Background Omadacycline is an aminomethylcycline antimicrobial approved by the United States Food and Drug Administration in 2018 for community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. It has in vitro activity against nontuberculous mycobacteria, including Mycobacterium abscessus complex, but clinical data for this indication are lacking. Methods Omadacycline use was reviewed at an 804-bed academic medical center. Patients were included if they received omadacycline for culture-proven M. abscessus disease in 2019. Results Four patients received omadacycline for the treatment of culture-positive M. abscessus disease in 2019. Two patients had cutaneous disease, one had pulmonary disease, and one had osteomyelitis and bacteremia. The patients received omadacycline for a median duration of 166 days (range 104-227) along with a combination of other antimicrobial agents. Omadacycline-containing regimens were associated with a clinical cure in three of four patients, with one patient improving on ongoing treatment. Omadacycline’s tolerability was acceptable for patients with M. abscessus disease, with one patient discontinuing therapy in month six due to nausea. Conclusions Omadacycline is a novel oral option for the treatment of Mycobacterium abscessus disease, for which safe and effective options are needed. While this case series is promising, further data are required to determine omadacycline’s definitive role in the treatment of Mycobacterium abscessus disease.

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Background Antimicrobial stewardship programs (ASPs) aim to provide optimal antimicrobial therapy to patients quickly to improve the likelihood of overcoming infection while reducing the risk of adverse effects. Rapid diagnostic tests (RDTs) for infectious diseases have become an integral tool for ASPs to achieve these aims. Content This review explored the demonstrated clinical value of longer-standing technologies and implications of newer RDTs from an antimicrobial stewardship perspective. Based on available literature, the focus was on the use of RDTs in bloodstream infections (BSIs), particularly those that perform organism identification and genotypic resistance detection, phenotypic susceptibility testing, and direct specimen testing. Clinical implications of rapid testing among respiratory, central nervous system, and gastrointestinal infections are also reviewed. Summary Coupling RDTs with ASPs facilitates the appropriate and timely use of test results, translating into improved patient outcomes through optimization of antimicrobial use. These benefits are best demonstrated in the use of RDT in BSIs. Rapid phenotypic susceptibility testing offers the potential for early pharmacokinetic/pharmacodynamic optimization, and direct specimen testing on blood may allow ASPs to initiate appropriate therapy and/or tailor empiric therapy even sooner than other RDTs. RDTs for respiratory, central nervous system, and gastrointestinal illnesses have also shown significant promise, although more outcome studies are needed to evaluate their full impact.