{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:04:08Z","timestamp":1753877048835,"version":"3.41.2"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12\u20132.76)] and for CAP (aOR 4.25, 95% CI 2.53\u20137.13), cholangitis (aOR 6.01, 95% CI 3.49\u201310.36), pyelonephritis (aOR 6.08, 95% CI 3.56\u201310.39) and BSI (aOR 4.49, 95% CI 2.50\u20138.09) compared with SSTI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlad087","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T10:47:01Z","timestamp":1690886821000},"source":"Crossref","is-referenced-by-count":2,"title":["Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8228-9095","authenticated-orcid":false,"given":"Kwadwo","family":"Mponponsuo","sequence":"first","affiliation":[{"name":"Sunnybrook Research Institute , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxandra","family":"Pinto","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute , Toronto , Canada"},{"name":"Department of Critical Care, Sunnybrook Health Sciences Centre , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Fowler","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute , Toronto , Canada"},{"name":"Department of Critical Care, Sunnybrook Health Sciences Centre , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6515-2118","authenticated-orcid":false,"given":"Ben","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Monash Health , Clayton, VIC , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute , Toronto , Canada"},{"name":"Division of Infectious Diseases, Public Health Ontario, Sunnybrook Health Sciences Centre, ICES, Institute of Health Policy Management and Evaluation, University of Toronto , 2075 Bayview Ave, G-wing Room 106, Toronto, ON M4N 3M5 , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"2023080110465580100_dlad087-B1","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":"2023080110465580100_dlad087-B2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.7326\/M18-3640","article-title":"Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study","volume":"171","author":"Vaughn","year":"2019","journal-title":"Ann Intern Med"},{"author":"Fleming","key":"2023080110465580100_dlad087-B3"},{"key":"2023080110465580100_dlad087-B4","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":"2023080110465580100_dlad087-B5","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2023080110465580100_dlad087-B6","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious 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bloodstream infections in critically ill children\u2014a survey of pediatric infectious diseases and critical care clinicians for clinical equipoise","volume":"17","author":"Pong","year":"2022","journal-title":"PLoS One"}],"container-title":["JAC-Antimicrobial 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