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Laboratories that use revised carbapenem breakpoints detect significantly more carbapenem-resistant Enterobacteriaceae than laboratories that use historical ones.

The Importance of Maintaining Antibiotic Breakpoints

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FACSc, offers some insights on the latest diagnostics, susceptibility testing for newer antimicrobials, and how infectious disease clinicians and laboratory professionals can collaborate in case management to help challenging cases.

Adoption of Rapid Diagnostic Tools, Susceptibility Testing for Gram-Negative Infections

This is part of a short series, looking at Gram-negative infections including diagnostics, treatment coordination, and newer agent uptake.

When thinking of diagnosing and treating gram-negative infections there are some inherent challenges including quick development to antimicrobial resistance, the time-consuming nature of traditional tests, and the limitations of rapid diagnostics in this area. And the unique cellular structure of gram-negative bacteria, which includes an additional outer membrane, can make antibiotic treatment more difficult.

One of the emerging areas within infectious disease is the development of diagnostic tools and how they are applicable to gram-negative infections. Some of these innovations include rapid diagnostics, next-generation sequencing (NGS), CRISPR-based methods, utilizing AI for data analysis and prediction, and the expansion of point-of-care (POC) testing, enabling faster, more accurate diagnoses.

Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FACSc, is a University Distinguished and Regents’ professor and chair for the Clinical Laboratory Science (CLS) Program in the College of Health Professions (CHP) at Texas State University mentions a few of the rapid tests for identifying gram-negative bacteria (GNB) including the Biofire FilmArray for blood culture identification, the Cepheid GeneXpert, a platform to rapidly detect carbapenemase resistance genes, the Verigene Blood-Culture Gram-Negative (BC-GN) test is a rapid, microarray-based nucleic acid test that identifies common Gram-negative bacteria and detects specific antibiotic resistance genes directly from positive blood cultures within hours, The BD Max Enteric Bacterial Pane

 (EBP) is a real-time PCR diagnostic test that identifies common enteric bacterial pathogens, and the MALDI-TOF MS, which is a rapid method for identifying microorganisms and other biomolecules by analyzing their unique protein "fingerprints." He notes the last one’s growth in hospitals and testing facilities.

“The MALDI TOF in general, as many of our audience will know, is becoming more and more implemented especially in larger healthcare systems across the country, including Texas; it gives you a faster turnaround,” Rohde said. 

In terms of susceptibility testing for newer antimicrobials, Rohde says there are a lot of variables involved including your location, access to these tools, and the patient’s underlying comorbidities.

“There's a variety available to different microbiology laboratories in which clinicians are ordering those tests… you still might need to know as a clinician to interact with that microbiology laboratory team, the pharmacist, and others involved, to pick the right susceptibility profile test.”

With the underlying challenges of identifying Gram-negative infections, and finding the right antimicrobials, Rohde stresses the importance of an all-hands on deck approach of building a team that includes providers, laboratory professionals, pharmacists, and everyone who touches patient care.

He believes everyone on these care teams should be pulling together using their education and clinical experience to use “collaborative communication.”

He stresses this to not only people in the fields now but wants to see this approach taught in educational institutions, where they are training future professionals.

“That should be a part of the bread and butter of the education process now—no silos,” Rohde said. “We can’t operate like that anymore in the global world we live in.”



From Pathogen to Infectious Disease Diagnosis

.

Watch the next episode in the series when Monica Mahoney, PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, provides insights on the outpatient side of therapy.

References
1. Giacobbe D, Giani T, Bassetti M, Marchese A, Viscoli C, Rossolini G. Rapid microbiological tests for bloodstream infections due to multidrug resistant Gram-negative bacteria: therapeutic implications. 

. Volume 26, Issue 6, 2020. Pages 713-722. 

https://doi.org/10.1016/j.cmi.2019.09.023


2. Anton-Vazquez, V., & Planche, T. (2021). Gram-negative blood stream infections: prospects and challenges of rapid antimicrobial susceptibility testing. 

https://doi.org/10.1080/14787210.2022.1999805


3. Why are Gram negative Bacteria Harder to Kill due to Antibiotic resistance? Crestone. Accessed September 15, 2025.
https://crestonepharma.com/why-are-gram-negative-bacteria-harder-to-kill-with-antibiotics.
4. Ducret YV. Gram-negative bacteria: Unveiling the complexity and resilience of a diverse group

. 2023;7(3):147
5. Ciotti B, Nicolai E, Pieri M,Development and optimization of diagnostic assays for infectious diseases. 

