winning the battle on antibiotic-resistant

10/8/21

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2021 Annual Meeting & ExhibitionNovember 4-7, 2021 | San Diego, California

Winning the Battle on Antibiotic-Resistant Gram-Negative Infections

Elias B. Chahine, PharmD, FCCP, FASCP, FFSHP, BCPS, BCIDPProfessor of Pharmacy PracticePalm Beach Atlantic UniversityGregory School of Pharmacy

Jonathan C. Cho, PharmD, MBA, BCIDP, BCPSDirector of Pharmacy

Director of PGY-2 Infectious Diseases Residency ProgramMountainView Hospital

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Meet the Speaker: Elias Chahine• Professor of Pharmacy Practice

• Palm Beach Atlantic University

• Clinical Pharmacy Specialist• Wellington Regional Medical Center

• Academic Leadership Fellow• American Association of Colleges of Pharmacy

• PGY-1 Pharmacy Resident• Mary Imogene Bassett Hospital & Columbia University

• Doctor of Pharmacy• Lebanese American University

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Meet the Speaker: Jonathan Cho• Director of Pharmacy & PGY-2 Infectious

Diseases Residency Program Director• MountainView Hospital

• Author/Editor of “Infectious Diseases: A Case Study Approach”• McGraw-Hill Education

• PGY-1 & PGY-2 Infectious Diseases Resident• Lee Health

• Doctor of Pharmacy• University of the Pacific

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Disclosures

•Elias Chahine• Advisory board for Theratechnologies• Speakers’ bureau for Paratek

• Jonathan Cho• Advisory board for AcelRx• Speakers’ bureau for Allergan

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Pharmacist Learning Objectives

• Describe recent epidemiological trends of antibiotic-resistant gram-negative organisms• Identify key aspects to the diagnosis of antibiotic-resistant gram-

negative infections• Compare and contrast the available treatment options for infections

caused by extended-spectrum β-lactamase-producing Enterobacterales(ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR)• Develop a personalized treatment plan for an older adult with an

antibiotic-resistant gram-negative infection

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Pharmacy Technician Learning Objectives

• Describe recent epidemiological trends of antibiotic-resistant gram-negative organisms.• Identify the available treatment options for infections caused by

antibiotic-resistant gram-negative organisms.

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Abbreviations

• ABSSSIs: acute bacterial skin and skin structure infections

• AmpC: AmpC β-lactamase-producing bacteria• BSIs: bloodstream infections• CABP: community-acquired bacterial pneumonia• cIAIs: complicated intra-abdominal infections• CNS: central nervous system• CrCl: creatinine clearance• CRE: carbapenem-resistant Enterobacterales• cUTIs: complicated urinary tract infections• DTR: difficult-to-treat resistance

• ESBL-E: extended-spectrum β-lactamase-producing Enterobacterales

• KPC: Klebsiella pneumoniae carbapenemase• HABP: hospital-acquired bacterial pneumonia• LFTs: liver function tests• MBL: metallo-β-lactamase• MRSA: methicillin-resistant Staphylococcus aureus • NTM: nontuberculous mycobacteria• OXA: oxacillinase• TMP/SMX: trimethoprim/sulfamethoxazole• VABP: ventilator-associated bacterial pneumonia• VRE: vancomycin-resistant Enterococcus

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Outline

• Epidemiology of antibiotic-resistant gram-negative organisms• Diagnostic considerations for resistant gram-negative infections• New antibiotics for resistant gram-negative infections• General approach to management of ESBL-E• General approach to management of CRE• General approach to management of DTR P. aeruginosa• Special considerations for older adults

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Background

• 20-50% of antimicrobial use is inappropriate• ~30% is considered unnecessary

• 1 out of 5 emergency department visits are for ADRs due to antibiotic use• >$10 billion spent on antibiotics; >$3.5 billion among hospitalized

patients• >2.8 million antibiotic-resistant infections annually in US• >35,000 deaths• Clostridioides difficile infection: >223,000 cases and >12,000 deaths

Centers for Disease Control and Prevention. 2019 AR Threats Report. American Hospital Association. Hospital Statistics, 2018 Edition.

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Antimicrobial Resistance Development

Centers for Disease Control and Prevention. 2019 AR Threats Report.

