{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:57:27Z","timestamp":1787702247203,"version":"build-2784847793"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS027170"],"award-info":[{"award-number":["R01HS027170"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U54CK000611"],"award-info":[{"award-number":["U54CK000611"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020930","name":"Ministry of Education","doi-asserted-by":"publisher","award":["22KK0264"],"award-info":[{"award-number":["22KK0264"]}],"id":[{"id":"10.13039\/501100020930","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020930","name":"Ministry of Education","doi-asserted-by":"publisher","award":["K08HS029518"],"award-info":[{"award-number":["K08HS029518"]}],"id":[{"id":"10.13039\/501100020930","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI007061"],"award-info":[{"award-number":["T32AI007061"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K08HS030118"],"award-info":[{"award-number":["K08HS030118"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Timely antibiotic initiation is critical to sepsis management, but there are limited data on the impact of giving \u03b2-lactams first versus vancomycin first among patients prescribed both agents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analyzed all adults admitted to 5 US hospitals from 2015\u20132022 with suspected sepsis (blood culture collected, antibiotics administered, and organ dysfunction) treated with vancomycin and a broad-spectrum \u03b2-lactam within 24\u2005hours of arrival. We estimated associations between \u03b2-lactam- versus vancomycin-first strategies and in-hospital mortality using inverse probability weighting (IPW) to adjust for potential confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 25 391 patients with suspected sepsis, 21 449 (84.4%) received \u03b2-lactams first and 3942 (15.6%) received vancomycin first. Compared with the \u03b2-lactam-first group, patients administered vancomycin first tended to be less severely ill, had more skin\/musculoskeletal infections (20.0% vs 7.8%), and received \u03b2-lactams a median of 3.5\u2005hours later relative to emergency department arrival. On IPW analysis, the \u03b2-lactam-first strategy was associated with lower mortality (adjusted odds ratio [aOR]: .89; 95% CI: .80\u2013.99). Point estimates were directionally similar but nonsignificant in a sensitivity analysis using propensity score matching rather than IPW (aOR: .94; 95% CI: .82\u20131.07) and in subgroups of patients with positive blood cultures, methicillin-resistant Staphylococcus aureus cultures, and those administered antipseudomonal \u03b2-lactams.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among patients with suspected sepsis prescribed vancomycin and \u03b2-lactam therapy, \u03b2-lactam administration before vancomycin was associated with a modest reduction in in-hospital mortality. These findings support prioritizing \u03b2-lactam therapy in most patients with sepsis but merit confirmation in randomized trials given the risk of residual confounding in observational analyses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae599","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T04:26:55Z","timestamp":1733286415000},"page":"761-769","source":"Crossref","is-referenced-by-count":4,"title":["Association Between the Sequence of \u03b2-Lactam and Vancomycin Administration and Mortality in Patients With Suspected Sepsis"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-7089","authenticated-orcid":false,"given":"Yutaka","family":"Kondo","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]},{"name":"Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine , Bunkyo-Ku, Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8641-4498","authenticated-orcid":false,"given":"Michael","family":"Klompas","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline S","family":"McKenna","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1676-2523","authenticated-orcid":false,"given":"Theodore R","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8316-1496","authenticated-orcid":false,"given":"Claire N","family":"Shappell","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"DelloStritto","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4245","authenticated-orcid":false,"given":"Chanu","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"2025043020405197400_ciae599-B1","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 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