. Volume 1, Issue 2. 2024. https://doi.org/10.1016/j.lmd.2024.100032

Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FACSc, offers some insights on the latest diagnostics, susceptibility testing for newer antimicrobials, and how infectious disease clinicians and laboratory professionals can collaborate on challenging cases.

Adoption of Rapid Diagnostic Tools, Susceptibility Testing for Gram-Negative Infections 

Monica V. Mahoney PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, provides insights on the outpatient side of therapy and how the ever-changing approach to treating outpatients for gram-negative infections. 

Gram-Negative Infections and the Evolving Paradigm for OPAT

Outpatient Parenteral Antibiotic Therapy (OPAT) refers to patients receiving IV antibiotic treatment outside of the hospital setting, and can include patients’ homes, clinics, nursing or rehab facilities. Typically, patients receiving OPAT are not being treated for severe Gram-negative infections and are well enough to be discharged from the hospital. However, Monica V. Mahoney PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, clinical specialist at Beth Israel Deaconess Medical Center, who works in this space, is seeing a paradigm shift with more patients who are not critically ill, and are dealing with these infections. And with the introduction of new Gram-negative agents, IV antibiotic infusion schedules can be highly irregular and questions around treatment stability become a front and center concern.

“There are logistical challenges with the infusion times of these newer medications in order to take advantage of their pharmacokinetic or pharmacodynamic properties. They're given over 2 hours or over 3 hours, so you're asking the patients to give that dose for that long amount of time and, oh, by the way, repeat it, and then 3 or 4 hours for your next dose,” Mahoney said. “There are stability concerns. The drugs, once they're reconstituted in the form that's going to be infused in the patient, they are maybe good at room temperature for 4 hours in the refrigerator and for maybe up to 24 hours, if we're lucky. That doesn't work when the patient's at home…the home infusion company will deliver the medications, ideally once per week. So we want longer stability data that you know you can keep this compounded medication in your refrigerator for the entire week.”

When considering OPAT with newer agents and thinking about stewardship, Mahoney says there are a number of factors to consider.

“Is this going to be easy for the patient to take? Can we give a regimen that's simple enough for the patient or their family member to administer? If they won't take the medication, because it's too complicated, they won't treat their infection. If they don't treat their infection, they're going to end up back into the hospital with the same cycle, possibly with a more resistant organism."

“While we still have the same core principles of stewardship in the outpatient setting, there are different priorities maybe that we will place,” she said.

In terms of adoption of newer agents for Gram-negative infections, Mahoney keeps the option open, but acknowledges there are a few considerations including the therapy’s availability, logistics, and coordination. 

“If the patient is well enough to go home, and if they have an organism that needs to be treated, we will investigate whatever we can to try to make it happen,” Mahoney said. “But it's a less contained environment. It is not our pharmacy; It is not our nurses; they are not within our institution. We need to coordinate with a lot of different people. We need to make sure that the home infusion company has it on their formulary. Sometimes they lag behind on adding these. If the patient's going to rehab, we have to make sure that they will accept this patient with the level of complexity as well, and that the appropriate follow up and monitoring is in place to make sure that the patient is getting better.” 

“As a clinician, obviously I want to give the drug the patient needs, but sometimes the answer we come back to is, ‘unfortunately, we can't discharge you because you need to be on this medication, and the best place for you to be is in the hospital to finish out your course of therapy,'” she said.



Check out our next episode in the series when Ryan Shields PharmD, MS, discusses new agents for Gram-negative infections.

Monica V. Mahoney PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, provides insights on the outpatient side of therapy, including treating outpatients for Gram-negative infections. 

