Editor’s Note: AmpC β-lactamases are class C serine β-lactamases that can be produced by a number of Enterobacteriaceae and glucose non-fermenting Gram-negative bacteria. Although AmpC β-lactamases have been associated with the development of third-generation cephalosporin resistance, this risk of AmpC deinhibition is not the same in different enterobacteria. At the recent Infectious Diseases Week 2023 (IDWeek 2023) conference, Professor Megan E. Hardy, a clinical pharmacologist in infectious diseases from the West Virginia University School of Medicine (WVU Medicine) in the United States, orally reported the results of a study titled, “Leveraging Stewardship to Promote Narrower-spectrum Antibiotic Use for Low-risk AmpC Enterobacterales” and shared his fascinating insights in an interview with Infectious Disease Frontier.

 

Megan E.Hardy,PharmD

Clinical Pharmacy Specialist, Infectious Diseases, West Virginia University School of Medicine (WVU Medicine), USA

Megan Hardy is a Doctor of Pharmacy currently working as an Infectious Disease Clinical Pharmacy Specialist at WVU Medicine-West Virginia University Hospitals in the United States, focusing on antimicrobial stewardship, outpatient parenteral antibiotic therapy (OPAT), and complex outpatient antibiotic therapy (COpAT). She completed her post-graduate year one (PGY-1) clinical pharmacy residency at Akron Polyclinic in Cleveland, Ohio. She recently completed a postgraduate year two (PGY-2) infectious disease pharmacy residency at Henry Ford Health in Detroit, Michigan.

 

Infectious Disease Frontier:Good afternoon Dr. Hardy for so far. I just want to say it’s a great presentation and thank you for having this interview with us. Could you briefly share the presentation you brought out at IDWeek with our audience in China?

 

  • Dr.Megan E.Hardy:Absolutely. So I was specifically looking at leveraging stewardship interventions in order to utilize neuro -respective antibiotic therapy, specifically subterriaxone for organisms with a lower risk of AmpC than we had previously thought. So low risk AmpC or no risk AmpC harboring enterobacter alleles.

 

Infectious Disease Frontier:Could you elaborate on the current challenges in ID diagnostic and how do you practice or approach this addressing this issue?

 

  • Dr.Megan E.Hardy:So we utilized a lot of microbiology reports within our electronic medical record to help guide therapy in one direction or another. The tough thing with AmpC being that it appears susceptible to third generation cephalosporins. So our microbiology reports will have them appear susceptible. But if you treat these AmpC harboring organisms with a third generation cephalosporin for 72 hours or so, then you can induce that resistance. So we were kind of playing with the diagnostic tools and how those appear in our electronic medical records to help guide physicians to, you know, kind of toward one therapy or another. So the idea is that we made it easier using our rapid diagnostic tools to guide towards f -carriaxone for any organism that doesn’t have a high risk of AmpC and d -repression and away from the broader spectrum therapies.

 

Infectious Disease Frontier:what advancements are in the measures you’re anticipating in the field of infectious disease diagnostic?

 

  • Dr.Megan E.Hardy:Absolutely. I think utilizing tools such as this, really any rapid diagnostic, I know we utilize our rapid blood PCRs so that we can identify these organisms sooner and guide towards correct therapy sooner. So we can eliminate broader spectrum therapies a lot sooner than we could otherwise. If we see, for example, serratio -mar -assessants pop up, we can say, oh, we can use f -carriaxone for that, as long as our anti -biogram supports it. So I think really continuing to utilize those rapid diagnostic tools and how quickly we can get the results and guide therapy even quicker so we can get the patient on the narrowest therapy possible to adequately treat their infection.