Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections

Pranita D Tamma; Samuel L Aitken; Robert A Bonomo; Amy J Mathers; David van Duin; Cornelius J Clancy

doi:10.1093/cid/ciad428

Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections

Clin Infect Dis. 2023 Jul 18:ciad428. doi: 10.1093/cid/ciad428. Online ahead of print.

Authors

Pranita D Tamma¹, Samuel L Aitken², Robert A Bonomo³, Amy J Mathers⁴, David van Duin⁵, Cornelius J Clancy⁶

Affiliations

¹ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Pharmacy, University of Michigan Health, Ann Arbor, Michigan, USA.
³ Medical Service and Center for Antimicrobial Resistance and Epidemiology, Louis Stokes Cleveland Veterans Affairs Medical Center, University Hospitals Cleveland Medical Center and Departments of Medicine, Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia, USA.
⁵ Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
⁶ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

PMID: 37463564
DOI: 10.1093/cid/ciad428

Abstract

Background: The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. This guidance document focuses on infections caused by extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. This updated document replaces previous versions of the guidance document.

Methods: A panel of six infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated questions about the treatment of infections caused by ESBL-E, AmpC-E, CRE, DTR-P. aeruginosa, CRAB, and S. maltophilia. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States.

Results: Preferred and alternative suggested treatment approaches are provided with accompanying rationales, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, transitioning to oral therapy, duration of therapy, and other management considerations are also discussed briefly. Suggested approaches apply for both adult and pediatric populations, although suggested antibiotic dosages are provided only for adults.

Conclusions: The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial resistant infections. This document is current as of December 31, 2022 and will be updated periodically. The most current version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance/.

Keywords: Pseudomonas aeruginosa; Stenotrophomonas maltophilia; AmpC; CRAB; ESBL; carbapenem-resistant Enterobacterales.