MeMed CEO Eran Eden, PhD, discusses the MeMed BV test and how it can help make the distinction between the types of infections, 

From Pathogen to Infectious Disease Diagnosis: 

One of the ongoing treatment challenges for providers is the ability to determine whether infections are bacterial or viral. Their presentation can be similar, and traditional testing can be time-consuming. Of course, clinicians want to be sure patients are receiving some type of intervention, so broad-spectrum antibiotics can often be prescribed in these cases.

“It [the MeMed BV test] tries to solve the following seemingly simple problem: A patient, a kid or adult, comes to urgent care or to an ED [emergency department] with a suspected acute infection. Broadly, we're trying to discern the etiologies of a bacterial or viral infection. Do we treat or not treat with antibiotics?” said MeMed's cofounder and CEO, Eran Eden, PhD.

Eden’s company developed a novel assay, the MeMed BV test, that can distinguish between bacterial and viral infections in 15 minutes. The test received a US Food and Drug Administration 510(k) clearance in 2023 and also has the European CE mark.



Eden says the test itself is a blood test that measures 3 proteins and integrates them into a score. “They are measured and then computationally integrated into a score between 0 and 100; the higher the score, the higher the likelihood of a bacterial infection.” 

MeMed shared results of 3 studies of the MeMed BV test, which demonstrated the following:

63% reduction in unnecessary antibiotic prescriptions (real-world study of 3920 patients)

70% of previously missed bacterial infections correctly identified, leading to significantly fewer hospitalizations (7.8% vs 30.3%)

Outperformance of standard biomarkers such as procalcitonin in distinguishing bacterial vs viral infections

Lower health care costs, especially in managing community-acquired pneumonia


Eden mentions the multiple challenges of pathogen testing. “The first is that even if you use a multiplex PCR [polymerase chain reaction], you're only going to put your hands on a microorganism in 30 to 40% of the cases; [in] 60% of the cases, there is no microorganism, and you still have to treat, so that's one gap we're trying to solve,” Eden said. “The second thing is inaccessible infections. So you can apply, say, a SARS-CoV-2 or strep [

test in cases of pharyngitis. But what about otitis, bronchitis, and pneumonia? The immune system circulates throughout the entire body, so it allows you to identify these infections or the source of infection in these inaccessible infection sites. Third is the issue of colonization. So let's say you identify a virus or bacteria. Some of them have very high prevalence, especially in kids, so mere detection does not apply causality, which is confusing, leading to overuse and underuse of antibiotics. Another element here is the element of superinfections. So you identify an influenza. There's about 10% to 20% probability of bacterial superinfection on top of that. So all these elements and obviously time—you want to get results fast—it's taking this simple problem and making it really hard to discern in real time.” 

He says these factors lead to uncertainty about the nature of the infection and that they are trying to reduce that with the use of this newer generation of screening tools. He says screening can greatly aid in antibiotic stewardship and address the global issue of antimicrobial resistance.

“When you talk about reduction of overuse, I would like to maybe broaden the discussion to say it's both…depending on the overprescribed or nonbacterial infection for which it does not provide any benefit,” Eden said. “But there's also an element of underuse where you should prescribe and you're not prescribing…. The BV test has started to show utility in reducing this uncertainty, reducing overuse of antibiotics but at the same time doing it in a safe manner [and] also reducing cases where there are missed bacterial infections.”



References
1. MeMed BV test demonstrates antibiotic overuse reduction in first US interventional trial. News release. MeMed. September 30, 2024. Accessed September 30, 2024. 

https://www.prnewswire.com/news-releases/memed-bv-test-demonstrates-antibiotic-overuse-reduction-in-first-us-interventional-trial-302260001.html


2. MeMed BV proven to optimize antibiotic use, outperform standard care, and cut costs in new studies. News release. MeMed. February 27, 2025. Accessed April 11, 2025.
https://www.me-med.com/press_release/memed-bv-proven-to-optimize-antibiotic-use-outperform-standard-care-and-cut-costs-in-new-studies/



MeMed CEO Eran Eden, PhD, discusses the MeMed BV test and how it can help make the distinction between the types of infections, aid in patient management, and reduce antimicrobial resistance.

