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Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV.

Publication ,  Journal Article
Evans, SR; Tran, TTT; Hujer, AM; Hill, CB; Hujer, KM; Mediavilla, JR; Manca, C; Domitrovic, TN; Perez, F; Farmer, M; Pitzer, KM; Wilson, BM ...
Published in: Clin Infect Dis
May 17, 2019

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. 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). 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). 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.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

May 17, 2019

Volume

68

Issue

11

Start / End Page

1823 / 1830

Location

United States

Related Subject Headings

  • beta-Lactamase Inhibitors
  • beta-Lactam Resistance
  • Tazobactam
  • Sensitivity and Specificity
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Molecular Diagnostic Techniques
  • Microbiology
  • Microbial Sensitivity Tests
  • Humans
 

Citation

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Evans, S. R., Tran, T. T. T., Hujer, A. M., Hill, C. B., Hujer, K. M., Mediavilla, J. R., … Antibacterial Resistance Leadership Group (ARLG), . (2019). Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV. Clin Infect Dis, 68(11), 1823–1830. https://doi.org/10.1093/cid/ciy801
Evans, Scott R., Thuy Tien T. Tran, Andrea M. Hujer, Carol B. Hill, Kristine M. Hujer, Jose R. Mediavilla, Claudia Manca, et al. “Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV.Clin Infect Dis 68, no. 11 (May 17, 2019): 1823–30. https://doi.org/10.1093/cid/ciy801.
Evans SR, Tran TTT, Hujer AM, Hill CB, Hujer KM, Mediavilla JR, et al. Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV. Clin Infect Dis. 2019 May 17;68(11):1823–30.
Evans, Scott R., et al. “Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV.Clin Infect Dis, vol. 68, no. 11, May 2019, pp. 1823–30. Pubmed, doi:10.1093/cid/ciy801.
Evans SR, Tran TTT, Hujer AM, Hill CB, Hujer KM, Mediavilla JR, Manca C, Domitrovic TN, Perez F, Farmer M, Pitzer KM, Wilson BM, Kreiswirth BN, Patel R, Jacobs MR, Chen L, Fowler VG, Chambers HF, Bonomo RA, Antibacterial Resistance Leadership Group (ARLG). Rapid Molecular Diagnostics to Inform Empiric Use of Ceftazidime/Avibactam and Ceftolozane/Tazobactam Against Pseudomonas aeruginosa: PRIMERS IV. Clin Infect Dis. 2019 May 17;68(11):1823–1830.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

May 17, 2019

Volume

68

Issue

11

Start / End Page

1823 / 1830

Location

United States

Related Subject Headings

  • beta-Lactamase Inhibitors
  • beta-Lactam Resistance
  • Tazobactam
  • Sensitivity and Specificity
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Molecular Diagnostic Techniques
  • Microbiology
  • Microbial Sensitivity Tests
  • Humans