{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:45:04Z","timestamp":1793108704163,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,8,22]],"date-time":"2020-08-22T00:00:00Z","timestamp":1598054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009238","name":"Virginia Commonwealth University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009238","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Centers for Medicare and Medicaid Services (CMS) implemented a core measure sepsis (SEP-1) bundle in 2015. One element was initiation of broad-spectrum antibiotics within 3 hours of diagnosis. The policy has the potential to increase antibiotic use and Clostridioides difficile infection (CDI). We evaluated the impact of SEP-1 implementation on broad-spectrum antibiotic use and CDI occurrence rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Monthly adult antibiotic data for 4 antibiotic categories (surgical prophylaxis, broad-spectrum for community-acquired infections, broad-spectrum for hospital-onset\/multidrug-resistant [MDR] organisms, and anti\u2013methicillin-resistant Staphylococcus aureus [MRSA]) from 111 hospitals participating in the Clinical Data Base Resource Manager were evaluated in periods before (October 2014\u2013September 2015) and after (October 2015\u2013June 2017) policy implementation. Interrupted time series analyses, using negative binomial regression, evaluated changes in antibiotic category use and CDI rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At the hospital level, there was an immediate increase in the level of broad-spectrum agents for hospital-onset\/MDR organisms (+2.3%, P\u2005=\u2005.0375) as well as a long-term increase in trend (+0.4% per month, P\u2005=\u2005.0273). There was also an immediate increase in level of overall antibiotic use (+1.4%, P\u2005=\u2005.0293). CDI rates unexpectedly decreased at the time of SEP-1 implementation. When analyses were limited to patients with sepsis, there was a significant level increase in use of all antibiotic categories at the time of SEP-1 implementation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>SEP-1 implementation was associated with immediate and long-term increases in broad-spectrum hospital-onset\/MDR organism antibiotics. Antimicrobial stewardship programs should evaluate sepsis treatment for opportunities to de-escalate broad therapy as indicated.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa456","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T19:28:59Z","timestamp":1596569339000},"page":"556-565","source":"Crossref","is-referenced-by-count":27,"title":["Impact of the Centers for Medicare and Medicaid Services Sepsis Core Measure on Antibiotic Use"],"prefix":"10.1093","volume":"72","author":[{"given":"Amy L","family":"Pakyz","sequence":"first","affiliation":[{"name":"Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M","family":"Orndahl","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Johns","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Harless","sequence":"additional","affiliation":[{"name":"Department of Economics, Virginia Commonwealth University School of Business, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Bearman","sequence":"additional","affiliation":[{"name":"Department of Hospital Epidemiology and Infection Control, Virginia 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