{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:45:55Z","timestamp":1792111555255,"version":"4.4.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"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>Antibiotic restriction policies are intended to curb resistance, but their effects on resistance, timely treatment, and patient outcomes remain uncertain. We evaluated linezolid restrictions and whether vancomycin-resistant Enterococcus (VRE) screening identifies patients most likely to benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a quasi-experimental difference-in-differences study using electronic health record data from 521,493 admissions at 2 academic medical centers from 2008 through 2019. Hospital 1 introduced a formal prior-authorization pager system in 2011 and stricter linezolid-specific criteria with enhanced post-prescription review in 2014; Hospital 2 served as a control. Outcomes included linezolid use, linezolid-resistant Enterococcus isolates, in-hospital mortality overall and by VRE status, and stewardship request behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Linezolid was used in 2.3% of admissions; 1.2% of Enterococcus isolates were linezolid resistant. Restriction policies were associated with a 27% reduction in linezolid use (-0.9 percentage points; 95% confidence interval, -1.1 to -0.7; P\u2009&amp;lt;\u2009.001) and a 41% reduction in resistance (-1.0 percentage points; 95% confidence interval, -1.6 to -0.4; P\u2009=\u2009.003). Overall mortality did not increase, but mortality among VRE-screen-positive patients increased by 4.7 percentage points (95% confidence interval, 1.9 to 7.5; P\u2009&amp;lt;\u2009.001), with larger increases among those with bacteremia or sepsis. Approval rates declined first, followed by fewer linezolid requests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Restriction policies can reduce antibiotic use and resistance but may benefit from screening-informed safeguards to preserve timely treatment for high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag656","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:34:24Z","timestamp":1791891264000},"source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Stewardship, Resistance, and Mortality in Vancomycin-Resistant Enterococcus: A Quasi-Experimental Study of Linezolid Restrictions"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-5302","authenticated-orcid":false,"given":"Edward L","family":"Kong","sequence":"first","affiliation":[{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3133-0945","authenticated-orcid":false,"given":"David W","family":"Kubiak","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8086-1123","authenticated-orcid":false,"given":"Erica S","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1514-2976","authenticated-orcid":false,"given":"Alyssa R","family":"Letourneau","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,16]]},"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag656\/71990095\/ciag656.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag656\/71990095\/ciag656.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:06:14Z","timestamp":1792109174000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciag656\/8923644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag656","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"article-number":"ciag656"}}