{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:54:52Z","timestamp":1785855292332,"version":"3.56.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"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":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We assessed the impact of a modified microbiology report and cascade that selectively reported narrower-spectrum \u03b2-lactams for low-risk AmpC Enterobacterales (AmpC-E).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a controlled interrupted time series analysis to assess the proportion of patients receiving ceftriaxone or piperacillin\/tazobactam on the fourth day of antibiotic treatment for low-risk AmpC-E infection (Serratia marcescens, Morganella morganii, Providencia spp., Citrobacter koseri) compared with a high-risk AmpC-E (Enterobacter cloacae complex, Klebsiella aerogenes, Citrobacter freundii) control group. Secondary outcomes included a pre-post measurement of antibiotic use on the fourth day of therapy, death at 30\u2005days, and recurrent infection at 90\u2005days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with low-risk AmpC-E infections were more likely to receive ceftriaxone or piperacillin\/tazobactam compared with high-risk AmpC-E controls [incidence rate ratio (IRR) 39.8, 95% CI 1.8\u2013871.7, P\u200a=\u200a0.02]. There was an upward shift and trend in ceftriaxone and piperacillin\/tazobactam use during the implementation period in the low-risk AmpC-E group compared with the control group (IRR 3.3, 95% CI 0.9\u201311.9, P\u200a=\u200a0.07 and slope 1.3, 95% CI 1.0\u20131.8, P\u200a=\u200a0.10), with an associated reduction in fluoroquinolone use. During the implementation period, 30 day mortality (13.8% versus 12.1%, P\u200a=\u200a0.70) and recurrent infection at 90\u2005days (6.4% versus 5.7%, P\u200a=\u200a0.83) were similar between low-risk and high-risk AmpC-E groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Modification of microbiology reporting for low-risk AmpC Enterobacterales infections to selectively report narrower-spectrum \u03b2-lactams resulted in a rapid and sustained increase in use of ceftriaxone and piperacillin\/tazobactam across two hospitals. Aligning this microbiology reporting with guidelines would have scalable impact on hospital antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag269","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:41:26Z","timestamp":1784893286000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of modified microbiology reporting on the treatment of low-risk AmpC Enterobacterales infections: a multi-centre controlled interrupted time series study"],"prefix":"10.1093","volume":"81","author":[{"given":"Marie-F\u00e9lixe","family":"Granger","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Elligsen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"McCready","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Michael Garron Hospital, Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xena X","family":"Li","sequence":"additional","affiliation":[{"name":"Shared Hospital Laboratory, Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Kozak","sequence":"additional","affiliation":[{"name":"Shared Hospital Laboratory, Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome A","family":"Leis","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto ,","place":["Canada"]},{"name":"Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto ,","place":["Canada"]},{"name":"Sunnybrook Health Sciences Centre Division of Infectious Diseases, , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip W","family":"Lam","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto ,","place":["Canada"]},{"name":"Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto ,","place":["Canada"]},{"name":"Sunnybrook Health Sciences Centre Division of Infectious Diseases, , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080410192481900_dkag269-B1","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1093\/jac\/dky084","article-title":"Species-specific mutation rates for ampC derepression in Enterobacterales with chromosomally encoded inducible AmpC beta- lactamase","volume":"73","author":"Kohlmann","year":"2018","journal-title":"J 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