{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T03:51:43Z","timestamp":1791604303091,"version":"4.3.4"},"reference-count":34,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centers for Disease Control and Prevention Epicenters Program","award":["U54CK000610"],"award-info":[{"award-number":["U54CK000610"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vancomycin is frequently administered empirically for suspected serious bacterial infections (SBIs) in the pediatric intensive care unit (PICU), despite the low prevalence of methicillin-resistant Staphylococcus aureus (MRSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a multicenter interrupted time series (ITS) study including 5 PICUs in 3 US children's hospitals evaluating the impact of a multifaceted stewardship intervention including consensus guidelines, education, and group-level audit and feedback on reducing empiric vancomycin use. The primary outcomes were (1) vancomycin administration within 12\u2005hours of suspected SBI onset and (2) empiric vancomycin days of therapy (DOT) during the first 3 days after suspected SBI onset. Secondary outcomes included overall vancomycin DOT\/1000 patient days; organ dysfunction at Days 3 and 7; 14-day mortality; and invasive MRSA infection not covered empirically. Empiric vancomycin use was modeled using mixed-effects logistic regression, and vancomycin DOT was modeled using mixed-effects Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4549 episodes targeted by the intervention, there was an immediate reduction in empiric vancomycin use after the intervention (OR 0.71, 95% CI .54\u2013.95, P = .02), with no significant change in the postintervention slope. Empiric vancomycin days after suspected SBI onset decreased by 24% immediately after the intervention (IRR: 0.76, 95% CI .65\u2013.89, P &amp;lt; .01), with no significant change in the postintervention slope. There were no increases in mortality, organ dysfunction, or missed MRSA infections postintervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A multifaceted stewardship intervention reduced empiric vancomycin use without evidence of harm, supporting the safety and feasibility of targeting empiric antibiotic prescribing in the PICU setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag545","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:37:20Z","timestamp":1788521840000},"source":"Crossref","is-referenced-by-count":0,"title":["Reducing Empiric Vancomycin Use in the Pediatric Intensive Care Unit: a Multicenter Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-8708","authenticated-orcid":false,"given":"Kathleen","family":"Chiotos","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Division of Critical Care Medicine, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0416-5171","authenticated-orcid":false,"given":"Preeti","family":"Jaggi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Children's Healthcare Atlanta , Atlanta, Georgia ,","place":["USA"]},{"name":"Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8986-7740","authenticated-orcid":false,"given":"Evan E","family":"Facer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri ,","place":["USA"]},{"name":"Department of Pediatrics, Advocate Children's Hospital , Park Ridge, Illinois ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Goldsmith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9979-7993","authenticated-orcid":false,"given":"Jason","family":"Newland","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri ,","place":["USA"]},{"name":"Division of Infectious Diseases, Nationwide Children's Hospital , Columbus, Ohio ,","place":["USA"]},{"name":"Department of Pediatrics, The Ohio State University , Columbus, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5333-0597","authenticated-orcid":false,"given":"Matthew M","family":"Sattler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5881-2752","authenticated-orcid":false,"given":"Christine","family":"Lockowitz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, St. Louis Children's Hospital , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0337-1168","authenticated-orcid":false,"given":"Rebecca G","family":"Same","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Pediatrics, Washington University in St. Louis , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8225-4554","authenticated-orcid":false,"given":"Yun","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-2409","authenticated-orcid":false,"given":"Ebbing","family":"Lautenbach","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0191-7928","authenticated-orcid":false,"given":"Kai","family":"Inoki","sequence":"additional","affiliation":[{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4076-6411","authenticated-orcid":false,"given":"Didien","family":"Meyahnwi","sequence":"additional","affiliation":[{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health , Bridgeport, Connecticut ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-8670","authenticated-orcid":false,"given":"Julia E","family":"Szymczak","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-3186","authenticated-orcid":false,"given":"Jeffrey S","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Clinical Futures, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"2026100923065471000_ciag545-B1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/PCC.0000000000003927","article-title":"Surviving