{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:52:12Z","timestamp":1791345132791,"version":"4.3.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Petrus and Augusta Hedlund"},{"name":"Per Sk\u00e5rman"},{"name":"Landsh\u00f6vding Per Westling"},{"name":"Rune Ljungdahl"},{"name":"Swedish National Health Service","award":["2022-YF0025"],"award-info":[{"award-number":["2022-YF0025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with bloodstream infections (BSIs) with antimicrobial resistant bacteria often receive ineffective empirical therapy (IET). The implications are still uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective, multicenter, study of patients with BSIs caused by extended-spectrum \u03b2-lactamase (ESBL)-producing gram-negative bacteria in southern Sweden from 2013 to 2022. Patients were categorized based on time to effective therapy: \u226424 hours (EET) and &amp;gt;24 hours (IET). Therapy was considered effective if the agent was active in susceptibility testing and administered intravenously at an appropriate dose. The primary outcome was 30-day mortality. Secondary outcomes were ICU admission and hospital length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 289\/644 (44.9%) patients received IET within the first 24 hours after the index blood culture collection. No significant impact of IET on 30-day mortality was found in univariable (Hazard ratio 0.66; P = .15) or multivariable Cox regression analysis (Hazard ratio 0.64; P = .13). Patients receiving EET were more likely to receive intensive care (Odds ratio 0.38; P = .008), but the association was nonsignificant after adjusting for severity of illness and comorbidities. IET was not associated with a longer hospital stay in Fine\u2013Gray competing risks regression analysis (univariable: sHR 1.15; P = .082; multivariable: sHR 1.11; P = .20).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IET was not associated with 30-day mortality, in patients with BSIs with ESBL-producing Enterobacterales. If confirmed in prospective studies, our findings could support antimicrobial stewardship efforts by reducing unnecessary empirical carbapenem use without compromising short-term clinical outcomes, particularly in low-prevalence settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag604","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T11:36:50Z","timestamp":1789817810000},"source":"Crossref","is-referenced-by-count":0,"title":["Time to Effective Antibiotic Therapy and Clinical Outcomes in Bloodstream Infections With ESBL-Producing Enterobacterales: A Retrospective Multicenter Cohort Study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4696-4588","authenticated-orcid":false,"given":"Thomas","family":"Sahlstr\u00f6m M\u00e5nsson","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Sahlgrenska University Hospital , Gothenburg 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