{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T07:54:33Z","timestamp":1777190073301,"version":"3.51.4"},"reference-count":34,"publisher":"Harborside Press, LLC","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3]]},"abstract":"Background:<\/jats:bold> There is minimal data evaluating the safety of antibiotic de-escalation in patients with acute myeloid leukemia (AML) with fever and ongoing neutropenia. Therefore, this study evaluated antibiotic prescribing, infection-related outcomes, and patient outcomes of an antibiotic de-escalation initiative. Patients and Methods:<\/jats:bold> This pre\u2013post quasiexperimental study included adult patients with AML hospitalized with febrile neutropenia. An antibiotic de-escalation guideline was implemented in January 2017, which promoted de-escalation or discontinuation of intravenous antipseudomonal \u03b2-lactams. The primary outcome assessment was the incidence of bacterial infection in a historical control group before guideline implementation compared with an intervention group after guideline implementation. Results:<\/jats:bold> A total of 93 patients were included. Antibiotic de-escalation occurred more frequently in the intervention group (71.7% vs 7.5%; P<\/jats:italic><.001), which resulted in fewer days of therapy for intravenous antipseudomonal \u03b2-lactams (14 vs 25 days; P<\/jats:italic><.001). Thirty-day all-cause mortality and length of hospitalization were not different between groups. However, the intervention group had significantly fewer episodes of Clostridioides difficile<\/jats:italic> colitis (5.7% vs 27.5%; P<\/jats:italic>=.007). Conclusions:<\/jats:bold> Implementation of an antibiotic de-escalation guideline resulted in decreased use of intravenous antipseudomonal \u03b2-lactams and fewer episodes of C difficile<\/jats:italic> colitis, without adversely impacting patient outcomes. Additional studies are needed, preferably in the form of randomized controlled trials, to confirm these results.<\/jats:p>","DOI":"10.6004\/jnccn.2021.7054","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T15:46:30Z","timestamp":1643989590000},"page":"245-252","source":"Crossref","is-referenced-by-count":15,"title":["Early Antibiotic Discontinuation or De-escalation in High-Risk Patients With AML With Febrile Neutropenia and Prolonged Neutropenia"],"prefix":"10.6004","volume":"20","author":[{"given":"William","family":"Alegria","sequence":"first","affiliation":[{"name":"1Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, and"},{"name":"2Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard L.","family":"Marini","sequence":"additional","affiliation":[{"name":"3Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan;"},{"name":"4University of Michigan, College of Pharmacy, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin Sellery","family":"Gregg","sequence":"additional","affiliation":[{"name":"3Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan;"},{"name":"5Division of Infectious Diseases, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dale Lee","family":"Bixby","sequence":"additional","affiliation":[{"name":"3Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan;"},{"name":"6Division of Hematology\/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Perissinotti","sequence":"additional","affiliation":[{"name":"3Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan;"},{"name":"4University of Michigan, College of Pharmacy, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerod","family":"Nagel","sequence":"additional","affiliation":[{"name":"3Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan;"},{"name":"4University of Michigan, College of Pharmacy, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"ref91","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.1016\/S2352-3026(17)30211-9","article-title":"Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 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