{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:15:19Z","timestamp":1791825319633,"version":"4.3.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"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":[[2026,1,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypoalbuminaemia in patients with MSSA bacteraemia is associated with a delayed time to blood culture sterilization and increased mortality. Although this phenomenon has been postulated to be due to suboptimal antimicrobial exposure, the albumin thresholds that predispose patients to worse outcomes remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multicentre, retrospective study of adult patients with MSSA-positive blood cultures for at least 48\u2005h despite treatment with in vitro active antimicrobials. To determine the precise cut-off for defining hypoalbuminaemia, we applied a bootstrap resampling approach in combination with Cox proportional hazards models. A range of candidate albumin thresholds was evaluated to identify the optimal value that maximized the partial log-likelihood of the Cox model, with time from target therapy to negative blood cultures as the outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 461 patients screened, 285 patients met the inclusion criteria; 34% (97\/285) were people who inject drugs and 45% (130\/285) had definite endocarditis. The median (IQR) albumin level was 2.4 (2\u20132.9)\u2005g\/dL. The albumin threshold that corresponded to the highest mean bootstrapped log-likelihood was \u22643.0\u2005g\/dL. After propensity score weighting, patients with an albumin level of \u22643.0\u2005g\/dL had a significantly slower time to blood culture sterilization compared with patients with albumin levels &amp;gt;3\u2005g\/dL (HR\u200a=\u200a0.6; 95% CI: 0.44\u20130.81; P\u200a&amp;lt;\u200a0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the largest study to evaluate the impact of hypoalbuminaemia on the outcomes of patients with MSSA bacteraemia, we identified a cut-off value of albumin \u22643\u2005g\/dL to be associated with an increased risk for a delayed blood culture sterilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkaf498","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:47:49Z","timestamp":1766494069000},"source":"Crossref","is-referenced-by-count":2,"title":["Evaluating hypoalbuminaemia thresholds associated with delayed blood sterilization among patients receiving cefazolin or antistaphylococcal penicillins for MSSA bacteraemia"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8873-1451","authenticated-orcid":false,"given":"Sunish","family":"Shah","sequence":"first","affiliation":[{"name":"Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, PA ,","place":["USA"]},{"name":"Department of Pharmacy, University of Pittsburgh Medical Center , Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyi","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, University of Pittsburgh , Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd G","family":"Clarke","sequence":"additional","affiliation":[{"name":"Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G K","family":"Balasubramani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh , Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J","family":"Smith","sequence":"additional","affiliation":[{"name":"Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, PA ,","place":["USA"]},{"name":"Department of Medicine, University of Pittsburgh , Pittsburgh PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9794-5665","authenticated-orcid":false,"given":"Ryan K","family":"Shields","sequence":"additional","affiliation":[{"name":"Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, PA ,","place":["USA"]},{"name":"Department of Medicine, 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