{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:16:13Z","timestamp":1777853773143,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T00:00:00Z","timestamp":1601856000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000897","name":"Cystic Fibrosis Foundation","doi-asserted-by":"crossref","award":["NOTO17Q0"],"award-info":[{"award-number":["NOTO17Q0"]}],"id":[{"id":"10.13039\/100000897","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The optimal timing for the de-escalation of broad-spectrum antibiotics with activity against Pseudomonas aeruginosa and resistant Gram-negative rods (GNRs) in critically ill adults remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Question:<\/jats:title>\n                    <jats:p>We tested the hypothesis that cultures will identify GNRs that ultimately demonstrate resistance to ceftriaxone within 48 hours, potentially allowing safe de-escalation at this time point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods:<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of data from the Isotonic Solutions and Major Adverse Renal Events Trial: a pragmatic, cluster-randomized, multiple-crossover trial comparing balanced crystalloids versus saline for intravenous fluid administration in 15,802 critically ill adults at 5 intensive care units (ICUs) at Vanderbilt University Medical Center in Nashville, TN, USA. The primary endpoint was the time-to-positivity of respiratory and blood cultures that ultimately demonstrated growth of GNRs resistant to ceftriaxone. Multivariable logistic regression modeling was used to examine risk factors for the growth of cultures after 48 hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 524 respiratory cultures had growth of GNRs, of which 284 (54.2%) had resistance to ceftriaxone. A total of 376 blood cultures grew GNRs, of which 70 (18.6%) had resistance to ceftriaxone. At 48 hours, 87% of respiratory cultures and 85% of blood cultures that ultimately grew GNRs resistant to ceftriaxone had demonstrated growth. Age, gender, predicted risk of inpatient mortality and prior use of antibiotics did not predict the growth of cultures after 48 hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation:<\/jats:title>\n                    <jats:p>Among a cohort of critically ill adults, 13% of respiratory cultures and 15% of blood cultures that ultimately grew GNRs resistant to ceftriaxone did not demonstrate growth until at least 48 hours after collection. Further work is needed to determine the ideal time for critically ill adults to de-escalate from broad-spectrum antibiotics targeting Pseudomonas aeruginosa and extended-spectrum \u03b2-lactamase-producing gram-negative pathogens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0885066620963903","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T06:00:31Z","timestamp":1601877631000},"page":"51-57","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Time to First Culture Positivity for Gram-Negative Rods Resistant to Ceftriaxone in Critically Ill Adults"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5718-3328","authenticated-orcid":false,"given":"Kevin G.","family":"Buell","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan D.","family":"Casey","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Noto","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd W.","family":"Rice","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew W.","family":"Semler","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6792-1646","authenticated-orcid":false,"given":"Joanna L.","family":"Stollings","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,10,5]]},"reference":[{"key":"bibr1-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu542"},{"key":"bibr2-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3485-3"},{"key":"bibr3-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182416ecf"},{"key":"bibr4-0885066620963903","first-page":"12","author":"Silva BNG","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"bibr5-0885066620963903","first-page":"6074","volume":"14","author":"Moustos E","year":"2017","journal-title":"Exp Ther Med"},{"key":"bibr6-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1177\/1060028013511229"},{"key":"bibr7-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1177\/1060028019877937"},{"key":"bibr8-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-1000-z"},{"key":"bibr9-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208819"},{"key":"bibr10-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.05.016"},{"key":"bibr11-0885066620963903","doi-asserted-by":"crossref","unstructured":"Harris AM, Bramley AM, Jain S, et al. Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. Open Forum Infect Dis. 2017;10(1):ofx014.","DOI":"10.1093\/ofid\/ofx014"},{"key":"bibr12-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-2080-3"},{"key":"bibr13-0885066620963903","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1711584"},{"key":"bibr14-0885066620963903","unstructured":"Clinical and Laboratory Standards Institute (CLSI). M45 Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. 3rd ed. https:\/\/clsi.org\/standards\/products\/microbiology\/documents\/m45\/. Accessed March 5, 2020."},{"key":"bibr15-0885066620963903","unstructured":"Clinical and Laboratory Standards Institute (CLSI). M100 Performance Standards for antimicrobial susceptibility testing. 29th ed. https:\/\/clsi.org\/standards\/products\/microbiology\/documents\/m100\/. 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