherichia coli infection in hospitalized patients","volume":"93","author":"Kengkla","year":"2016","journal-title":"J Hosp Infect"},{"key":"2021051810394874700_CIT0032","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/cid\/ciw425","article-title":"A clinical decision tree to predict whether a bacteremic patient is infected with an extended-spectrum \u03b2-lactamase\u2013producing organism","volume":"63","author":"Goodman","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0033","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1093\/cid\/ciy1031","article-title":"Empiric antibiotic treatment thresholds for serious bacterial infections: a scenario-based survey study","volume":"69","author":"Cressman","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0034","volume-title":"Antimicrobial stewardship strategy: empiric antibiotic prescribing guidelines","author":"Ontario Agency for Health Protection and Promotion (Public Health Ontario)","year":"2016"},{"key":"2021051810394874700_CIT0035","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1093\/cid\/ciu445","article-title":"Hospital-wide rollout of antimicrobial stewardship: a stepped-wedge randomized trial","volume":"59","author":"Palmay","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021051810394874700_CIT0036","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1086\/664757","article-title":"Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis","volume":"33","author":"Elligsen","year":"2012","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021051810394874700_CIT0037","article-title":"Improving decision- making in empiric antibiotic selection (IDEAS) for Gram-negative bacteremia: a prospective clinical implementation study","author":"Elligsen","journal-title":"Clin Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa1397\/34452109\/ciaa1397.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/10\/e630\/37950455\/ciaa1397.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/10\/e630\/37950455\/ciaa1397.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T10:44:32Z","timestamp":1621334672000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/72\/10\/e630\/5905899"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,15]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,9,15]]},"published-print":{"date-parts":[[2021,5,18]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa1397","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,15]]},"published":{"date-parts":[[2020,9,15]]}}}