Antibiotic Approved Year Resistance Identified YearPenicillin 1941 Penicillin-resistant Staphylococcus aureus 1942

Methicillin 1960 MRSA 1960

Cefotaxime 1980 ESBL-producing Escherichia coli 1983

Azithromycin 1980 Azithromycin-resistant Neisseria gonorrhoeae 2011

Imipenem/cilastatin 1985 KPC-producing Klebsiella pneumoniae 1996

Daptomycin 2003 Daptomycin-resistant MRSA 2004

Ceftazidime/avibactam 2015 Ceftazidime/avibactam-resistant CRE 2015

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Estimates of Antibiotic Usage Trends

660

680

700

720

740

760

780

800

820

840

200 6 200 7 200 8 200 9 201 0 201 1 201 2

DOT/

1000

PD

Year

All ABX Use

<300 Beds

300 + Beds

Teaching

Non-Teaching

Baggs J. JAMA Intern Med. 2016;176:1639–48.

ABX = antibiotics; DOT = days of therapy; PD = patient-days.

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Antibiotic Use by Hospital Unit

Hospital Locations• Medical unit• Surgical unit• Critical care unit• Orthopedic ward• Postpartum ward• Specialty areas

• Neonatal units

Commonly Used Antibiotics• Vancomycin• Ceftriaxone• Levofloxacin• Piperacillin/tazobactam• Gentamicin• Azithromycin

• Metronidazole

Magill SS. JAMA. 2014;12:1438–46.

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CDC Threat Levels

Urgent Threats• Carbapenem-resistant Acinetobacter

sp.• Candida auris• Clostridioides difficile • CRE • Drug-resistant Neisseria

gonorrhoeae

Serious Threats• Drug-resistant Candida• ESBL-E • Vancomycin-resistant Enterococci• DTR P. aeruginosa • Drug-resistant Salmonella, Shigella,

Campylobacter• MRSA• Drug-resistant Streptococcus

pneumoniae• Drug-resistant Mycobacterium

tuberculosis


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Gram-Negative Infections Impact

• 70% of gram-negative infections are caused by E. coli, K. pneumoniae, and P. aeruginosa• 60-70% of severe infections are caused by P. aeruginosa, K.

pneumoniae, and A. baumannii• In a global study, 82% of carbapenem-resistant infections were due to

Pseudomonas and Acinetobacter sp. • Rates of gram-negative infections depend on site of infection• Different strains/mechanisms seen in various areas

• Antimicrobial treatment options are limited

Nordmann P. Clin Infect Dis. 2019; 69(Suppl 7):S521-S528.Morris S. Antibiotics. 2020;9(4):196.

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CDC 2013 vs. 2019 Report ComparisonPathogen 2013 Data 2019 Data Increase or

DecreaseDrug-resistant N. gonorrhoeae 246,000 cases 550,000 cases ↑

ESBL-E 131,900 cases6,300 deaths

197,400 cases9,100 deaths

↑

CRE 11,800 cases1,000 deaths


↑

Carbapenem-resistant Acinetobacter 11,700 cases1,000 deaths

8,500 cases700 deaths

↓

DTR P. aeruginosa 46,000 cases3,900 deaths


↓


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Question

Which pathogen is classified as a serious threat by the CDC?

A) Carbapenem-resistant Acinetobacter

B) Clostridioides difficile

C) DTR Pseudomonas aeruginosa

D) Drug-resistant Neisseria gonorrhoeae

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Diagnosing Resistant Gram-Negative Infection

• Diagnosis depends on site of infection, but techniques include:• Gram-staining and characteristics • Commercially available automated systems [Microscan, Phoenix, Thermo

Fisher, Vitek]• Rapid diagnostics

• Polymerase chain reaction [BioFire]• Nucleic acid extraction [Verigene]• Magnetic resonance [T2 Biosystems]• Peptide nucleic acid fluorescent in situ hybridization [PNA-FISH]

• Example: oxidase (+), indole (-), smells fruity/grapes• Which organism is this?

