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On Demand Replay: The Evolution of Antibiotic Therapy for the Treatment of Gram-Negative Pathogens

Program Description:

This activity features a replay of a live symposia held following IDWeek 2016 in New Orleans, Louisiana.

Today it is realistic to ask whether the antibiotic era is coming to an end – as foreshadowed by Sir Alexander Fleming as early as 1943. Among all of the bacterial resistance problems, gram-negative pathogens are particularly worrisome, and treating infections of either pan-resistant or nearly pan-resistant gram-negative microorganisms is an increasingly common challenge in many hospitals. 

Characterized by the CDC as an Urgent Threat Level, Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a global threat and has been labeled as one of the three greatest threats to human health by the World Health Organization.  A recent study in the US showed that the rate of CRE detection in community hospitals is rapidly and significantly increasing – more than five-fold in a network of community hospitals from 2008-2012. 

CRE were identified in every surveillance site in the Multi-site Gram-negative Surveillance Initiative network with incidence rates in some regions high enough to suggest that CRE are endemic.  And perhaps most worrisome, the emergence of MCR-1 heralds the breach of the last group of antibiotics, polymyxins, by plasmid-mediated resistance.  With the advent of transmissible colistin resistance, progression of Enterobacteriaceae from extensive drug resistance to pan-drug resistance is inevitable and will ultimately become global.

Practitioners must not base immediate future practice on the assumption that new classes of antibiotics will emerge. At least for the foreseeable future, we will just have improvements on existing agents/classes. It is imperative that clinicians understand the profile of these agents that have been recently and are soon to be approved and how they fit into the current treatment paradigms in order to optimize treatment.  Examples include a re-formulation of an old agent, minocycline, the addition of new beta-lactamase inhibitors avibactam and tazobactam to established beta-lactam antibiotics, and synthetic/engineered analogs of current classes such as the aminoglycoside plazomicin. 

Target Audience:

The target audience for this activity includes physicians, pharmacists, clinical microbiologists, nurses, and researchers specializing in infectious diseases and as such have an interest in the management of Gram-negative infections.

Learning Objectives:

Upon completion of this knowledge activity, participants should be able to:

  • Describe the scope, prevalence and clinical implications of resistant Gram-negative pathogens.
  • Identify and understand the clinical impact of resistant Gram-negative bacteria and their various mechanisms of resistance on different types of infections and patient types in order to optimize treatment strategies.
  • List currently available and near-term pipeline treatment options for Gram-negative infections and how each of their profiles may help direct the selection of optimal antibiotic therapy in clinical practice.
  • Review the evolution of the newer antibiotics with a focus on the evolution of aminoglycosides and how to optimize treatment strategies that include this class.

Acceditation Statement:

In support of improving patient care the Center for Education Development is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Credit Designation:

Center for Education Development designates this live educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™, 1.0 CPE credit (UAN # 0498-0000-17-001-H01-P) or 1.0 ANCC credit.

Participants should claim credit commensurate with the extent of their participation in the activity. Participants must participate in the session and complete an activity evaluation before January 6, 2018. Pharmacists are required to pass the post-test with a minimum score of 70%.

Activity Participation and Obtaining Credit:

There are no fees for participating in and receiving credit for this activity. Participants must view the symposia replay and complete a post test and activity evaluation form. The post test and evaluation form must be completed by January 6, 2018 to be eligible for credit. Pharmacists are required to pass the post test with a score of 70%.


Center for Education Development supports recommendations that will promote life long learning through continuing education. The following desirable physician attributes are addressed through this activity:

  • Provide patient-centered care
  • Work in interdisciplinary teams
  • Employ evidence-based practice
  • Apply quality improvement

Required Hardware/Software:

The computer you plan to use should meet the following requirements:

  • Peripherals: Computer speakers or headphones
  • Monitor Screen Resolution: 320 x 480 or higher
  • Media Viewing Requirements: Adobe Reader, Microsoft PowerPoint, Flash Player & HTML

Faculty Bio:

Andrew Shorr, MD, MPH
Chief, Pulmonary and Critical Care
Washington Hospital Center
Associate Professor of Medicine
George Washington University
Washington, DC

Andrew F. Shorr, MD, MPH, is Director of Pulmonary and Critical Care at the Washington Hospital Center and Associate Professor of Medicine at Georgetown University. He received his undergraduate degree (public policy) from Princeton University, an MPH from Johns Hopkins University, and his medical degree from the University of Virginia. He is currently pursuing an MBA.  Dr Shorr’s research interests address healthcare outcomes, epidemiology in pulmonology/critical care, and infection in the hospitalized patient. He is an authority on healthcare outcomes research, a relatively new field requiring expertise in applying aspects of both traditional and social sciences. Health outcomes research can facilitate improvement in the practice and delivery of healthcare, thus limiting mortality and/or improving quality of health outcomes for patients.

Dr Shorr is the author/co-author of nearly 300 peer-reviewed manuscripts and book chapters. He has served on the editorial board of Chest, currently serves on the editorial board of Critical Care Medicine, and is a reviewer on several medical and critical care journals. He also served as a Fullbright Specialist Scholar in 2010.


