What question did this study set out to answer?

To introduce the escalation antibiogram as a tool to direct empiric antimicrobial adjustments in patients with gram-negative bacteremia who fail initial therapy.

April 5, 2022Clinical Infectious Diseases

Introducing the Escalation Antibiogram: A Simple Tool to Inform Changes in Empiric Antimicrobials in the Nonresponding Patient

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To introduce the escalation antibiogram as a tool to direct empiric antimicrobial adjustments in patients with gram-negative bacteremia who fail initial therapy.
Analyzed 6,577 episodes of gram-negative bacteremia between 2017 and 2020 across 6 hospitals in the Greater Toronto Area.
Constructed escalation antibiograms for 12 commonly used antimicrobials by assessing susceptibility to the remaining 11 agents among isolates resistant to each primary drug.
Evaluated stability of resistance patterns across study years, individual hospitals, infection onset setting (community vs hospital), and bacterial pathogen species.
Baseline overall coverage among 6,577 bacteremia episodes ranged from 31.8% for ampicillin and 67.1% for ceftriaxone to 97.5% for amikacin and 98.2% for meropenem.
Among ceftriaxone-resistant isolates, susceptibility to piperacillin-tazobactam was 21.2%, significantly lower than to trimethoprim-sulfamethoxazole (54.2%), ciprofloxacin (63.0%), ertapenem (73.4%), tobramycin (80.1%), gentamicin (82.8%), meropenem (94.3%), and amikacin (97.1%; P < .0001 for all comparisons).
Trimethoprim-sulfamethoxazole ranked as the second most active agent in the meropenem escalation antibiogram (49.6% susceptible) and the top-ranked agent in the amikacin escalation antibiogram (86.0% susceptible).

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Implication

Multicenter cohort study demonstrates cross-resistance patterns for treatment switching in gram-negative bacteremia, highlighting optimal secondary empiric antibiotic choices.

Cite This Study

Teitelbaum et al. (2022) studied this question.

synapsesocial.com/papers/6aa61898b3a9aaf5308e3f8a https://doi.org/10.1093/cid/ciac256

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Implication

Multicenter cohort study demonstrates cross-resistance patterns for treatment switching in gram-negative bacteremia, highlighting optimal secondary empiric antibiotic choices.

Introducing the Escalation Antibiogram: A Simple Tool to Inform Changes in Empiric Antimicrobials in the Nonresponding Patient

Key Points

Discussion

Implication

Cite This Study

Introducing the Escalation Antibiogram: A Simple Tool to Inform Changes in Empiric Antimicrobials in the Nonresponding Patient

Key Points

Discussion

Implication

Cite This Study

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