From Pathogen to Infectious Disease Diagnosis: Test Determines Between Bacterial and Viral Infections in 15 Minutes

In our latest From Pathogen to Infectious Disease Diagnosis podcast, bioMérieux Chief Medical Officer Chuck Cooper, MD, discusses the burden of resistance, and insights on the company’s novel Vitek Compact Pro ID/AST system.

Can Diagnostics Aid in Alleviating Antimicrobial Resistance and Sepsis? 

Antimicrobial resistance (AMR) continues to be an increasingly significant public health issue, leading to higher mortality rates. Findings from one study estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.

Untreated or undertreated bacterial infections are a major cause of sepsis, a serious complication that places a significant burden on hospitalized patients. The Centers for Disease Control and Prevention estimates that 1.7 million adults in the US develop sepsis each year. In terms of mortality, the agency reports that at least 350,000 adults who develop sepsis die during hospitalization or are discharged to hospice. Additionally, 1 in 3 people who die in the hospital had sepsis.

Chuck Cooper, MD, chief medical officer at bioMérieux, highlights the urgency of timely diagnosis and treatment.

“Every hour of delay in getting patients on effective therapy dramatically increases their mortality,” Cooper said.

“The challenge with antimicrobial resistance is that it compromises our ability to treat sepsis effectively, because it limits the options from an antimicrobial therapeutic perspective and it makes it more difficult to get patients on the right therapy as quickly as possible,” Cooper said. “So it's critically important for clinicians to receive accurate, rapid information about the antimicrobials that will work for an infection so that they can treat patients with the effective therapy as soon as possible.”

To address resistance—and by extension, sepsis—bioMérieux has developed a diagnostic platform designed to efficiently and quickly identify infectious diseases. Earlier this year, the US Food and Drug Administration cleared bioMérieux’s Vitek Compact Pro ID/AST system for microorganism identification (ID) and antibiotic susceptibility testing (AST). This system is intended to support clinical laboratories in identifying infectious diseases and combating AMR and for use in industrial laboratories to identify contaminants and ensure consumer safety.

“The Vitek Compact Pro provides both microorganism identification and antibiotic susceptibility testing results. This is essential for helping laboratories diagnose infectious diseases and combat resistance,” Cooper said.

The Vitek Compact Pro ID/AST system combines new diagnostic technology with features from its predecessor, the Vitek 2 Compact. With an ergonomically advanced design and simplified workflow, it enhances the user experience and boosts efficiency, reducing the time laboratory technicians need to spend on sample loading and processing.

“It has a very intuitive user interface with guided workflow steps. This leads to a faster, more streamlined hands-on process before loading cassettes into the instrument, significantly reducing hands-on time,” Cooper added.

For industrial applications, the system will be used for the routine identification of pathogens to help ensure the quality and safety of food, pharmaceutical, and cosmetic products.

The commercial launch of the Vitek Compact Pro is planned in select countries, with a global rollout beginning this quarter.

1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. 

. 2022;399(10325):629-655.
2. About sepsis. Centers for Disease Control and Prevention. March 8, 2024. Accessed May 16, 2025. https://www.cdc.gov/sepsis/about/index.html
3. bioMérieux receives FDA 510(k) clearance for its Vitek Compact Pro, a new ID/AST system to fight against antimicrobial resistance. Press release. bioMérieux. March 18, 2025. Accessed May 16, 2025. 

https://www.biomerieux.com/corp/en/journalists/press-releases/vitek-compact-pro-fda-clearance-antimicrobial-resistance.html

In our latest From Pathogen to Infectious Disease Diagnosis podcast, bioMérieux Chief Medical Officer Chuck Cooper, MD, discusses the burden of resistance and insights on the company’s novel Vitek Compact Pro ID/AST system, which looks to identify infectious disease in a timely manner and aid clinicians in diagnosing patients, streamlining antimicrobial treatment, and avoiding severe complications such as sepsis. 

In our latest podcast, Tim Gauthier, PharmD, BCPS, BCIDP, discusses his passion for all things pathogens and antibiotics.  He also details the opportunities for antimicrobial stewardship when it combines diagnostics and treatment duration. 

