Susceptibility testing for piperacillin-tazobactam has undergone rapid evolution, largely driven by some surprising results from the MERINO trial, which compared the efficacy of piperacillin-tazobactam and meropenem for treatment of patients with ceftriaxone-resistant E. coli or Klebsiella pneumoniae bacteremia. We discuss how the results of the MERINO trial led to reconsideration of breakpoints for pipercillin-tazobactam at the Clinical Laboratory Standards Institute, or CLSI, how the breakpoints were changed, and how well commercial platforms perform piperacillin-tazobactam testing using FDA or CLSI breakpoints. Spoiler alert: the news isn’t great.  If you are interested in beta-lactam/beta lactamase combinations, you should check out the previous episode of this podcast, hosted by our friend Dr. Cesar Arias, the Editor-in-Chief of Antimicrobial Agents and Chemotherapy. Cesar and the guests did a great review of recent developments in this fast-moving area. Guests:  Dr. Trish Simner - Director of the Medical Bacteriology and Infectious Disease Sequencing Laboratories, Johns Hopkins Hospital Dr. Romney Humphries - Director of the Division of Laboratory Medicine and the Medical Director of the Microbiology Laboratory at Vanderbilt University Medical Center. 

Susceptibility Testing for Piperacillin-Tazobactam (JCM ed.)

Editors in Conversation is the official podcast of the American Society for Microbiology Journals. Editors in Conversation features discussions between ASM Journals Editors, researchers and clinicians working on the most cutting edge issues in the microbial sciences. Topics include laboratory diagnosis and clinical treatment of infectious diseases, antimicrobial resistance, epidemiology of infections, multidrug-resistant organisms, pharmacology of antimicrobial agents, susceptibility testing, and more.

The podcast is directed to microbiologists, infectious diseases clinicians, pharmacists and basic, clinical and translational researchers interested in the microbial sciences. A particular emphasis is on basic, epidemiological and pharmacological aspects of infectious diseases, including antimicrobial resistance and therapeutics.

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Rhodococcus infections are uncommon, however they can cause serious disease in certain patients. There are a number of challenges though when dealing with Rhodococcus infections, including the fact that much of what we know around their susceptibility profiles and the clinical management of infected individuals actually comes from a number case series and in some situations, from the veterinary literature.  So today, our two guests are going to tell us about their experiences with Rhodococcus over a 10-year period and bring us up-to-speed on things like:    Which species of Rhodococcus are most commonly isolated and associated with clinical disease What is the recommended approach to susceptibility testing for Rhodococcus and what sorts of susceptibility trends do we see at both the genus and species levels And also, of course, we’re going to talk about the clinical manifestations and outcomes of clinically significant Rhodococcus infections  Guests:  Adi S. Shah, M.B.B.S., Mayo Clinic Nancy L. Wengenack, Ph.D., Mayo Clinic  Related article: Rhodococcus infection: a 10-year retrospective analysis of clinical experience and antimicrobial susceptibility profile | Journal of Clinical Microbiology  This episode of Editors in Conversation is brought to you by the Journal of Clinical Microbiology and hosted by JCM Editor in Chief, Alex McAdam and Dr. Elli Theel. JCM is available at https://jcm.asm.org and on https://twitter.com/JClinMicro.  Visit journals.asm.org/journal/jcm to read articles and/or submit a manuscript. Follow JCM on Twitter via @JClinMicro

10 Years of Rhodococcus: Clinical Trends and Susceptibility Profiles

Phage therapy has gained a lot of traction but the challenges created by this approach have not been properly assessed at a big scale. We often read about therapy successes on isolated cases but, rarely, we read or hear about failures. AAC recently published a case series of patients who failed phage therapy. Today, we will discuss this topic with the principal investigator on the research. Topics discussed:  Phage therapy as an approach for MDR bacteria. The challenges of phage therapies. Issues that can influence the success of phage therapy  Guest:  Saima Aslam, MBBS. Director, Solid Organ Transplant Infectious Diseases Service, Professor of Medicine, University of California, San Diego.  Article: Pseudomonas aeruginosa ventricular assist device infections: findings from ineffective phage therapies in five cases https://journals.asm.org/doi/10.1128/aac.01728-23 Questions Answered:  How are we doing with phage therapy at this point? What are the challenges to deploy phage therapy in clinical settings? The 5 cases of failure of phage therapy in patients with LVADs summarized What factors did Dr. Aslam identify that were related with the failure? How do you develop neutralization against phages and how can you prevent it?   Bacterial isolates with varying phage susceptibility, how can this be detected? What did Dr. Aslam learn? Future research  This episode is brought to you by the Antimicrobial Agents and Chemotherapy journal available at aac.asm.org. If you plan to publish in AAC, ASM Members get up to 50% off publishing fees. Visit asm.org/membership to sign up. Visit journals.asm.org/journal/aac to browse issues and/or submit a manuscript.

