{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:12Z","timestamp":1790571372074,"version":"4.1.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007446","name":"King Khalid University","doi-asserted-by":"publisher","award":["RGP.2\/711\/46"],"award-info":[{"award-number":["RGP.2\/711\/46"]}],"id":[{"id":"10.13039\/501100007446","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Antimicrobial resistance (AMR) among urinary Gram-negative bacilli (GNB) is rising in Saudi Arabia, but how interim antibiotic exposure relates to within-patient changes in susceptibility is not well characterized. We evaluated the association between class-matched antibiotic exposure occurring between consecutive cultures and susceptible (S)-to-non-susceptible (NS) and non-susceptible-to-susceptible transitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a single-center, retrospective, culture-based, pharmacy-linked paired-culture cohort at a 500-bed tertiary hospital in southern Saudi Arabia (Aseer Central Hospital [ACH]), consecutive same-patient, same-species urinary GNB cultures 14\u2013365 days apart formed pairs, and interim exposure was defined as ACH-recorded antibiotic dispensing. For each of the seven feasible phenotypes, adjusted transition models estimated S\u2192NS odds and separate direct models estimated NS\u2192S odds, with supporting analyses using inverse probability weighting, cross-class models, E-values, penalized-likelihood sensitivity analyses, and exploratory pragmatic null-covariable diagnostics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The primary cohort comprised 1,274 pairs from 1,078 patients, of whom 807 (74.9%) had at least one interim ACH-recorded systemic antibiotic dispensing. Class-matched dispensing was associated with higher adjusted odds of an S\u2192NS transition for extended-spectrum cephalosporins (OR, 3.83), difficult-to-treat resistance (OR, 2.91), piperacillin\u2013tazobactam (OR, 2.46), and fluoroquinolones (OR, 2.29), but not carbapenems (OR, 0.93). In direct models, matched dispensing was associated with lower odds of an NS\u2192S transition, reaching significance only for piperacillin\u2013tazobactam (OR, 0.39).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In recurrent urinary GNB, interim class-matched hospital-recorded antibiotic dispensing was associated with within-patient S\u2192NS transitions for several clinically important phenotypes. These observational associations do not establish treatment effects; they identify patterns for confirmation in prospective studies and may inform surveillance and stewardship evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1897524","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:28:53Z","timestamp":1790569733000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Class-matched antibiotic dispensing and susceptibility transitions in recurrent urinary gram-negative bacilli"],"prefix":"10.3389","volume":"16","author":[{"given":"Ibrahim","family":"Tawhari","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona M.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M.","family":"Somily","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, King Saud University and King Saud University Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalifa","family":"Binkhamis","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulah J.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah A.","family":"Al-Shahrani","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safia Abdullah","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Aseer Central Hospital","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmahan","family":"Tahtouh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Aseer Central Hospital","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Tawhari","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Shabi","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulah O. 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