sepsis campaign international guidelines for the management of sepsis and septic shock in children 2026","volume":"27","author":"Weiss","year":"2026","journal-title":"Pediatr Crit Care Med"},{"key":"2026100923065471000_ciag545-B2","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1093\/cid\/cir531","article-title":"The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the Infectious Diseases Society of America","volume":"53","author":"Bradley","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026100923065471000_ciag545-B3","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2026100923065471000_ciag545-B4","first-page":"519","article-title":"Variability in antibiotic use across PICUs","volume":"19","author":"Brogan","year":"2018","journal-title":"Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc"},{"key":"2026100923065471000_ciag545-B5","doi-asserted-by":"crossref","first-page":"e226","DOI":"10.1093\/cid\/ciaa036","article-title":"Appropriateness of antibiotic prescribing in United States Children's hospitals: a national point prevalence survey","volume":"71","author":"Tribble","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026100923065471000_ciag545-B6","doi-asserted-by":"crossref","first-page":"e1021","DOI":"10.1093\/cid\/ciac698","article-title":"Antibiotic indications and appropriateness in the pediatric intensive care unit: a ten-center point prevalence study","volume":"76","author":"Chiotos","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026100923065471000_ciag545-B7","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1128\/AAC.04523-14","article-title":"Inappropriate continued empirical vancomycin use in a hospital with a high prevalence of methicillin-resistant Staphylococcus aureus","volume":"59","author":"Kim","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2026100923065471000_ciag545-B8","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/INF.0000000000002391","article-title":"Vancomycin-associated nephrotoxicity and risk factors in critically ill children without preexisting renal injury","volume":"38","author":"Feiten","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"2026100923065471000_ciag545-B9","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/jpids\/piy030","article-title":"Incidence of nephrotoxicity among pediatric patients receiving vancomycin with either piperacillin-tazobactam or cefepime: a cohort study","volume":"8","author":"Cook","year":"2019","journal-title":"J Pediatr Infect Dis Soc"},{"key":"2026100923065471000_ciag545-B10","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1136\/archdischild-2021-323429","article-title":"Vancomycin-associated acute kidney injury epidemiology in children: a systematic review","volume":"107","author":"Williams","year":"2022","journal-title":"Arch Dis Child"},{"key":"2026100923065471000_ciag545-B11","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/INF.0b013e31824e10d7","article-title":"Defining risk factors for red man syndrome in children and adults","volume":"31","author":"Myers","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"2026100923065471000_ciag545-B12","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/j.1365-2125.2007.02897.x","article-title":"Severe local vancomycin induced skin necrosis","volume":"64","author":"Hoelen","year":"2007","journal-title":"Br J Clin Pharmacol"},{"key":"2026100923065471000_ciag545-B13","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.ijantimicag.2017.01.008","article-title":"Vancomycin-resistant enterococci colonisation, risk factors and risk for infection among hospitalised paediatric patients: a systematic review and meta-analysis","volume":"49","author":"Flokas","year":"2017","journal-title":"Int J Antimicrob Agents"},{"key":"2026100923065471000_ciag545-B14","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the society for healthcare epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026100923065471000_ciag545-B15","doi-asserted-by":"crossref","first-page":"e2021052165","DOI":"10.1542\/peds.2021-052165","article-title":"Improving vancomycin stewardship in critically ill children","volume":"149","author":"Chiotos","year":"2022","journal-title":"Pediatrics"},{"key":"2026100923065471000_ciag545-B16","doi-asserted-by":"crossref","first-page":"ofad500.1478","DOI":"10.1093\/ofid\/ofad500.1478","article-title":"1644. quantifying empiric vancomycin overuse in two tertiary care pediatric intensive care units","volume":"10","author":"Chiotos","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026100923065471000_ciag545-B17","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1017\/ice.2018.123","article-title":"Rate of positive cultures necessitating definitive treatment in patients receiving empiric vancomycin therapy","volume":"39","author":"Waters","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026100923065471000_ciag545-B18","doi-asserted-by":"crossref","first-page":"100021","DOI":"10.1016\/j.acepjo.2024.100021","article-title":"Methicillin-resistant Staphylococcus aureus and vancomycin prescribing in the emergency department: a single-center study assessing antibiotic prescribing","volume":"6","author":"Niforatos","year":"2025","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"2026100923065471000_ciag545-B19","doi-asserted-by":"crossref","first-page":"e202899","DOI":"10.1001\/jamanetworkopen.2020.2899","article-title":"Prevalence