{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:05:38Z","timestamp":1791353138681,"version":"4.3.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T00:00:00Z","timestamp":1649116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospital antibiograms guide initial empiric antibiotic treatment selections, but do not directly inform escalation of treatment among nonresponding patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using gram-negative bacteremia as an exemplar condition, we sought to introduce the concept of an escalation antibiogram. Among episodes of gram-negative bacteremia between 2017 and 2020 from 6 hospitals in the Greater Toronto Area, we generated escalation antibiograms for each of 12 commonly used agents. Among organisms resistant to that antibiotic, we calculated the likelihood of susceptibility to each of the other 11 agents. In subgroup analyses, we examined escalation antibiograms across study years, individual hospitals, community versus hospital onset, and pathogen type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6577 gram-negative bacteremia episodes, the likelihood of coverage was ampicillin 31.8%, cefazolin 62.7%, ceftriaxone 67.1%, piperacillin-tazobactam 72.5%, ceftazidime 74.1%, trimethoprim-sulfamethoxazole 74.4%, ciprofloxacin 77.1%, tobramycin 88.3%, gentamicin 88.8%, ertapenem 91.0%, amikacin 97.5%, and meropenem 98.2%. The escalation antibiograms revealed marked shifts in likelihood of coverage by the remaining 11 agents. For example, among ceftriaxone-resistant isolates, piperacillin-tazobactam susceptibility (21.2%) was significantly lower than trimethoprim-sulfamethoxazole (54.2%, P\u2005&amp;lt;\u2005.0001), ciprofloxacin (63.0%, P\u2005&amp;lt;\u2005.0001), ertapenem (73.4%, P\u2005&amp;lt;\u2005.0001), tobramycin (80.1%, P\u2005&amp;lt;\u2005.0001), gentamicin (82.8%, P\u2005&amp;lt;\u2005.0001), meropenem (94.3%, P\u2005&amp;lt;\u2005.0001), and amikacin (97.1%, P\u2005&amp;lt;\u2005.0001). Trimethoprim-sulfamethoxazole was the second-ranked agent in the meropenem escalation antibiogram (49.6%) and first in the amikacin escalation antibiogram (86.0%). Escalation antibiograms were consistent across 4 study years and 6 hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Escalation antibiograms can be generated to inform empiric treatment changes in nonresponding patients. These tools can yield important insights such as avoiding the common maneuver of escalating from ceftriaxone to piperacillin-tazobactam in suspected gram-negative bacteremia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciac256","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T10:03:36Z","timestamp":1649153016000},"page":"1763-1771","source":"Crossref","is-referenced-by-count":19,"title":["Introducing the Escalation Antibiogram: A Simple Tool to Inform Changes in Empiric Antimicrobials in the Nonresponding Patient"],"prefix":"10.1093","volume":"75","author":[{"given":"Daniel","family":"Teitelbaum","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Elligsen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada"},{"name":"Department of Laboratory Medicine, University of Toronto , Ontario , Canada"},{"name":"Shared Hospital Laboratories , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip W","family":"Lam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada"},{"name":"Division of Infectious Diseases, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"MacFadden","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa , Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Vermeiren","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Toronto , Ontario , Canada"},{"name":"Shared Hospital Laboratories , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada"},{"name":"Division of Infectious Diseases, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada"},{"name":"Sunnybrook Research Institute , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,4,5]]},"reference":[{"key":"2022111415394486900_CIT0001","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study.","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"2022111415394486900_CIT0002","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1001\/jama.2014.5804","article-title":"Hospital deaths in patients with sepsis from 2 independent cohorts.","volume":"312","author":"Liu","year":"2014","journal-title":"JAMA"},{"key":"2022111415394486900_CIT0003","doi-asserted-by":"crossref","first-page":"35","DOI":"10.12927\/hcq.2010.21963","article-title":"National analysis of sepsis hospitalizations and factors contributing to sepsis in-hospital mortality in 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is the critical determinant of survival in human septic shock.","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit Care Med"},{"key":"2022111415394486900_CIT0007","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/CCM.0000000000002255","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016.","volume":"45","author":"Rhodes","year":"2017","journal-title":"Crit Care Med"},{"key":"2022111415394486900_CIT0008","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/jhm.899","article-title":"Resistance to empiric antimicrobial treatment predicts outcome in severe sepsis associated with Gram-negative bacteremia.","volume":"6","author":"Micek","year":"2011","journal-title":"J Hosp Med"},{"key":"2022111415394486900_CIT0009","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S1473-3099(20)30477-1","article-title":"Inappropriate empirical antibiotic therapy for bloodstream infections 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