To provide updated guidance on treating antimicrobial-resistant gram-negative infections, incorporating newer therapies and evolving evidence.
Approach:
Guidance Development: The guidance was developed by a panel of infectious diseases specialists based on literature review, clinical expertise, and expert consensus, without using GRADE methodology.
Target Pathogen Groups: It addresses six groups of resistant gram-negative pathogens: ESBL-E, AmpC-E, CRE, DTR P. aeruginosa, CRAB, and S. maltophilia.
Treatment Recommendations: Recommendations emphasize susceptibility testing, appropriate empiric treatment, and reassessment based on susceptibility profiles.
Key Findings:
Carbapenems are preferred for invasive ESBL-E infections outside the urinary tract.
Cefepime is preferred for AmpC-E infections when susceptible.
For CRE infections, treatment varies by resistance mechanism, with ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam preferred for KPC-producing infections.
Aztreonam-avibactam and cefiderocol are preferred for New Delhi metallo-beta-lactamase-producing infections.
Newer beta-lactam agents like cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-relebactam may be effective against DTR P. aeruginosa.
Sulbactam-durlobactam combined with imipenem or meropenem is preferred for invasive CRAB infections.
Cefiderocol monotherapy is preferred for invasive S. maltophilia infections.
Interpretation:
The guidance aims to assist clinicians in making informed treatment decisions amidst evolving antimicrobial resistance.
Limitations:
Specific dosing guidance is provided only for adults.
The recommendations are based on expert consensus and literature review, not GRADE methodology.
Conclusion:
The guidance is intended to help clinicians navigate treatment decisions for serious infections caused by drug-resistant pathogens.
A national claims analysis found modest uptake and declining persistence over 2 years despite increasing use of injectable HIV pre-exposure prophylaxis.
