Clin Infect Dis. 2020 Oct 27:ciaa1478. doi: 10.1093/cid/ciaa1478. Online ahead of print.
BACKGROUND: This guidance document provides recommendations to clinicians for the treatment of infections caused by extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Antimicrobial resistant infections are commonly encountered in United States hospitals, result in significant morbidity and mortality.
METHODS: A panel of six infectious diseases specialists with expertise in managing antimicrobial resistant infections formulated common questions about the treatment of ESBL-E, CRE, and DTR-P. aeruginosa infections. Based on review of the published literature and clinical experience, the panel provides recommendations and associated rationale for each recommendation. The document is framed so that each question can stand on its own. Because of significant differences in the molecular epidemiology of resistance and availability of specific anti-infectives globally, the document focuses on treatment of antimicrobial resistant infections in the United States.
RESULTS: Approaches to empiric treatment selection, duration of therapy, and other management considerations are briefly discussed. The majority of guidance focuses on preferred and alternative treatment recommendations for antimicrobial resistant infections, assuming that the causative organism has been identified and antibiotic susceptibility testing results are known. Treatment recommendations apply to both adult and pediatric populations.
CONCLUSIONS: The field of antimicrobial resistance is dynamic and rapidly evolving, and the treatment of antimicrobial resistant infections will continue to challenge clinicians. This guidance document is current as of September 17th, 2020. Updates to this guidance document will occur periodically as new data emerge. Furthermore, the panel will expand recommendations to include other problematic Gram-negative pathogens in future versions. The most current version of the guidance including the date of publication can be found at www.idsociety.org/practice-guideline/amr-guidance/.