{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T19:30:23Z","timestamp":1787686223763,"version":"build-2784847793"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Current guidelines recommend adding vancomycin to empiric treatment of FN in patients who meet specific criteria. After 48\u00a0hours, the guidelines recommend discontinuing vancomycin if resistant Gram\u2010positive organisms are not identified. Based on these recommendations, a vancomycin stewardship team defined criteria for discontinuation of vancomycin at 48\u00a0hours and increased surveillance of vancomycin usage through a multimodal approach. The purpose of this retrospective analysis is to assess the impact of this multimodal approach on the discontinuation of empiric vancomycin at 48\u00a0hours in FN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective analysis included a pre\u2010 and post\u2010intervention cohort of 200 HSCT recipients with FN from 2015 to 2018. Criteria for continued vancomycin use beyond 48\u00a0hours included culture\u2010documented resistant Gram\u2010positive infection, positive Methicillin\u2010Resistant <jats:italic>S\u00a0aureus<\/jats:italic> (MRSA) nasal swab with evidence of pneumonia, or hemodynamic instability with concern for sepsis. The following patient characteristics were collected: previous MRSA infection, MRSA nasal swab collection and results, culture results, duration of vancomycin use, rationale for continuation of vancomycin beyond 48\u00a0hours, and re\u2010initiation of vancomycin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the post\u2010intervention cohort, vancomycin discontinuation at 48\u00a0hours increased from 31% (95% CI 21.94\u201040.05) to 70% (95% CI 61.02\u201078.97; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001). An additional 23% of vancomycin orders were discontinued at 72\u00a0hours. Off criteria vancomycin use decreased from 33% in pre to 1% in the post\u2010implementation cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Establishing define criteria for vancomycin use in FN patients with a multimodal approach of physicians from hematology and infectious diseases, clinical pharmacists and the antibiotic stewardship team significantly improved vancomycin discontinuation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13059","type":"journal-article","created":{"date-parts":[[2019,2,9]],"date-time":"2019-02-09T02:14:44Z","timestamp":1549678484000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The impact of a multimodal approach to vancomycin discontinuation in hematopoietic stem cell transplant recipients (HSCT) with febrile neutropenia (FN)"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4502-7579","authenticated-orcid":false,"given":"Sarah","family":"Perreault","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayna","family":"McManus","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noffar","family":"Bar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine","family":"Foss","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lohith","family":"Gowda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Isufi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Seropian","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maricar","family":"Malinis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Infectious Diseases Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Topal","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Yale\u2010New Haven Hospital New Haven Connecticut"},{"name":"Department of Internal Medicine, Section of Infectious Diseases Yale\u2010New Haven Hospital New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2015.01.013"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir073"},{"key":"e_1_2_7_4_1","volume-title":"Prevention and Treatment of Cancer\u2010Related Infections (Version1.2018)","author":"NCCN Clinical Practice Guidelines in Oncology","year":"2018"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1086\/376637"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/163.5.951"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofu006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw118"},{"key":"e_1_2_7_9_1","unstructured":"Centers for Disease Control and Prevention.Core elements of hospital antibiotic stewardship programs. Available at:https:\/\/www.cdc.gov\/antibiotic-use\/healthcare\/implementation\/core-elements.htmlAccessed 28 May 2018."},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1078155216668672"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofx226"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-007-0390-7"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/501846"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/652530"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01805-13"},{"key":"e_1_2_7_16_1","first-page":"1","article-title":"The role of negative methicillin\u2010resistant Staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients","author":"Chotiprasitsakul D","year":"2018","journal-title":"Infect Control Hosp Epidemiol"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.13059","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13059","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.13059","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T21:25:36Z","timestamp":1694381136000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.13059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,22]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1111\/tid.13059"],"URL":"https:\/\/doi.org\/10.1111\/tid.13059","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,22]]},"assertion":[{"value":"2018-09-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13059"}}