A Passion for Infectious Disease Education and Communication

Tim Gauthier, PharmD, BCPS, BCIDP, began his career in academia, and although he has transitioned to working in a health system, he has never left behind his passion for education about pathogens, antibiotics, and stewardship. He has 2 websites, 

, on these topics, and it has allowed him to continue communicating and educating people globally on these infectious disease subjects.

“I love this stuff so much, genuinely. I have a website called ID Stewardship, and many people are familiar with my work and my reach through that avenue, where it's been supercool to connect with people from all over the world and help people learn about antibiotics,” Gauthier said.

This website has reached millions of people since he first launched it in 2016, and he says it has allowed him to talk about his experiences in the field.

“It's really geared toward practical, real-life experience and suggestions about how to go about navigating something. It could be anything in the field of clinical pharmacy or infectious diseases, antimicrobial stewardship, or pharmacy education. And the goal is to provide quick information that is useful and practical for the reader,” Gauthier explained.

He reminds people that everyone learns differently and that having resources such as websites can be helpful for young learners as they begin to digest the voluminous amounts of educational materials they need to commit to memory.

For years, Gauthier has been communicating with the masses through social media, especially using X, formerly known as Twitter, and building a large audience through it. “I think it's been pretty neat to provide education in that forum too,” Gauthier said.

He sees the changes in social media today, and as many people in the infectious disease community have steered away from the X platform, Gauthier still uses it and acknowledges how it has evolved.

“I've been a content creator for infectious diseases education material for almost a decade, and it just changes,” Gauthier said. “So Instagram becomes more popular as Facebook pages become less popular, or TikTok gains traction and then TikTok loses traction. It's always changing, and it's always evolving. You always have to—in my mind at least—go back to, why am I here? What is my purpose? What am I doing? And if what you're engaging in aligns with what your purpose is, then you're probably fine…. I don't feel great about X. I go on my profile, and I just see content that I'm not interested in. It's supertoxic, and I don't feel good about being part of that community right now. I’m keeping an eye on it and trying to maybe have a voice to some degree, because if we don't have a voice, someone will be happy to speak for us.” 

He also mentions the importance of staying professional on these platforms, and he values the importance of taking the time to reach out, whether it is remotely through digital means or connecting in person with professionals in the infectious disease field or other fields at institutions, including the laboratory.

“Respect for all individuals is something that we need to keep front of mind as we go through these very turbulent times and consider using social media or not,” Gauthier said. “That's one of my biggest things…as I'm looking around. The other thing is, we can get a lot of happiness out of working together. I really do believe that, and we should not hesitate to reach out and make connections with each other. If you haven't talked to your ID [infectious diseases] pharmacist or if you haven't spoken to your microbiology laboratory folks, just go visit them.” 

Although Gauthier is excited to see some new antibiotics approved by the US Food and Drug Administration, he does acknowledge they will not likely replace the older, more established “workhorse” antibiotics. Resistance is always a concern, and he is seeing extended-spectrum β-lactamase (ESBL) 

 where he lives. Nonetheless, he sees a stewardship opportunity in these situations that combines shorter courses of antibiotics with help from the laboratory.

“When we look at the latest CDC [Centers for Disease Control and Prevention] report that they had put out, ESBLs are on the upward trend. And locally in the Miami area, many of the hospitals here have considerable rates of ESBL 

,” he explained. “And you know what comes next? You probably use more carbapenems. OK, use more carbapenems. What happens? You get more carbapenem resistance. That is the major issue right now that I'm seeing. I think people need to be aware of managing asymptomatic bacteria appropriately, picking shorter courses of antibiotics, and, when reasonable, de-escalating and narrowing within 48 to 72 hours, utilizing and leveraging the data that are coming out of the laboratory to make those decisions faster and smarter.”

, and much like other areas, Gauthier is seeing this mostly in patients in long-term care with chronic conditions and comorbidities.

“There are definitely more patients with bloodstream infections with 

In our latest podcast, Tim Gauthier, PharmD, BCPS, BCIDP, discusses all things pathogens and antibiotics. He also details the opportunities presented for antimicrobial stewardship when it combines diagnostics and treatment duration. 

Joni Meehan, BS

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