Disclosures: Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara and Melinta for work outside study, and serving on advisory boards or consulting for Astellas, Cidara, the Medicines Company, Merck, Needham & Company, Qpex, Scynexis and Shionogi. Clancy also has spoken at symposia sponsored by Merck and T2Biosystems. File reports receiving a research grant from Nabriva to his institution and serving as a consultant for bioMérieux, Curetis, Melinta, Merck, Paratek and Shionogi.
September 10, 2020
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IDSA issues new guidance for antimicrobial-resistant infections

Disclosures: Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara and Melinta for work outside study, and serving on advisory boards or consulting for Astellas, Cidara, the Medicines Company, Merck, Needham & Company, Qpex, Scynexis and Shionogi. Clancy also has spoken at symposia sponsored by Merck and T2Biosystems. File reports receiving a research grant from Nabriva to his institution and serving as a consultant for bioMérieux, Curetis, Melinta, Merck, Paratek and Shionogi.
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The Infectious Diseases Society of America has issued new guidance for the clinical treatment of three common drug-resistant pathogens.

The guidelines, which were developed by a panel of six actively practicing infectious disease specialists, address extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistance (DTR) Pseudomonas aeruginosa.

Cornelius (Neil) J. Clancy
Thomas File Jr.

“Clinicians rely on evidence-based guidelines from other clinicians who have considered the literature and available data,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, said in a press release. “This guidance provides clinicians with real-word recommendations on how to deal with real-world problems.”

For each of the three pathogens, the guidelines provide the following information regarding:

  • preferred antibiotics for uncomplicated cystitis treatment caused by each pathogen;
  • recommended antibiotics for treatment of complicated UTI and pyelonephritis caused by each pathogen; and
  • preferred antibiotics for infection treatment outside of the urinary tract caused by each pathogen.

The panel also provided recommendations for the role of combination antibiotic therapy for DTR P. aeruginosa. For CRE, the guidance includes:

  • recommended antibiotics for non-UTI infections caused by CRE that are resistant to meropenem and ertapenem when carbapenemase test results are negative or unavailable;
  • recommended antibiotics for non-UTI infections caused by CRE if carbapenemase production is present;
  • the role of polymyxins for infections stemming from CRE; and
  • antibiotic combination therapy for the treatment of infections caused by CRE.

Recommendations for ESBL-E include:

  • the use of piperacillin-tazobactam for ESBL-E-related infections if in vitro susceptibility to piperacillin-tazobactam is present;
  • the use of cefepime for the treatment of infections caused by ESBL-E if in vitro susceptibility to cefepime is present;
  • suggested antibiotics for the treatment of infections caused by Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca or Proteus mirabilis that are not susceptible to ceftriaxone if phenotypic ESBL testing is negative and;
  • preferred antibiotic treatment of bloodstream infections caused by ceftriaxone-nonsusceptible E. coli, K. pneumoniae, K. oxytoca or P. mirabilis when a blaCTX-M gene is not found with a molecular test.

“More and more, as we get through this pandemic, we’re going to see antimicrobial resistance raise its ugly head,” IDSA President and Infectious Disease News Editorial Board Member Thomas File Jr., MD, MSc, FIDSA, said in the release. “Now more than ever, it’s important for us to prioritize antimicrobial stewardship — we can’t forget that this, too, is a global health crisis.

The guidelines do not include recommendations for empiric therapy or duration of therapy, but the authors said that prolonged treatment courses are unnecessary against infections caused by antimicrobial-resistant pathogens compared with infections caused by the same bacteria with a more susceptible phenotype.

“Antibiotics are unique among drugs in medicine, and we have an imperative to use them responsibly to limit the emergence of resistance,” Clancy said. “Now there’s pressure on stewardship programs to help clinicians come up with a plan to use antibiotics responsibly to treat COVID-19 patients.”