ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
Difficult-to-Treat Resistance in Gram-negative Bacteremia at 173 US Hospitals: Retrospective Cohort Analysis of Prevalence, Predictors, and Outcome of Resistance to All First-line Agents.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 377 papers, 3 of them syntheses that pooled it.
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Who cites it
377 citing papers in PubMed, 3 syntheses or guidelines pooled it, 547 citations in OpenAlex.
- Comparison of Ceftolozane-Tazobactam and Ceftazidime-Avibactam in the Treatment of Multidrug-Resistant/Difficult-to-Treat Resistant Pseudomonas aeruginosa Infections: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Pooled it
- Worldwide threatening prevalence of carbapenem-resistantEpidemiology and infection · 2025Pooled it
- Pooled it
- Multicenter Evaluation of Ceftazidime/Avibactam in Pediatric Patients Across the United States: Real-World Insights into the Management of Drug-Resistant Gram-Negative Infections.Open forum infectious diseases · 2026Trial
- Safety and pharmacokinetics of single and multiple doses of ledaborbactam etzadroxil with or without ceftibuten in healthy volunteers.Antimicrobial agents and chemotherapy · 2025Trial
- Real-World Applications of Imipenem-Cilastatin-Relebactam: Insights From a Multicenter Observational Cohort Study.Open forum infectious diseases · 2025Trial
- Is less always more? Ceftazidime/avibactam alone or in combination to treat infections caused by Pseudomonas aeruginosa: a retrospective observational multi-centre cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Observational
- A review of bloodstream infections-pathogens, pathogenesis, diagnostic strategies, treatment methods-challenges and future aspects.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Review
- Use of standard definitions for the extent of antibiotic resistance in bacteria: a systematic review and framework for future consensus definitions.JAC-antimicrobial resistance · 2026Review
- Global epidemiology of carbapenem-resistantJAC-antimicrobial resistance · 2026Review
- Emerging therapies and diagnostic innovations for multidrug-resistant infections in kidney allograft recipients: Challenges and future directions.World journal of nephrology · 2026Review
- Evaluation of carbapenem inactivation method-based phenotypic assays for the detection of GES-type carbapenemases in Enterobacterales,Journal of clinical microbiology · 2026Article
- Detection of carbapenem resistance mechanisms in difficult-to-treat Pseudomonas aeruginosa clinical isolates from a tertiary care hospital in Egypt.BMC microbiology · 2026Article
- Difficult-to-treat resistant Gram-negative bacteria and genomic resemblances between colonization and infection among patients in an intensive care unit of a tertiary care hospital in Bangladesh.Microbiology spectrum · 2026Article
- Prevalence and antimicrobial resistance trends of ESKAPEE pathogens in clinical isolates from Hyderabad, Pakistan: a cross-sectional study.IJID regions · 2026Article
- Acinetobacter baumannii resistance trends in an ICU from Saudi Arabia over 12 years.The Indian journal of medical research · 2026Article
- In vitro activity of aztreonam-avibactam against carbapenem-resistant Pseudomonas aeruginosa from Southern Brazil.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- ESKAPE Pathogens in a Hungarian Emergency Department: A 5-Year Retrospective Observational Study of Prevalence and Resistance Patterns Utilizing the AWaRe Framework.Antibiotics (Basel, Switzerland) · 2026Article
- Long-Term Environmental Surveillance ofPathogens (Basel, Switzerland) · 2026Article
- Redefining susceptibility in practice : clinical and resistance outcomes of the EUCAST 'I' category for wild-type Pseudomonas aeruginosa.Infection · 2026Article
317 more citing papers are in PubMed but not listed here.
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16 authors at 6 institutions in 1 country.
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Abstract
Background: Resistance to all first-line antibiotics necessitates the use of less effective or more toxic "reserve" agents. Gram-negative bloodstream infections (GNBSIs) harboring such difficult-to-treat resistance (DTR) may have higher mortality than phenotypes that allow for ≥1 active first-line antibiotic. Methods: The Premier Database was analyzed for inpatients with select GNBSIs. DTR was defined as intermediate/resistant in vitro to all ß-lactam categories, including carbapenems and fluoroquinolones. Prevalence and aminoglycoside resistance of DTR episodes were compared with carbapenem-resistant, extended-spectrum cephalosporin-resistant, and fluoroquinolone-resistant episodes using CDC definitions. Predictors of DTR were identified. The adjusted relative risk (aRR) of mortality was examined for DTR, CDC-defined phenotypes susceptible to ≥1 first-line agent, and graded loss of active categories. Results: Between 2009-2013, 471 (1%) of 45011 GNBSI episodes at 92 (53.2%) of 173 hospitals exhibited DTR, ranging from 0.04% for Escherichia coli to 18.4% for Acinetobacter baumannii. Among patients with DTR, 79% received parenteral aminoglycosides, tigecycline, or colistin/polymyxin-B; resistance to all aminoglycosides occurred in 33%. Predictors of DTR included urban healthcare and higher baseline illness. Crude mortality for GNBSIs with DTR was 43%; aRR was higher for DTR than for carbapenem-resistant (1.2; 95% confidence interval, 1.0-1.4; P = .02), extended-spectrum cephalosporin-resistant (1.2; 1.1-1.4; P = .001), or fluoroquinolone-resistant (1.2; 1.0-1.4; P = .008) infections. The mortality aRR increased 20% per graded loss of active first-line categories, from 3-5 to 1-2 to 0. Conclusion: Nonsusceptibility to first-line antibiotics is associated with decreased survival in GNBSIs. DTR is a simple bedside prognostic measure of treatment-limiting coresistance.
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