What are the guideline sources, guidelines and references for Antimicrobial-resistant Gram-negative infections ?
Guideline sources The following summarized guidelines for the management of antimicrobial-resistant Gram-negative infections are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2023) and the European Society for Microbiology and Infectious Diseases (ESCMID 2021; 2019). 1 2 3 Guidelines 1. Medical management General principles: use optimal antibiotic dosing schemes with attention to side effects, especially with the old antibiotics (polymyxins and aminoglycosides). E Show 3 more Management of Enterobacterales infections (extended-spectrum beta-lactamase- producing): administer nitrofurantoin or TMP-sulfamethoxazole as preferred options for the treatment of uncomplicated cystitis caused by extended-spectrum -lactamase-producing Enterobacterales. Administer ciprofloxacin, levofloxacin, or carbapenems as alternative options. Do not use the latter if nitrofurantoin and TMP-sulfamethoxazole are active. Administer single- dose aminoglycosides or oral fosfomycin (for E. coli only) as another alternative option. E Show 6 more Management of Enterobacterales infections (AmpC beta-lactamase-producing): recognize that E. cloacae complex, K. aerogenes, and C. freundii are the most common Enterobacterales at moderate-to-high risk for clinically significant AmpC production. E Show 7 more https://web.pathway.md/diseases/recbVX0szAPj9Tev5 1/3 6/23/23, 2:39 AM Antimicrobial-resistant Gram-negative infections Pathway Show 7 more Management of Enterobacterales infections (third-generation cephalosporin-resistant): administer a carbapenem (imipenem or meropenem) as targeted therapy for the treatment of bloodstream infections and severe infections caused by third-generation cephalosporin-resistant Enterobacterales. B Show 8 more Management of Enterobacterales infections, carbapenem-resistant: As per IDSA 2023 guidelines, administer nitrofurantoin, TMP-sulfamethoxazole, ciprofloxacin, or levofloxacin as preferred options for the treatment of uncomplicated cystitis caused by carbapenem-resistant Enterobacterales, although the likelihood of susceptibility to any of these agents is low. Administer a single dose of an aminoglycoside, oral fosfomycin (for E. coli only), colistin, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, or cefiderocol as alternative options. E Show 9 more As per ESCMID 2021 guidelines, consider administering cefiderocol for the treatment of severe infections caused by carbapenem-resistant Enterobacterales carrying metallo- -lactamases and/or resistant to all other antibiotics, including ceftazidime-avibactam and meropenem- vaborbactam. C Show 8 more Management of Pseudomonas aeruginosa infections (carbapenem-resistant): consider administering ceftolozane-tazobactam, if active in vitro, for the treatment of severe infections caused by carbapenem-resistant P. aeruginosa with difficult-to-treat resistance. C Show 4 more Management of Pseudomonas aeruginosa infections (with difficult-to-treat resistance): administer traditional non-carbapenem -lactam agents (such as piperacillin-tazobactam, ceftazidime, cefepime, aztreonam) over carbapenems if P. aeruginosa isolates test susceptible to them. Consider administerimg a traditional agent as high-dose extended-infusion therapy for the treatment of infections caused by P. aeruginosa isolates not susceptible to any carbapenem agent but susceptible to traditional -lactams, and repeat antimicrobial susceptibility testing. Consider administering a novel -lactam agent testing susceptible (such as ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam) in critically ill patients or patients with poor source control with P. aeruginosa isolates resistant to carbapenems but susceptible to traditional -lactams. E Show 7 more Management of Acinetobacter baumannii infections, carbapenem-resistant: As per IDSA 2023 guidelines, consider administering high-dose ampicillin-sulbactam (total daily dose of 6-9 g of the sulbactam component) combined with at least one other agent for the treatment of carbapenem-resistant A. baumannii infections. E Show 8 more As per ESCMID 2021 guidelines, consider administering ampicillin-sulbactam for the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia caused by carbapenem- https://web.pathway.md/diseases/recbVX0szAPj9Tev5 2/3 6/23/23, 2:39 AM Antimicrobial-resistant Gram-negative infections Pathway resistant A. baumannii susceptible to sulbactam. C Show 5 more Management of Stenotrophomonas maltophilia infections: Consider administering any of the following regimens for the treatment of S. maltophilia infections: two of the following agents: TMP-sulfamethoxazole, minocycline/tigecycline, cefiderocol, or levofloxacin combination of ceftazidime-avibactam and aztreonam in case of evident significant clinical instability or observed intolerance to or inactivity of other agents. E Show 5 more 2. Preventative measures Decolonization of multidrug-resistant Gram-negative bacteria carriers: do not offer routine decolonization in third-generation cephalosporin-resistant or carbapenem-resistant Enterobacterales carriers. D References 1. Mical Paul, Elena Carrara, Pilar Retamar et al. European Society of clinical microbiology and infectious diseases ESCMID guidelines for the treatment of infections caused by Multidrug-resistant Gram-negative bacilli (endorsed by ESICM European Society of intensive care Medicine). Clin Microbiol Infect. 2021 Dec 16;S1198 743X 21 00679 0. Open 2. Pranita D. Tamma, Samuel L. Aitken, Robert A. Bonomo et al. IDSA 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. IDSA. 2023 Jun 7. Open 3. E Tacconelli, F Mazzaferri, A M de Smet et al. ESCMID EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect. 2019 Jul;25 7 807 817. Open 4. Pranita D. Tamma, Samuel L. Aitken, Robert A. Bonomo et al. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum -lactamase Producing Enterobacterales ESBL E , Carbapenem-Resistant Enterobacterales CRE , and Pseudomonas aeruginosa with Difficult-to-Treat Resistance DTR P. aeruginosa). IDSA. 2022 Mar 7. Open 5. Pranita D. Tamma, Samuel L. Aitken, Robert A. Bonomo et al. Infectious Diseases Society of America Guidance on the Treatment of AmpC -lactamase- Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections. IDSA. 2022 Mar 31. Open https://web.pathway.md/diseases/recbVX0szAPj9Tev5 3/3