of antibiotic-resistant pathogens in culture-proven sepsis and outcomes associated with inadequate and broad-Spectrum empiric antibiotic use","volume":"3","author":"Rhee","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026100923065471000_ciag545-B20","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1001\/jamainternmed.2019.7495","article-title":"Empirical anti-MRSA vs standard antibiotic therapy and risk of 30-day mortality in patients hospitalized for pneumonia","volume":"180","author":"Jones","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2026100923065471000_ciag545-B21","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-009142","article-title":"Empiric vancomycin reduction in a pediatric intensive care unit","volume":"148","author":"Lanata","year":"2021","journal-title":"Pediatrics"},{"key":"2026100923065471000_ciag545-B22","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1001\/jama.2024.6259","article-title":"Stewardship prompts to improve antibiotic selection for urinary tract infection: the INSPIRE randomized clinical trial","volume":"331","author":"Gohil","year":"2024","journal-title":"JAMA"},{"key":"2026100923065471000_ciag545-B23","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1001\/jama.2024.6248","article-title":"Stewardship prompts to improve antibiotic selection for pneumonia: the INSPIRE randomized clinical trial","volume":"331","author":"Gohil","year":"2024","journal-title":"JAMA"},{"key":"2026100923065471000_ciag545-B24","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1001\/jamainternmed.2025.0887","article-title":"Improving empiric antibiotic selection for patients hospitalized with skin and soft tissue infection: the INSPIRE 3 skin and soft tissue randomized clinical trial","volume":"185","author":"Gohil","year":"2025","journal-title":"JAMA Intern Med"},{"key":"2026100923065471000_ciag545-B25","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1001\/jamasurg.2025.1108","article-title":"Improving empiric antibiotic selection for patients hospitalized with abdominal infection: the INSPIRE 4 cluster randomized clinical trial","volume":"160","author":"Gohil","year":"2025","journal-title":"JAMA Surg"},{"key":"2026100923065471000_ciag545-B26","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1542\/peds.2021-052888J","article-title":"Renal dysfunction criteria in critically ill children: the PODIUM consensus conference","volume":"149","author":"Fitzgerald","year":"2022","journal-title":"Pediatrics"},{"key":"2026100923065471000_ciag545-B27","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.3390\/antibiotics14101011","article-title":"Establishing priority pediatric antimicrobial stewardship interventions in the US: findings from a Delphi consensus study","volume":"14","author":"Obeng","year":"2025","journal-title":"Antibiotics"},{"key":"2026100923065471000_ciag545-B28","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12879-018-3081-1","article-title":"Effect of an intervention targeting inappropriate continued empirical parenteral vancomycin use: a quasi-experimental study in a region of high MRSA prevalence","volume":"18","author":"Choe","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2026100923065471000_ciag545-B29","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":"2026100923065471000_ciag545-B30","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1097\/CCM.0b013e31828e9863","article-title":"Impact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial utilization and patient outcome","volume":"41","author":"Rimawi","year":"2013","journal-title":"Crit Care Med"},{"key":"2026100923065471000_ciag545-B31","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1093\/jpids\/piy031","article-title":"Antimicrobial stewardship program in a pediatric intensive care unit","volume":"7","author":"Aizawa","year":"2018","journal-title":"J Pediatr Infect Dis Soc"},{"key":"2026100923065471000_ciag545-B32","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/INF.0000000000000615","article-title":"Implications and impact of prior authorization policy on vancomycin use at a tertiary pediatric teaching hospital","volume":"34","author":"Chan","year":"2015","journal-title":"Pediatr Infect Dis J"},{"key":"2026100923065471000_ciag545-B33","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1093\/jpids\/pix015","article-title":"Evaluation of a second-sign process for antimicrobial prior authorization","volume":"7","author":"Dassner","year":"2018","journal-title":"J Pediatr Infect Dis Soc"},{"key":"2026100923065471000_ciag545-B34","doi-asserted-by":"crossref","first-page":"e710","DOI":"10.1097\/pq9.0000000000000710","article-title":"Antimicrobial stewardship and improved antibiotic utilization in the pediatric cardiac intensive care unit","volume":"9","author":"Hillyer","year":"2024","journal-title":"Pediatr Qual Saf"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag545\/70967604\/ciag545.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag545\/70967604\/ciag545.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T03:07:05Z","timestamp":1791601625000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciag545\/8786221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,5]]},"references-count":34,"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag545","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,5]]},"article-number":"ciag545"}}