1. Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV
- Author
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Evans, Scott R, Tran, Thuy Tien T, Hujer, Andrea M, Hill, Carol B, Hujer, Kristine M, Mediavilla, Jose R, Manca, Claudia, Domitrovic, T Nicholas, Perez, Federico, Farmer, Michael, Pitzer, Kelsey M, Wilson, Brigid M, Kreiswirth, Barry N, Patel, Robin, Jacobs, Michael R, Chen, Liang, Fowler, Vance G, Chambers, Henry F, and Bonomo, Robert A
- Subjects
Infectious Diseases ,Biodefense ,Vaccine Related ,Emerging Infectious Diseases ,Prevention ,Antimicrobial Resistance ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Infection ,Good Health and Well Being ,Anti-Bacterial Agents ,Azabicyclo Compounds ,Ceftazidime ,Cephalosporins ,Drug Combinations ,Drug Resistance ,Multiple ,Bacterial ,Genotype ,Humans ,Microbial Sensitivity Tests ,Molecular Diagnostic Techniques ,Pseudomonas Infections ,Pseudomonas aeruginosa ,Sensitivity and Specificity ,Tazobactam ,beta-Lactam Resistance ,beta-Lactamase Inhibitors ,ceftolozane ,tazobactam ,ceftazidime ,avibactam ,antimicrobial resistance ,Antibacterial Resistance Leadership Group ,Pseudomonas aeruginosa ,ceftazidime/avibactam ,ceftolozane/tazobactam ,Biological Sciences ,Medical and Health Sciences ,Microbiology - Abstract
BackgroundOvercoming β-lactam resistance in pathogens such as Pseudomonas aeruginosa is a major clinical challenge. Rapid molecular diagnostics (RMDs) have the potential to inform selection of empiric therapy in patients infected by P. aeruginosa.MethodsIn this study, we used a heterogeneous collection of 197 P. aeruginosa that included multidrug-resistant isolates to determine whether 2 representative RMDs (Acuitas Resistome test and VERIGENE gram-negative blood culture test) could identify susceptibility to 2 newer β-lactam/β-lactamase inhibitor (BL-BLI) combinations, ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (TOL/TAZO).ResultsWe found that the studied RMD platforms were able to correctly identify BL-BLI susceptibility (susceptibility sensitivity, 100%; 95% confidence interval [CI], 97%, 100%) for both BLs-BLIs. However, their ability to detect resistance to these BLs-BLIs was lower (resistance sensitivity, 66%; 95% CI, 52%, 78% for TOL/TAZO and 33%; 95% CI, 20%, 49% for CZA).ConclusionsThe diagnostic platforms studied showed the most potential in scenarios where a resistance gene was detected or in scenarios where a resistance gene was not detected and the prevalence of resistance to TOL/TAZO or CZA is known to be low. Clinicians need to be mindful of the benefits and risks that result from empiric treatment decisions that are based on resistance gene detection in P. aeruginosa, acknowledging that such decisions are impacted by the prevalence of resistance, which varies temporally and geographically.
- Published
- 2019