Gram-negative pathogens (GNPs) are clinically important pathogens in both the hospital and outpatient settings. GNPs are often acquired in healthcare facilities, and therefore have a high incidence of drug resistance to even the most powerful of antibiotics. The rise in drug-resistance rates, including resistance to multiple classes of antibiotics, and the lack of newly approved agents in the last ten years has led to a critical need for new therapies for multi-drug-resistant (MDR) GNPs. This report provides insight into the management of patients with GN infections (GNIs) in the hospital setting and analyzes the hospital antibiotic prescribing practices for the treatment of key infections due to emerging and clinically important GNPs. The study provides longitudinal information on market dynamics, including insight into practice patterns, attitudes and perceptions, unmet needs, and projected use of antibiotics in the hospital setting. We also explore the physician-perceived advantages and disadvantages of emerging and currently available therapies, including two recently launched cephalosporin/beta-lactamase combinations—ceftolozane/tazobactam (Merck’s Zerbaxa) and ceftazidime/avibactam (Allergan/AstraZeneca’s Avycaz).

Questions Answered in This Report:

  • Drug resistance rates of GNPs in hospital-treated infections continue to rise. Which specific GNPs have ID specialists seen increasing rates for over the past two years? How do these changes compare to the level of physician concern about individual pathogens? What percentages of key GNP isolates are resistant to specific therapies (e.g. carbapenems)?

  • The majority of GNI patients in the hospital setting are initially treated empirically. What are the key factors driving physician choice of empiric therapies? What are the ID specialists’ preferred treatments by GNI type?

  • GNI patients are commonly discharged on oral antibiotics or outpatient parenteral antibiotic therapy (OPAT). Which GNIs are ID specialists most likely to prescribe OPAT for? What are their preferred discharge agents by infection type?

  • Despite the growing rates of drug resistance among GNPs, the hospital antibiotic market remains dominated by lower-cost generics. How do physicians rate key drug attributes in terms of importance in selecting an antibiotic therapy? How do current GNI agents, including both established and recently-launched brands, perform on these attributes?

  • The GNI hospital market is continuing to experience a paucity of antibiotics effective against MDR GNPs. What is the current level of unmet need for specific GNPs and infection types? Which efficacy and non-efficacy attributes would ID specialists like to see new agents possess?

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Markets covered: United States.

Primary research: 102 infectious disease specialists.

Indication coverage: GNIs, including complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bloodstream infections (BSIs).

Author(s): Brenda Perez-Cheeks, Ph.D.
Mladen Tomich, Ph.D.