Antibiotic treatment of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, a list of recommendations from European guidelines!

Yimaitong compiles and organizes, please do not reprint without authorization
.

In December 2021, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) issued guidelines for the treatment of multidrug-resistant Gram-negative bacilli infections
.

This article proposes guidance and recommendations for targeted antibiotic therapy of third-generation cephalosporin-resistant enterobacteria and carbapenem-resistant gram-negative bacteria, regarding carbapenem-resistant Pseudomonas aeruginosa (CRPA) and For the antibiotic treatment of carbapenem-resistant Acinetobacter baumannii (CRAB), the guidelines mainly have the following recommendations
.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) 1.
CRPA antibiotic selection ➤ For patients with severe infection caused by refractory and drug-resistant CRPA (DTR-CRPA), it is recommended to use ceftaroza/tazobactam ( If effective in vitro) (conditional recommendation, very low quality of evidence)
.

At present, there is not enough evidence to confirm that imipenem-relebactam, cefadil and ceftazidime-avibactam are available
.

➤For non-severe or low-risk CRPA infections, consider antibiotic management.
Based on the individual patient and the source of infection, use old antibiotics with in vitro activity to treat
.

(Good practice statement) 2.
Treatment of CRPA infections (combination and monotherapy) ➤Due to lack of evidence, it is not recommended to use new β-lactam/β-lactamase inhibitors (BLBLIs) (ceftazidime-avibactam and ceftrol) Za/tazobactam) or cefadil in the treatment of CRPA infection
.

➤When using polymyxin, aminoglycoside or fosfomycin to treat severe infections caused by CRPA, two drugs with in vitro activity are recommended (conditional recommendation, very low-quality evidence)
.

There are no recommendations for or against specific drug combinations
.

➤For patients with non-severe infections or low-risk CRPA infections, consider antibiotic management.
Among drugs with in vitro activity, select single-agent treatment based on the individual patient and the source of infection
.

(Good practice statement) Carbapenem-resistant Acinetobacter baumannii (CRAB) 1.
CRAB antibiotic selection ➤ For CRAB infection and sensitive to sulbactam and HAP/VAP patients, ampicillin/sulbactam is recommended
.

(Conditional recommendation, low quality of evidence) ➤For patients with CRAB infection and resistance to sulbactam, if they have in vitro activity, they can be treated with polymyxin or high-dose tigecycline
.

Due to lack of evidence, there is no recommendation for the antibiotic of choice
.

  ➤Cefadil is not recommended to treat infections caused by CRAB
.

(Not recommended with conditions, low quality of evidence) 2.
Treatment of CRAB infection (combination and monotherapy) ➤ For all patients with CRAB infection, polymyxin-meropenem combination therapy is not recommended (strong not recommended, high quality of evidence) ) Or polymyxin-rifampicin combination therapy (strong not recommended, moderate quality of evidence)
.

➤For patients with severe or high-risk CRAB infection, it is recommended to choose a combination of two drugs with in vitro activity among the available antibiotics (polymyxin, aminoglycoside, tigecycline, and sulbactam combination)
.

(Conditional recommendation, very low quality of evidence) ➤For patients with CRAB infection and meropenem MIC <8 mg/L, consider carbapenem combination therapy and apply high-dose extended carbapenem infusion
.

(Good Practice Statement) Reference source: Paul M, Carrara E, Retamar P, 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.
doi: 10.
1016/j.
cmi.
2021.
11.
025.