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

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

Clin Infect Dis. 2018 Sep 20;:

Authors: 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)

Abstract
Background: Overcoming-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 (MDR) isolates to investigate whether two representative RMDs (Acuitas Resistome Test and VERIGENE Gram-Negative Blood Culture Test) could identify susceptibility to two newer -lactam/-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% CI: 97%, 100%)] for both BL-BLIs. However, their ability to detect resistance to these BL-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 resulting from empiric treatment decisions based on resistance gene detection in P.aeruginosa, acknowledging that such decisions are impacted by the prevalence of resistance which varies temporally and geographically.

PMID: 30239599 [PubMed - as supplied by publisher]