New Guidance for Treating Resistant Gram-Negative Infections

Jennifer Garcia

November 05, 2020

New guidance from the Infectious Diseases Society of America provides practitioners with actionable information for the treatment of antimicrobial-resistant gram-negative pathogens, including extended-spectrum β-lactamase–producing Enterobacterales, carbapenem-resistant Enterobacterales, and Pseudomonas aeruginosa with difficult-to-treat resistance.

"These pathogens have been designated urgent or serious threats by the CDC [Centers for Disease Control and Prevention]," write lead author Pranita D. Tamma, MD, MHS, from John Hopkins University School of Medicine, Baltimore, Maryland, and colleagues. "They are encountered in US hospitals of all sizes and cause a wide range of serious infections that carry significant morbidity and mortality."

The authors of the guidance document, published online October 27 in Clinical Infectious Diseases, identify core clinical issues relevant to each pathogen group and provide appropriate recommendations and rationale for those approaches. The document includes treatment recommendations for uncomplicated cystitis, pyelonephritis with concurrent complicated urinary tract infection, infections outside of the urinary tract, and bloodstream infections.

The report offers guidance on antibiotics that should be avoided or used as a last resort, regardless of in vitro susceptibility testing, based on the pathogen and the organ system affected.

"Because antimicrobial-resistant infections are continuing to rise and often there are few antibiotic options available, we wanted to develop a user-friendly guidance document to help clinicians manage these very complex infections and ultimately to optimize patient outcomes," Tamma told Medscape Medical News.

"We have had several new antibiotics approved in the past few years, which is definitely good news, but unfortunately, there are still several organisms, like highly drug-resistant P aeruginosa, where the options remain limited," she continued.

In addition to disease management recommendations, the guidelines provide useful tables with antibiotic dosage recommendations as well as preferred and alternative antibiotic options for each of the three bacterial groups based on the source of the infection. The guidelines do not offer guidance on duration of therapy.

Tamma told Medscape Medical News that this is the first version of the document and that she and her colleagues plan to update the guidance every 6 months. They are planning to prepare a new report with three new pathogens, which will be available in the spring of 2021.

"Because antibiotics are such a precious resource and desperately needed for some critically ill patients, we need to continue to be very judicious in our antibiotic use to limit the emergence of antimicrobial resistance, and we hope that the guidance will help clinicians navigate complex treatment decisions," Tamma concluded.

Several coauthors report a variety of financial relationships with Merck, Paratek, Medicines Company, Zavante, Shionogi, Sempra, Theravance, Melinta, VenatoRx, Entasis, Tetraphase, Rempex, Qpex Biopharma, Acceclerate Diagnostics, VenatoRX; Antimicrobial Resistance Services, Roche, Allergan, Achaogen, Astellas, Cidara, and Scynexis.

Clin Infect Dis. Published online October 27, 2020. Abstract

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