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Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU

OBJECTIVES: To describe the pathogen predominance and to evaluate the probability of covering the most common Gram-negative pathogens collectively in both empirical and early adjustment prescribing scenarios in ICU patients with respiratory infections. METHODS: Data were collected from an internatio...

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Autores principales: Moise, Pamela A, Gonzalez, Marcela, Alekseeva, Irina, Lopez, Diego, Akrich, Brune, DeRyke, C Andrew, Chen, Wei-Ting, Pavia, Jacqueline, Palermo, Brandon, Hackel, Meredith, Motyl, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209971/
https://www.ncbi.nlm.nih.gov/pubmed/34223078
http://dx.doi.org/10.1093/jacamr/dlaa129
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author Moise, Pamela A
Gonzalez, Marcela
Alekseeva, Irina
Lopez, Diego
Akrich, Brune
DeRyke, C Andrew
Chen, Wei-Ting
Pavia, Jacqueline
Palermo, Brandon
Hackel, Meredith
Motyl, Mary
author_facet Moise, Pamela A
Gonzalez, Marcela
Alekseeva, Irina
Lopez, Diego
Akrich, Brune
DeRyke, C Andrew
Chen, Wei-Ting
Pavia, Jacqueline
Palermo, Brandon
Hackel, Meredith
Motyl, Mary
author_sort Moise, Pamela A
collection PubMed
description OBJECTIVES: To describe the pathogen predominance and to evaluate the probability of covering the most common Gram-negative pathogens collectively in both empirical and early adjustment prescribing scenarios in ICU patients with respiratory infections. METHODS: Data were collected from an international cohort of hospitals as part of the SMART Surveillance Program (2018). Susceptibility testing (mg/L) was performed by broth microdilution methods. RESULTS: 7171 Gram-negative respiratory isolates from adult ICU patients across 209 hospitals from 56 different countries were studied. Overall, the most common ICU respiratory pathogens isolated were Pseudomonas aeruginosa (25%), Klebsiella pneumoniae (18%), Acinetobacter baumannii (14%), and Escherichia coli (11%), with inter-regional differences among these pathogens. Among Enterobacterales, 36% were ESBL positive. When the collective susceptibility profile of this set of pathogens (P. aeruginosa plus Enterobacterales; comprising 78% of all organisms isolated) was performed, ceftolozane/tazobactam (84%), followed by meropenem (81%), provided the most reliable in vitro activity in the empirical prescribing scenario compared with other β-lactam antibiotics. P. aeruginosa co-resistance was common among first-line β-lactam antibiotics. If P. aeruginosa was non-susceptible to piperacillin/tazobactam, less than one-third were susceptible to meropenem or ceftazidime. In contrast, ceftolozane/tazobactam offered in vitro coverage in over two-thirds of these resistant pathogens. CONCLUSIONS: Ceftolozane/tazobactam demonstrated high cumulative susceptibility levels and in vitro activity in both empirical and adjustment antibiotic prescribing scenarios. High frequency of co-resistance undermines reliable coverage for Gram-negative pathogens already resistant to first-line agents. Ceftolozane/tazobactam would offer additional coverage in this setting.
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spelling pubmed-82099712021-07-02 Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU Moise, Pamela A Gonzalez, Marcela Alekseeva, Irina Lopez, Diego Akrich, Brune DeRyke, C Andrew Chen, Wei-Ting Pavia, Jacqueline Palermo, Brandon Hackel, Meredith Motyl, Mary JAC Antimicrob Resist Original Article OBJECTIVES: To describe the pathogen predominance and to evaluate the probability of covering the most common Gram-negative pathogens collectively in both empirical and early adjustment prescribing scenarios in ICU patients with respiratory infections. METHODS: Data were collected from an international cohort of hospitals as part of the SMART Surveillance Program (2018). Susceptibility testing (mg/L) was performed by broth microdilution methods. RESULTS: 7171 Gram-negative respiratory isolates from adult ICU patients across 209 hospitals from 56 different countries were studied. Overall, the most common ICU respiratory pathogens isolated were Pseudomonas aeruginosa (25%), Klebsiella pneumoniae (18%), Acinetobacter baumannii (14%), and Escherichia coli (11%), with inter-regional differences among these pathogens. Among Enterobacterales, 36% were ESBL positive. When the collective susceptibility profile of this set of pathogens (P. aeruginosa plus Enterobacterales; comprising 78% of all organisms isolated) was performed, ceftolozane/tazobactam (84%), followed by meropenem (81%), provided the most reliable in vitro activity in the empirical prescribing scenario compared with other β-lactam antibiotics. P. aeruginosa co-resistance was common among first-line β-lactam antibiotics. If P. aeruginosa was non-susceptible to piperacillin/tazobactam, less than one-third were susceptible to meropenem or ceftazidime. In contrast, ceftolozane/tazobactam offered in vitro coverage in over two-thirds of these resistant pathogens. CONCLUSIONS: Ceftolozane/tazobactam demonstrated high cumulative susceptibility levels and in vitro activity in both empirical and adjustment antibiotic prescribing scenarios. High frequency of co-resistance undermines reliable coverage for Gram-negative pathogens already resistant to first-line agents. Ceftolozane/tazobactam would offer additional coverage in this setting. Oxford University Press 2021-02-19 /pmc/articles/PMC8209971/ /pubmed/34223078 http://dx.doi.org/10.1093/jacamr/dlaa129 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Moise, Pamela A
Gonzalez, Marcela
Alekseeva, Irina
Lopez, Diego
Akrich, Brune
DeRyke, C Andrew
Chen, Wei-Ting
Pavia, Jacqueline
Palermo, Brandon
Hackel, Meredith
Motyl, Mary
Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title_full Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title_fullStr Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title_full_unstemmed Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title_short Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU
title_sort collective assessment of antimicrobial susceptibility among the most common gram-negative respiratory pathogens driving therapy in the icu
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209971/
https://www.ncbi.nlm.nih.gov/pubmed/34223078
http://dx.doi.org/10.1093/jacamr/dlaa129
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