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Gram-Negative Resistance Mechanisms

• Four major antimicrobial resistance mechanisms for gram-negatives:• Enzymatic inactivation

• β-lactams, aminoglycosides

• Altered binding sites• Fluoroquinolones, polymyxins

• Overexpression of efflux pumps• Pseudomonas and Acinetobacter sp. à affects β-lactams, aminoglycosides,

tetracyclines, fluoroquinolones

• Decreased porin production/mutation• Pseudomonas and Acinetobacter sp. à affects β-lactams

• Treatment considerations are impacted by resistance mechanisms

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Enzymatic Inactivation: β-lactamasesClass Examples Spectrum of Hydrolysis

A

Narrow-spectrum β-lactamases(Early TEM, SHV-1)

ESBL(Later TEM, SHV-12; CTX-M)

Serine carbapenemases(KPC, IMI)

Penicillins, extended-spectrum penicillins, cephalosporins (excluding cephamycins),

aztreonam

BMBL

(NDM, IMP, VIM)All penicillins, cephalosporins,

carbapenems; aztreonam not hydrolyzedC Cephalosporinases

(AmpC, CMY-2)Cephalosporins, including cephamycins

D Oxacillinases(OXA)

Oxacillin, extended-spectrum cephalosporins, carbapenems

Sidjabat HE. Antimicrob Agents Chemother. 2011;55:4922-25.

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New Antibiotics for Resistant Gram-Negative Infections• Aminoglycoside

• Carbapenem β-lactamase inhibitor combinations

• Cephalosporin

• Cephalosporin β-lactamase inhibitor combinations

• Fluoroquinolone

• Tetracyclines

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Plazomicin – ZemdriTM

Drug Class Approval Year

Route of Administration

Noteworthy Spectrum of Activity

Indications

Aminoglycoside 2018 IV MRSAESBL-EAmpC

CRE (KPC, OXA)

cUTIs

Prescribing Information

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Plazomicin – Safety Profile

Contraindication Warnings and Precautions

Common Adverse Reactions

Drug Interactions

Hypersensitivity to anyaminoglycoside

Hypersensitivity reactionsNephrotoxicityOtotoxicityNeuromuscular blockadeFetal harm

Decreased renal function, diarrhea, hypertension, headache, nausea, vomiting, and hypotension

Nephrotoxic agentsOtotoxic agentsNeuromuscular blockers


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Meropenem/Vaborbactam – Vabomere®




Indications

Carbapenem β-lactamase inhibitor

combination

2017 IV ESBL-EAmpC

CRE (KPC)

cUTIs


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Meropenem/Vaborbactam – Safety Profile

Contraindications Warnings and Precautions


Drug Interactions

Hypersensitivity reactions to meropenem or vaborbactam or anaphylactic reactions to β-lactams

Hypersensitivity reactionsSeizures and other CNS adverse effectsThrombocytopeniaPotential for neuromotorimpairment

Headache, phlebitis/infusion site reactions, and diarrhea

Valproic acidProbenecid


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Imipenem/Cilastatin/Relebactam –RecarbrioTM




Indications

Carbapenem β-lactamase inhibitor

combination

2019 IV ESBL-EAmpC

CRE (KPC)DTR P. aeruginosa

cIAIscUTIs

HABP/VABP


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Imipenem/Cilastatin/Relebactam – Safety Profile



Drug Interactions

Hypersensitivity to imipenem, relebactam, or cilastatin

Hypersensitivity reactionsSeizures and other CNS adverse reactions

Diarrhea, nausea, vomiting, hypokalemia, hyponatremia, headache, elevated LFTs, anemia phlebitis/infusion site reactions, pyrexia, and hypertension

GanciclovirValproic acid


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Cefiderocol – Fetroja®




Indications

Siderophorecephalosporin

2019 IV ESBL-EAmpC

CRE (KPC, OXA, MBL)DTR P. aeruginosaDTR A. baumanniiDTR S. maltophilia

cUTIsHABP/VABP


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Cefiderocol – Safety Profile



Drug Interactions

Severehypersensitivity to cefiderocol and other β-lactams

Increased mortality in patients with carbapenem-resistant gram-negative infectionsHypersensitivity reactionsSeizures and other CNS adverse reactions

Diarrhea, constipation, infusion site reactions, rash, candidiasis, cough, elevated LFTs, headache,hypokalemia, nausea, and vomiting

Urine dipstick tests


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Ceftolozane/Tazobactam – Zerbaxa®




Indications

Cephalosporin β-lactamase

inhibitor combination

2014 IV ESBL-EAmpC

DTR P. aeruginosa

cIAIscUTIs

HABP/VABP


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Ceftolozane/Tazobactam – Safety Profile



Drug Interactions

Serious hypersensitivity to ceftolozane, tazobactam, piperacillin/tazobactam, or other β-lactams

Decreased efficacy in adults with cIAIsand a CrCl between 30 and 50 mL/minHypersensitivity reactions

