{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:09:07Z","timestamp":1792084147669,"version":"4.4.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T00:00:00Z","timestamp":1568764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic stewardship is challenging in hematological malignancy patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a quasiexperimental implementation study of 2 antimicrobial stewardship interventions in a hematological malignancy unit: monthly antibiotic cycling for febrile neutropenia that included cefepime (\u00b1 metronidazole) and piperacillin-tazobactam and a clinical prediction rule to guide anti-vancomycin-resistant Enterococcus faecium (VRE) therapy. We used interrupted time-series analysis to compare antibiotic use and logistic regression in order to adjust observed unit-level changes in resistant infections by background community rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2434 admissions spanning 3 years pre- and 2 years postimplementation were included. Unadjusted carbapenem and daptomycin use decreased significantly. In interrupted time-series analysis, carbapenem use decreased by \u2212230 days of therapy (DOT)\/1000 patient-days (95% confidence interval [CI], \u2212290 to \u2212180; P &amp;lt; .001). Both VRE colonization (odds ratio [OR], 0.64; 95% CI, 0.51 to 0.81; P &amp;lt; .001) and infection (OR, 0.41; 95% CI, 0.2 to 0.9; P = .02) decreased after implementation. This shift may have had a greater effect on daptomycin prescribing (\u2212160 DOT\/1000 patient-days; 95% CI, \u2212200 to \u2212120; P &amp;lt; .001) than did the VRE clinical prediction score (\u221230 DOT\/1000 patient-days; 95% CI, \u221250 to 0; P = .08). Also, 46.2% of Pseudomonas aeruginosa isolates were carbapenem-resistant preimplementation compared with 25.0% postimplementation (P = .32). Unit-level changes in methicillin-resistant Staphylococcus aureus and extended-spectrum beta lactamase (ESBL) incidence were explained by background community-level trends, while changes in AmpC ESBL and VRE appeared to be independent. The program was not associated with increased mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An antibiotic cycling-based strategy for febrile neutropenia effectively reduced carbapenem use, which may have resulted in decreased VRE colonization and infection and perhaps, in turn, decreased daptomycin prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciz900","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T15:26:15Z","timestamp":1568129175000},"page":"960-967","source":"Crossref","is-referenced-by-count":31,"title":["Antimicrobial Stewardship in a Hematological Malignancy Unit: Carbapenem Reduction and Decreased Vancomycin-Resistant Enterococcus Infection"],"prefix":"10.1093","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-3315","authenticated-orcid":false,"given":"Brandon J","family":"Webb","sequence":"first","affiliation":[{"name":"Intermountain Healthcare, Division of Epidemiology and Infectious Disease, Salt Lake City, Utah, USA"},{"name":"Stanford University, Division of Infectious Diseases and Geographic Medicine, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Majers","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, LDS Hospital Acute Leukemia\/Blood and Marrow Transplant Program, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regan","family":"Healy","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, LDS Hospital Acute Leukemia\/Blood and Marrow Transplant Program, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Bjorn","family":"Jones","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, Division of Epidemiology and Infectious Disease, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M","family":"Butler","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, Statistical Data Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Snow","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, Statistical Data Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Forsyth","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, Division of Epidemiology and Infectious Disease, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert K","family":"Lopansri","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, Division of Epidemiology and Infectious Disease, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde D","family":"Ford","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, LDS Hospital Acute Leukemia\/Blood and Marrow Transplant Program, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daanish","family":"Hoda","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare, LDS Hospital Acute Leukemia\/Blood and Marrow Transplant Program, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,9,18]]},"reference":[{"key":"2020081419071265600_CIT0001","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1128\/MMBR.00016-10","article-title":"Origins and evolution of antibiotic resistance","volume":"74","author":"Davies","year":"2010","journal-title":"Microbiol Mol Biol 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