{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:10:05Z","timestamp":1793315405053,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"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":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Whether antibiotic de-escalation reduces the risk of subsequent antibiotic resistance is uncertain. We sought to determine if beta-lactam (BL) antibiotic de-escalation is associated with decreased incidence of new Gram-negative resistance in hospitalized patients with sepsis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a retrospective cohort study, patients with sepsis who were treated with at least 3 consecutive days of BL antibiotics, the first 2 days of which were with a broad-spectrum BL agent defined as a spectrum score (SS) of \u22657 were enrolled. Patients were grouped into three categories: (1) de-escalation of beta-lactam spectrum score (BLSS), (2) no change in BLSS, or (3) escalation of BLSS. The primary outcome was the isolation of a new drug-resistant Gram-negative bacteria from a clinical culture within 60 days of cohort entry. Fine-Gray proportional hazards regression modeling while accounting for in-hospital death as a competing risk was performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Six hundred forty-four patients of 7742 (8.3%) patients developed new gram-negative resistance. The mean time to resistance was 23.7 days yielding an incidence rate of 1.85 (95% confidence interval [CI]: 1.71\u20132.00) per 1000 patient-days. The lowest incidence rate was observed in the de-escalated group 1.42 (95% CI: 1.16\u20131.68) per 1000 patient-days. Statistically significant reductions in the development of new gram-negative resistance were associated with BL de-escalation compared to no-change (hazards ratio (HR) 0.59 [95% CI: .48\u2013.73]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>De-escalation was associated with a decreased risk of new resistance development compared to no change. This represents the largest study to date showing the utility of de-escalation in the prevention of antimicrobial resistance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae253","type":"journal-article","created":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T17:16:44Z","timestamp":1717694204000},"page":"826-833","source":"Crossref","is-referenced-by-count":39,"title":["Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study"],"prefix":"10.1093","volume":"79","author":[{"given":"Besu F","family":"Teshome","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, University of Health Sciences and Pharmacy in St. Louis , St. Louis, Missouri ,","place":["USA"]},{"name":"Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy in St. Louis , St. Louis, Missouri 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, St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott T","family":"Micek","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, University of Health Sciences and Pharmacy in St. Louis , St. Louis, Missouri ,","place":["USA"]},{"name":"Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy in St. Louis , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,6]]},"reference":[{"key":"2024101519065231100_ciae253-B1","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/cid\/ciab696","article-title":"Mortality, length of stay, and healthcare costs associated with multidrug-resistant bacterial infections among elderly hospitalized patients in the United States","volume":"74","author":"Nelson","year":"2022","journal-title":"Clin Infect 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