Nausea, diarrhea, headache, pyrexia, elevated LFTs

None known


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Ceftazidime/Avibactam – Avycaz®




Indications

Cephalosporin β-lactamase

inhibitor combination

2015 IV ESBL-EAmpC

CRE (KPC, OXA-48)DTR P. aeruginosa

cIAIscUTIs

HABP/VABP


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Ceftazidime/Avibactam – Safety Profile



Drug Interactions

Serious hypersensitivity to ceftazidime, avibactam, or other cephalosporins

Decreased efficacy in adults with cIAIs and a CrCl between 30 and 50 mL/minHypersensitivity reactionsSeizures and other CNS adverse reactions

Adults: diarrhea, nausea, and vomitingPediatrics: vomiting, diarrhea, rash, and infusion site phlebitis

ProbenecidLaboratory tests to detect glucose in the urine


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Delafloxacin – Baxdela®


Routes of Administration


Indications

Fluoroquinolone 2017 IVPO

MRSAS. pneumoniae

Other streptococciESBL-E

P. aeruginosa

ABSSSIsCABP


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Delafloxacin – Safety ProfileContraindications Warnings and Precautions Common Adverse

ReactionsDrug Interactions

Hypersensitivity to delafloxacin or other fluoroquinolones

Hypersensitivity reactions Tendinitis and tendon rupturePeripheral neuropathyPsychiatric and other CNS adverse effectsExacerbation of myasthenia gravisAortic aneurysm and dissectionBlood glucose disturbances

Nausea,diarrhea, headache, elevated LFTs, and vomitingIntravenous formulation: accumulation of sulfobutylether-β-cyclodextrin in patients with renal impairment

Oral formulation: antacids containing aluminum ormagnesium, sucralfate, metal cations such as iron, multivitamins containing zinc or iron, didanosine buffered tablets or the pediatric powder for oral solution


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Eravacycline – XeravaTM




Indications

Tetracycline 2018 IV MRSAStreptococci

VREESBL-EAmpC

CRE (KPC, MBL)DTR A. baumanniiDTR S. maltophilia

NTM

cIAIs


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Eravacycline – Safety Profile

Contraindications Warnings and Precautions Common Adverse Reactions

Drug Interactions

Hypersensitivity to eravacycline or other tetracyclines

Hypersensitivity reactionsTooth discoloration and enamel hyperplasia in children up to 8 years of ageInhibition of bone growth in children up to 8 years of ageFetal harm

Infusion site reactions, nausea, and vomiting

Strong CYP3A inducers such as rifampinAnticoagulants


Lower risk of Clostridioides difficile infection compared to β-lactams

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Omadacycline – Nuzyra®Drug Class Approval

YearRoutes of

AdministrationNoteworthy

Spectrum of ActivityIndications

Tetracycline 2018 IVPO

MRSAS. pneumoniae

Other streptococciVRE

ESBL-EAmpC

CRE (KPC)DTR A. baumanniiDTR S. maltophilia

NTM

ABSSSIsCABP


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Omadacycline – Safety ProfileContraindications Warnings and Precautions Common Adverse

ReactionsDrug Interactions

Hypersensitivity to omadacycline or other tetracyclines

Mortality imbalance in patients with CABPHypersensitivity reactionsTooth discoloration and enamel hyperplasia in children up to 8 years of ageInhibition of bone growth in children up to 8 years of ageFetal harm

Nausea, vomiting, infusion site reactions, elevated LFTs, hypertension, headache, diarrhea, insomnia, and constipation

AnticoagulantsOral formulation: aluminum, calcium, magnesium, bismuth subsalicylate, and iron containing preparations


Lower risk of Clostridioides difficile infection compared to β-lactams

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DosingNew antimicrobial Usual dosing for resistant infections Dose adjustment for

renal impairmentCefiderocol 2 g q8h, infused over 3 h Yes

Ceftazidime/avibactam 2.5 g q8h, infused over 3 h Yes

Ceftolozane/tazobactam Cystitis: 1.5 g q8h, infused over 1 hOther: 3 g q8, infused over 3 h

Yes

Eravacycline 1 mg/kg q12h, infused over 1 h No

Imipenem/cilastatin/relebactam 1.25 g q6h, infused over 30 min Yes

Meropenem/vaborbactam 4 g q8h, infused over 3 h Yes

Plazomicin Cystitis: 15 mg/kg x 1, infused over 30 minOther: 15 mg/kg x 1, then based on PK

Yes

Tamma PD. Clin Infect Dis. 2021;72(7):e169-e183.Prescribing information

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Question

Which antibiotic is known to be nephrotoxic?