Why Phage Therapy May Fail

The protozoan Lophomonas has been reported to be a pathogen of humans in a large number of case reports and case series. Most of these case reports describe infections of the respiratory tract. Editors in Conversation is joined by two experts to discuss this possible parasite.  Some of the questions addressed include:  What are the characteristics of the species in the genus Lophomonas? What are the laboratory and morphological data that suggest that Lophomonas species cause human infections? What are the purported clinical manifestations of Lophomonas? Finally, is Lophomonas truly a pathogen of humans?  Guests:  Dr. Abhishek Mewara - Additional Professor in the Department of Medical Parasitology at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. Dr. Bobbi Pritt - Chair of the Division of Clinical Microbiology and Professor of Laboratory Medicine and Pathology at Mayo Clinic.  Related article: “Lophomonas as a respiratory pathogen—jumping the gun,” by Abhishek Mewara, Gillian H. Gile, Blaine Mathison, Huan Zhao, Bobbi Pritt, and Richard S. Bradbury (https://journals.asm.org/doi/10.1128/jcm.00845-23). This episode of Editors in Conversation is brought to you by the Journal of Clinical Microbiology and hosted by JCM Editor in Chief, Alex McAdam and Dr. Elli Theel. JCM is available at https://jcm.asm.org and on https://twitter.com/JClinMicro. Visit journals.asm.org/journal/jcm to read articles and/or submit a manuscript. Follow JCM on Twitter via @JClinMicro

Is Lophomonas a Pathogen?

Tuberculosis is one of the most deadly infectious diseases that still causes significant burden of disease, particularly in the developing world.  The emergence of resistance to first line agents severely limits the therapeutic options and threaten the ability to control dissemination of this disease. Fortunately, new drugs and regimens are now emerging as important alternatives against these organisms.  Today, we will discuss this topic with outstanding experts in the field. Welcome to the editors in conversation. Topics discussed:  The burden of multidrug-resistant TB. New drugs and regimens for MDR TB. The current and future pipeline for TB  Guests:  Kelly Dooley, MD Ph.D.  Professor and Addison B. Scoville, Jr., Chair in Medicine, Director, Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center. Past Editor of AAC Sean Wasserman, MD Ph.D, Reader in Infectious Diseases at St Georges University of London and Associate Professor in the Division of Infectious Diseases and HIV Medicine at University of Cape Town, SA. Editor of AAC.  This episode is brought to you by the Antimicrobial Agents and Chemotherapy journal available at aac.asm.org. If you plan to publish in AAC, ASM Members get up to 50% off publishing fees. Visit asm.org/membership to sign up. Visit journals.asm.org/journal/aac to browse issues and/or submit a manuscript. Subscribe to Editors in Conversation (free) on Apple Podcasts, Google Podcasts, Android, Spotify, Email.

Treatment of Multidrug-resistant Tuberculosis

A new generation of B-lactamase inhibitors is likely to reach the market in the upcoming year. These broad-spectrum inhibitors exhibit activity against the most feared class B metallo-B-lactamases maintaining the inhibition of other enzymes. Recently AAC has published three papers that describe the mechanistic bases of taniborbactam resistance among metallo-enzymes. This knowledge is crucial to understand the limitation of these compounds in clinical practice. Today, we will discuss this topic with some of the authors of the mentioned papers. Welcome to the editors in conversation. Topics discussed:  The activity and chemical basis of new generation B-lactamase inhibitors with activity against metallo-B-lactamases. Taniborbactam as an example of novel B-lactam, B-lactam inhibitors Mechanisms of resistance to taniborbactam and other inhibitors  Guest:  Robert Bonomo, MD.  Director of the VA CARES Center and Distinguished Professor at Case Western Reserve University (CWRU) School of Medicine. Past Editor of AAC Pranita Tamma, MD MPH. Associate Professor of Pediatrics, Johns Hopkins School of Medicine, Editor of AAC Alejandro Vila, PhD Professor of Biophysics, Instituto de Biologia Molecular y Celular de Rosario, CONICET - Universidad Nacional de Rosario, Rosario, Argentina  This episode of Editors in Conversation is brought to you by the Antimicrobial Agents and Chemotherapy Journal and hosted by AAC Editor in Chief, Cesar Arias.  AAC is available at https://asm.org/aac.  Follow Cesar on twitter at https://twitter.com/SuperBugDoc for AAC updates.  Subscribe to the podcast at https://asm.org/eic

Susceptibility Testing for Piperacillin-Tazobactam (JCM ed.)

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