Yehuda Carmeli, MD, MPH 
Professor in Medicine, Tel Aviv University
Head, National Institute for Antibiotic Resistance and Infection Control
Tel Aviv Medical Center.  Israel

Yehuda Carmeli, MD, MPH, professor of medicine, Tel Aviv University, is the Head of the Israeli National Center for Antibiotic Resistance and Infection Control, and the chief of the Division of Epidemiology at the Tel Aviv Medical Center, in Tel Aviv, Israel.  Dr. Carmeli received his MD degree from Ben Gurion University, Israel and his MPH degree at Harvard School of Public Health.  He served his residency at Hadassah Medical Center, Hebrew University, Jerusalem, and then served as a fellow in Medicine at Massachusetts General Hospital, Boston.  Dr. Carmeli completed his fellowship in Infectious Diseases at Beth Israel Deaconess Medical Center, Boston, MA.  His primary research interest is the epidemiology of resistance to antibiotics.  Dr. Carmeli is the author of over 250 research articles, the recipient of multiple research grants and awards, and member of editorial board of major journals in the fields of Infectious Diseases and antibiotic research. 


Keith A. Rodvold, PharmD, FCCP, FIDSA
Professor of Pharmacy Practice and Pharmacy in Medicine
Colleges of Pharmacy and Medicine
Co-Director, Section of Infectious Diseases Pharmacotherapy
Department of Pharmacy Practice
University of Illinois at Chicago
Chicago, IL

Dr Keith A. Rodvold received his BS and PharmD degrees from the University of Minnesota. He completed his research fellowship in clinical pharmacokinetics and pharmacology at St. Paul-Ramsey Medical Center and the University of Minnesota, and was a Clinical Pharmacy Specialist at St. Joseph’s Hospital in Marshfield, Wisconsin, from 1981 to 1984. Dr Rodvold was appointed as an Assistant Professor in the Department of Pharmacy Practice at the University of Illinois at Chicago in 1984, promoted to the rank of Associate Professor with tenure in 1989, and to the rank of Professor in 1994. He is also a Professor of Pharmacy Practice and Pharmacy in Medicine in the Colleges of Pharmacy and Medicine at the University of Illinois at Chicago.

Dr Rodvold is currently conducting research in the area of clinical pharmacokinetics and pharmacodynamics of anti-infective agents, funded by the NIH and major pharmaceutical companies.

He has authored more than 125 original research and review publications, 40 book chapters, and served as co-editor of the textbook Drug Interactions in Infectious Diseases. The American College of Clinical Pharmacy presented Dr Rodvold with the 2003 Russell R. Miller Award in recognition of his sustained and outstanding contributions to the literature of clinical pharmacy. He is a former member of the Anti-Infective Drug Advisory Committee and Pediatric Drug Advisory Subcommittee for the Food and Drug Administration, and an active member of numerous professional societies and has been elected Fellow of the Infectious Diseases Society of America, American College of Clinical Pharmacology, and American College of Clinical Pharmacy.



Faculty reported the following financial relationships. A copy of Center for Education Development's policy on resolving conflicts of interest can be found at

Andrew Shorr, MD, MPH: Speaker for, consultant to or gotten research support from: Actavis, Astellas, AZ, Bayer, Cubist, Pfizer, Roche, Theravance, Wockhardt, Medco, and Consultant/Advisor for Alios, AKP, Cempra, Entasis, Zvante Pharma

Yehuda Carmeli, MD, MPH: Achaogen – Consultant/speaker; Allecra – Consultant; AstraZeneca – Consultant, Investigator, Speaker; DaVoltera – Consultant; Durata – Investigator; MSD – Consultant, Investigator, Speaker; Rempex – Consultant; Roche – Consultant, Speaker; Valneva - Consultant

Keith Rodvold, PharmD, FCCP, FIDSA: Theravance Biopharma – Advisory Board, Consultant, Investigator-Initiated Study; Jensson – Safety Monitoring Board; Merck – Speakers Bureau; Paratek – Consultant, Advisory Board; Actavis – Advisory Board, Speakers Bureau, Investigator-initiated Study; The Medicines Company – Advisory Board, Speakers Bureau; Achaogen – Advisory Board; Melinta – Advisory Board; Zavanta – Advisory Board, Clinical Advisory; Shionogi – Advisoroy Board; Wockhardt – Consultant; Spero Therapeutics – Clinical Advisory; Bayer – Advisory Board

Center for Education Development
Thomas Zimmerman, PhD (Reviewer, CED) has nothing to disclose.
John Zitel (Reviewer, CED) has nothing to disclose.
Danielle Amodio (Planner, CED has nothing to disclose.

Support Statement:

This activity was supported by an unrestricted educational grant from Achaogen, Inc.
This activity is sponsored by Center for Education Development

Unlabeled and Investigational Usage:

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non-FDA approved or investigational use of products/devices.


Created and published by Center for Education Development. Copyright © 2016 Center for Education Development. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of continuing medical education activities does not necessarily reflect the views and opinions of CED. Neither CED nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

References and Resources


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