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The distinction between an imaging agent used to evaluate target expression for patient selection and therapeutic response monitoring and a surrogate agent used for treatment planning is important.
We evaluated the usefulness of linezolid as a surrogate agent for predicting the susceptibility of clinically significant Gram-positive pathogens to tedizolid.
Very major error rates (ie, tedizolid false-susceptible errors) were very low and within acceptable limits for a surrogate agent: S. aureus and other staphylococcal species, 0%; Enterococcus spp, 0.2%; and Streptococcus spp, 0%.
This analysis demonstrated that linezolid, the only oxazolidinone available in commercial susceptibility testing products [ 16], can serve as a surrogate agent to predict tedizolid susceptibility of clinically relevant Gram-positive pathogens.
In this circumstance, the use of a surrogate agent to assess for in vitro susceptibility is well precedented and has significant utility pending the addition of the new antibacterial agent to an established diagnostic testing susceptibility platform [ 3, 4].
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Other radiopharmaceuticals such as 111In-pentetreotide, 111In-DOTATOC, and 86Y-DOTATOC (PET) have been used as surrogate agents for this purpose [32],[32].
Before the ready availability of non-injectible testosterone preparations, and because of their ease of administration by the oral route, 17-alkylated steroids were popular surrogate agents for testosterone.
The use of a surrogate SPECT agent, 111In-DTPA-anti-PD-L1-BC, is beneficial in optimizing the dose delivered to the tumor sites.
As commercial tedizolid susceptibility products become available, they could rapidly replace the interim use of linezolid as the surrogate testing agent.
When linezolid is used as a surrogate testing agent for tedizolid, cfr-positive isolates will likely result in major errors (false resistance or false nonsusceptible).
Much of what was known came from studies conducted by the United States and Canadian military biological defense programs, using surrogate biological agents dispersed outdoors at very high concentrations (10 10 agent-containing particles/m).
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