{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:20:00Z","timestamp":1787934000000,"version":"build-2784847793"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bloodstream infections (BSIs) due to ceftriaxone (CRO)-resistant Enterobacteriaceae are associated with delays in time to appropriate therapy and worse outcomes compared with infections due to susceptible isolates. However, treating all at-risk patients with empiric carbapenem therapy risks overexposure. Strategies are needed to appropriately balance these competing interests. The purpose of this study was to compare 4 methods for achieving this balance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective hypothetical observational study of patients at the Detroit Medical Center with monomicrobial BSIs due to E. coli, K. oxytoca, K. pneumoniae, or P. mirabilis. This study compared the effectiveness of 4 methods to predict CRO resistance at the time of organism isolation. Three methods were based on applying published extended-spectrum beta-lactamase (ESBL) scoring tools. The fourth method was based on the presence or absence of the CTX-M marker from Verigene.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Four hundred fifty-one Enterobacteriaceae BSIs were included, 73 (16%) of which were CRO-resistant. Verigene accurately predicted ceftriaxone susceptibility for 97% of isolates, compared with 70%\u201381% using the scoring tools (P\u2005&amp;lt;\u2005.001). Verigene was associated with fewer cases of treatment with CRO when the isolate was CRO-resistant (15% vs 63%\u201371% with scoring tools) and fewer cases of overtreatment with a carbapenem for CRO-susceptible strains (0.3% vs 10%\u201312%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Verigene significantly outperformed published ESBL scoring tools for identifying CRO-resistant Enterobacteriaceae BSI. Institutions should validate scoring tools before implementation. Stewardship programs should consider adoption of rapid diagnostic tests to optimize early therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaa278","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T18:24:00Z","timestamp":1593714240000},"source":"Crossref","is-referenced-by-count":9,"title":["Minimizing Time to Optimal Antimicrobial Therapy for Enterobacteriaceae Bloodstream Infections: A Retrospective, Hypothetical Application of Predictive Scoring Tools vs Rapid Diagnostics Tests"],"prefix":"10.1093","volume":"7","author":[{"given":"Laura N","family":"Cwengros","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, CJW Medical Center, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P","family":"Mynatt","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan T","family":"Timbrook","sequence":"additional","affiliation":[{"name":"BioFire Diagnostics, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Microbiology Division, Detroit Medical Center University Laboratories, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Salimnia","sequence":"additional","affiliation":[{"name":"Microbiology Division, Detroit Medical Center University Laboratories, Detroit, Michigan, USA"},{"name":"Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lephart","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M","family":"Pogue","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"2020082715321052900_CIT0001","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/1469-0691.12195","article-title":"Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe","volume":"19","author":"Goto","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"2020082715321052900_CIT0002","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ijid.2019.06.017","article-title":"National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United 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