A) Ceftazidime/avibactam

B) Ceftolozane/tazobactam

C) Omadacycline

D) Plazomicin

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Question

Which antibiotic is known to interact with valproic acid?

A) Ceftazidime/avibactam

B) Eravacycline

C) Imipenem/cilastatin/relebactam

D) Plazomicin

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ESBL-E Uncomplicated Cystitis

• Preferred treatment options: • Nitrofurantoin • Sulfamethoxazole/trimethoprim

• Alternative treatment options:• Fluoroquinolones (toxicities)• Carbapenems (intravenous)

• Other treatment options:• Amoxicillin/clavulanate (higher failure rate than fluoroquinolones)• Aminoglycosides (toxicities, lacking data)• Fosfomycin (can consider for E. coli but contains fosA gene [hydrolysis]

intrinsic to K. pneumoniae and other gram-negative pathogens)

Tamma PD. Clin Infect Dis. 2021;72(7):e169-e183.

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ESBL-E cUTI or Pyelonephritis

• Preferred treatment options: • Carbapenems• Fluoroquinolones • Sulfamethoxazole/trimethoprim

• If a carbapenem is initiated and susceptibility to other preferred options are found, patient should be transitioned to fluoroquinolones or sulfamethoxazole/trimethoprim• Nitrofurantoin and fosfomycin should not be considered options

• Do not achieve adequate concentrations in renal parenchyma


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ESBL-E Non-Urinary Source

• Preferred treatment options: • Carbapenems

• Oral stepdown options: • Fluoroquinolones• Sulfamethoxazole/trimethoprim

• Oral options can be considered once patient is hemodynamically stable, source control is achieved, and susceptibility is known

• Nitrofurantoin, fosfomycin, doxycycline, amoxicillin/clavulanate have poor/unreliable serum concentrations


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ESBL-E Treatment Considerations

• Piperacillin/tazobactam and cefepime should be avoided even if found susceptible• Exception: if initially started for treatment of cystitis and patient improves,

can continue therapy on piperacillin/tazobactam or cefepime• When ESBL enzymes are present, MIC testing may be inaccurate

• If validated phenotypic ESBL test does not indicate ESBL production, antimicrobial selection from susceptibility results can occur• If blaCTX-M gene is not detected, treatment with carbapenem is still

preferred as other ESBL genes may still be present


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CRE Uncomplicated Cystitis

• Preferred treatment options: • Nitrofurantoin • Sulfamethoxazole/trimethoprim • Fluoroquinolones• Aminoglycosides

• Alternative treatment options:• Meropenem (if ertapenem-R but meropenem-S)

• Other treatment options:• Ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam• Cefiderocol (clinical trials did not show increased mortality in urinary sources)• Fosfomycin (can consider for E. coli)• Colistin (nephrotoxicity; do not use polymyxin B due to non-renal clearance)


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CRE cUTI or Pyelonephritis

• Preferred treatment options: • Ceftazidime/avibactam• Meropenem/vaborbactam• Imipenem/cilastatin/relebactam• Cefiderocol• Meropenem (via extended-infusion if ertapenem-R but meropenem-S)

• Alternative treatment options:• Aminoglycosides

• Nitrofurantoin and fosfomycin should not be considered options


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CRE Non-Urinary Source

• Treatment options if ertapenem-R but meropenem-S: • Meropenem (via extended-infusion)• Ceftazidime/avibactam (alternative)

• Meropenem/vaborbactam and imipenem/cilastatin/relebactam should not be used

• Treatment options if ertapenem-R and meropenem-R:• Ceftazidime/avibactam• Meropenem/vaborbactam• Imipenem/cilastatin/relebactam• Cefiderocol (alternative due to higher mortality in clinical trials)• Colistin (last resort)

• If known exposure to MBL, use ceftazidime/avibactam + aztreonam or cefiderocol• If treating intra-abdominal infection, tigecycline or eravacycline can be considered


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General Approach to Management of CRE

KPCCeftazidime/avibactam

Meropenem/vaborbactamImipenem/relebactam

CefiderocolTigecycline

Eravacycline

MBLCeftazidime/avibactam + aztreonam

Cefiderocol

TigecyclineEravacycline

OXA-48

Ceftazidime/avibactam


Eravacycline


Preferred treatmentsAlternative treatments

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Patient Case #1

• D.A. is a 67-year-old female being treated for uncomplicated cystitis due to KPC-producing Klebsiella pneumoniae. • She has NKDA and has a normal diet. • All other labs are WNL and her CrCl is 65

mL/min. • She is currently taking valproic acid,

famotidine, and aspirin.• What antimicrobial therapy would you

recommend for DA?

