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ACP: Next-Generation Antibiotics Underused for Gram-Negative Infections

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41.5 percent of difficult-to-treat resistance episodes were treated exclusively with traditional agents

By Elana Gotkine HealthDay Reporter

MONDAY, April 22, 2024 (HealthDay News) — Clinicians frequently treat gram-negative infection with older, generic antibiotics, despite recent approval of next-generation, gram-negative antibiotics, according to a study published online April 19 in the Annals of Internal Medicine to coincide with the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 18 to 20 in Boston.

In a retrospective cohort study at 619 U.S. hospitals, Jeffrey R. Strich, M.D., from the National Institutes of Health in Bethesda, Maryland, and colleagues examined use patterns of recently U.S. Food and Drug Administration-approved gram-negative antibiotics and identified factors associated with their preferential use over traditional generic agents in patients with gram-negative infections due to pathogens displaying difficult-to-treat resistance (DTR).

The researchers found that ceftolozane-tazobactam (approved in 2014) and ceftazidime-avibactam (approved in 2015) predominated new antibiotic usage between quarter 1 of 2016 and quarter 2 of 2021, while there was relatively low uptake of subsequently approved gram-negative antibiotics. Overall, 0.7 percent of the gram-negative infection hospitalizations displayed DTR pathogens. In 41.5 percent of DTR episodes, patients were treated exclusively using traditional agents, including reserve antibiotics such as polymyxins, aminoglycosides, and tigecycline in 79.3 percent. The adjusted probability of receiving newer versus traditional antibiotics for DTR infections was greater for patients with bacteremia and chronic diseases and was lower for those with do-not-resuscitate status, acute liver failure, and Acinetobacter baumannii complex and other nonpseudomonal nonfermenter pathogens.

“There is a stark imbalance between available new antibiotics and unmet pathogen targets,” the authors write. “These findings call for paradigm-changing countermeasures.”

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