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Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 May 17; Vol. 68 (11), pp. 1823-1830. - Publication Year :
- 2019
-
Abstract
- Background: Overcoming 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.<br />Methods: In 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).<br />Results: We 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).<br />Conclusions: The 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.<br /> (Published by Oxford University Press for the Infectious Diseases Society of America 2018.)
- Subjects :
- Anti-Bacterial Agents pharmacology
Drug Combinations
Genotype
Humans
Microbial Sensitivity Tests
Molecular Diagnostic Techniques methods
Pseudomonas Infections microbiology
Pseudomonas aeruginosa drug effects
Sensitivity and Specificity
beta-Lactam Resistance
beta-Lactamase Inhibitors pharmacology
beta-Lactamase Inhibitors therapeutic use
Anti-Bacterial Agents therapeutic use
Azabicyclo Compounds therapeutic use
Ceftazidime therapeutic use
Cephalosporins therapeutic use
Drug Resistance, Multiple, Bacterial
Molecular Diagnostic Techniques standards
Pseudomonas Infections drug therapy
Tazobactam therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 68
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 30239599
- Full Text :
- https://doi.org/10.1093/cid/ciy801