Assessing Clinician Utilization of Next-Generation Antibiotics Against Resistant Gram-Negative Infections in U.S. Hospitals

The U.S. antibiotic market failure has threatened future innovation and supply. Understanding why clinicians underutilize recently approved gram-negative antibiotics could help prioritize patients in future antibiotic development and potential market entry rewards. A retrospective cohort study of 619 U.S. hospitals found that ceftazidime-avibactam and ceftazidime-avibactam predominated new antibiotic usage between 2016 and 2021, while subsequently approved gram-negative antibiotics saw relatively slow uptake. Patients with bacteremia and chronic diseases had greater adjusted probabilities of receiving newer antibiotics for DTR infections, while those with do-not-resuscitate status, acute liver failure, and Acinetobacter baumannii complex had lower probabilities. The availability of susceptibility testing for new antibiotics increased the probability of usage. Despite FDA approval of 7 next-generation gram-negative antibiotics between 2014 and 2019, clinicians still treat resistant gram-negative infections with older, generic antibiotics with suboptimal safety-efficacy profiles.