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DTR-P. aeruginosa Uncomplicated Cystitis

• Preferred treatment options: • Ceftolozane/tazobactam• Ceftazidime/avibactam• Imipenem/cilastatin/relebactam• Cefiderocol• Aminoglycosides (no added benefit with plazomicin)

• Alternative treatment options:• Colistin (nephrotoxicity; do not use Polymyxin B due to non-renal clearance)

• Do not use fosfomycin (high rates of clinical failure as P. aeruginosa intrinsically contains fosA gene [hydrolysis])


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DTR-P. aeruginosa cUTI or Pyelonephritis

• Preferred treatment options: • Ceftolozane/tazobactam• Ceftazidime/avibactam• Imipenem/cilastatin/relebactam• Cefiderocol

• Alternative treatment options:• Aminoglycosides (no added benefit with Plazomicin)

• Fosfomycin should not be considered


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DTR-P. aeruginosa Non-Urinary Source

• Preferred treatment options: • Ceftolozane/tazobactam• Ceftazidime/avibactam• Imipenem/cilastatin/relebactam

• Alternative treatment options:• Cefiderocol• Aminoglycosides (no added benefit with Plazomicin)

• Combination therapy not recommended if in vitro susceptibility to a first-line antimicrobial is known• Empiric “double coverage” can be considered

• If susceptibility to a first-line agent is unknown or not demonstrated, aminoglycosides or polymyxins can be considered with a first-line agent


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Patient Case #2

• J.T. is a 66-year-old male being treated with piperacillin/tazobactam 4.5g IV q8h, infused over 4-hours, and gentamicin (pharmacy to dose) for suspected DTR-P. aeruginosa bacteremia, likely from a urinary source. • His CrCl is 105 mL/min, he is hemodynamically stable, and he is not

immunocompromised. • Three days later, blood cultures confirmed P. aeruginosa that is susceptible

to gentamicin, intermediate to ceftolozane/tazobactam and ceftazidime/avibactam, and resistant to everything else.• Antimicrobial therapy was changed to ceftolozane/tazobactam.• Do you agree with the course of antimicrobial therapy?

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General Approach to Management of ESBL-E

Cystitis

NitrofurantoinTMP/SMX

Amoxicillin/clavulanateAminoglycoside

Fosfomycin

FluoroquinoloneCarbapenem

cUTIs or pyelonephritis

CarbapenemFluoroquinolone

TMP/SMX

N/A

Systemic

Carbapenem

Oral step-down:Fluoroquinolone

TMP/SMX



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General Approach to Management of CRE

Cystitis

Nitrofurantoin

FluoroquinoloneTMP/SMX

Aminoglycoside

Ceftazidime/avibactamMeropenem/vaborbactam

Imipenem/relebactam

CefiderocolColistin


Ceftazidime/avibactam

Meropenem/vaborbactamImipenem/relebactam

Cefiderocol

Aminoglycoside

Systemic

Ceftazidime/avibactamMeropenem/vaborbactam

Imipenem/relebactam


Eravacycline



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General Approach to Management of DTR P. aeruginosa

Cystitis

Ceftolozane/tazobactamCeftazidime/avibactamImipenem/relebactam

CefiderocolAminoglycoside

Colistin


Ceftolozane/tazobactam

Ceftazidime/avibactamImipenem/relebactam

Cefiderocol

Aminoglycoside

Systemic

Ceftolozane/tazobactamCeftazidime/avibactamImipenem/relebactam

CefiderocolAminoglycoside



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Winning the Battle on Antibiotic-Resistant Gram-Negative Infections

Elias B. Chahine, PharmD, FCCP, FASCP, FFSHP, BCPS, BCIDPProfessor of Pharmacy PracticePalm Beach Atlantic UniversityGregory School of Pharmacy

Jonathan C. Cho, PharmD, MBA, BCIDP, BCPSDirector of Pharmacy

Director of PGY-2 Infectious Diseases Residency ProgramMountainView Hospital

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winning the battle on antibiotic-resistant

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