Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections

Pranita D Tamma; Emily L Heil; Julie Ann Justo; Amy J Mathers; Michael J Satlin; Robert A Bonomo

doi:10.1093/cid/ciae403

Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections

Clin Infect Dis. 2024 Aug 7:ciae403. doi: 10.1093/cid/ciae403. Online ahead of print.

Authors

Pranita D Tamma¹, Emily L Heil², Julie Ann Justo³, Amy J Mathers⁴, Michael J Satlin⁵, Robert A Bonomo⁶

Affiliations

¹ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Practice, Sciences, and Health-Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
³ Department of Pharmacy, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
⁴ Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia, USA.
⁵ Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
⁶ 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.

PMID: 39108079
DOI: 10.1093/cid/ciae403

Abstract

Background: The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant (AMR) 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 AMR and availability of specific anti-infectives internationally, this document focuses on the treatment of AMR 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 discussed briefly. Suggested approaches apply for both adult and pediatric populations, although suggested antibiotic dosages are provided only for adults.

Conclusions: The field of AMR is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of AMR infections. This document is current as of December 31, 2023 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; AmpC; CRAB; ESBL; Stenotrophomonas maltophilia; carbapenem-resistant Enterobacterales.

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