{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:52:13Z","timestamp":1781830333497,"version":"3.54.5"},"reference-count":12,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2018,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n Rapid diagnostic tests (RDTs) have revolutionized the management of Gram-negative bacteremia by allowing antimicrobial stewardship teams the ability to escalate therapy and improve patient outcomes through timely organism identification and detection of certain resistance determinants. However, given the complex nature of Gram-negative resistance, stewardship teams are left without clear direction for how to respond when resistance determinants are absent, as the safety of de-escalation in this setting is unknown. The primary purpose of this analysis was to determine the negative predictive values (NPVs) of resistance marker absence for predicting susceptibility in target bug-drug scenarios at two geographically distinct institutions. A total of 1,046 Gram-negative bloodstream isolates that were analyzed with the Verigene BC-GN platform were assessed. Except for\n Pseudomonas aeruginosa<\/jats:named-content>\n , the absence of resistance determinants as reported by the RDT largely predicted susceptibility to target antibiotics at both institutions. NPVs for ceftriaxone susceptibility in\n Escherichia coli<\/jats:named-content>\n and\n Klebsiella pneumoniae<\/jats:named-content>\n in the absence of either CTX-M or a carbapenemase gene were 98% and 93 to 94%, respectively. Similar results were seen with other target bug-drug scenarios, with NPVs of 94 to 100% demonstrated at both institutions, with the exception of\n P. aeruginosa<\/jats:named-content>\n , for which NPVs were poor, likely due to the more complex nature of resistance in this pathogen. The results of this study show that clinicians at both institutions should have confidence in de-escalation in the absence of resistance determinant detection by Verigene BC-GN testing, and the methodology described within this article can serve as a blueprint for other stewardship programs to employ at their institutions to optimize management of Gram-negative bacteremia.\n <\/jats:p>","DOI":"10.1128\/aac.02538-17","type":"journal-article","created":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T16:15:44Z","timestamp":1522253744000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":46,"title":["An Antibiotic Stewardship Program Blueprint for Optimizing Verigene BC-GN within an Institution: a Tale of Two Cities"],"prefix":"10.1128","volume":"62","author":[{"given":"Jason M.","family":"Pogue","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan, USA"},{"name":"Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily L.","family":"Heil","sequence":"additional","affiliation":[{"name":"University of Maryland School of Pharmacy, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lephart","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Kristie","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Mynatt","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Salimnia","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly C.","family":"Claeys","sequence":"additional","affiliation":[{"name":"University of Maryland School of Pharmacy, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw649"},{"key":"e_1_3_1_3_2","volume-title":"Verigene Gram-negative blood culture nucleic acid test (BC-GN) package insert 027-00039-01, rev B","author":"Nanosphere, Inc","year":"2014","unstructured":"Nanosphere, Inc. 2014. Verigene Gram-negative blood culture nucleic acid test (BC-GN) package insert 027-00039-01, rev B. Nanosphere Inc, Northbrook, IL."},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-017-3008-6"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2015.10.021"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00189-17"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"e_1_3_1_8_2","volume-title":"CLSI document M39-A4","author":"CLSI","year":"2014","unstructured":"CLSI. 2014. Analysis and presentation of cumulative antimicrobial susceptibility test data; approved guideline, 4th ed. CLSI document M39-A4. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"4"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1086\/338782"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.04259-14"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2018.01.012"},{"key":"e_1_3_1_12_2","volume-title":"CLSI supplement M100","author":"CLSI","year":"2018","unstructured":"CLSI. 2018. Performance standards for antimicrobial susceptibility testing, 28th ed. CLSI supplement M100. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"28"},{"key":"e_1_3_1_13_2","unstructured":"European Committee on Antimicrobial Susceptibility Testing. 2018. Breakpoint tables for interpretation of MICs and zone diameters version 8.0. http:\/\/www.eucast.org\/clinical_breakpoints\/."}],"container-title":["Antimicrobial Agents and Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.02538-17","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.02538-17","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T21:09:27Z","timestamp":1645477767000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/AAC.02538-17"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1128\/AAC.02538-17"],"URL":"https:\/\/doi.org\/10.1128\/aac.02538-17","relation":{},"ISSN":["0066-4804","1098-6596"],"issn-type":[{"value":"0066-4804","type":"print"},{"value":"1098-6596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5]]},"assertion":[{"value":"2017-12-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e02538-17"}}