Disclosures: Kadri and Strich report no relevant financial disclosures.
July 28, 2020
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Treatment opportunities for novel gram-negative antibiotics are rare in US hospitals

Disclosures: Kadri and Strich report no relevant financial disclosures.
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Treatment opportunities for novel gram-negative antibiotics are relatively infrequent in hospitals — representing just 39 to 138 days of therapy per 10,000 encounters, according to a study.

Sameer S. Kadri
Jeffrey R. Strich

The results, which were published in Lancet Infectious Diseases, were based on 2.9 million inpatient encounters from 134 U.S. hospitals.

“COVID-19 is clearly at the center of everyone’s attention, but we cannot afford to lose sight of other important national security threats including the one posed by antibiotic resistance,” Sameer S. Kadri, MD, MS, FIDSA, and Jeffrey R. Strich, MD, MHS, of the NIH Clinical Center’s Critical Care Medicine Department, told Healio. “If we do not focus attention on the development of antibiotics with efficacy against difficult to treat gram-negative infections (DTR-GNIs), we risk not being prepared as new strains of highly resistant bacterial pathogens surface.”

Kadri, Strich and colleagues used data from an electronic health record repository to find potential hospital treatment opportunities for GNIs with resistance to first-line drugs. They identified 1,352 episodes of DTR-GNI, 1,765 episodes that included therapy with polymyxin B or colistin and 16,632 episodes that involved aminoglycosides. The researchers noted that the days-of-therapy estimate for beta-lactam-susceptible GNIs was 70 times greater than the estimate for the DTR-GNI-targeted drug. The most common DTR-GNI site and pathogen they identified were lower respiratory (43.3%) and Pseudomonas aeruginosa (38.1%).

“The medical community has suspected for a while that the number of gram-negative infections with no optimal treatment options among U.S. inpatients is small and represents a marketplace that could not sustain the development of new antibiotics based on volume of sales alone,” Kadri and Strich said. “Our study simply confirms this notion using real-world data from 134 U.S. hospitals and potentially makes the argument more actionable in the world of policy and legislation.”

Kadri and Strich noted that one of the study’s major limitations was its inability to account for other potential treatment opportunities that exist outside of the U.S.

“We must consider [innovative] ways to incentivize the development of novel antibiotics, which include nonrevenue-based strategies such as pull incentives,” they said.