Empirical antibiotic therapy for difficult-to-treat Gram-negative infections: when, how, and how long?
Journal
Current opinion in infectious diseases
ISSN: 1473-6527
Titre abrégé: Curr Opin Infect Dis
Pays: United States
ID NLM: 8809878
Informations de publication
Date de publication:
01 12 2022
01 12 2022
Historique:
pubmed:
8
10
2022
medline:
10
11
2022
entrez:
7
10
2022
Statut:
ppublish
Résumé
To discuss empirical therapy for severe infections due to Gram-negative bacteria with difficult-to-treat resistance (GNB-DTR) in current clinical practice, focusing in particular on the positioning of novel therapeutic agents and rapid diagnostic tests. The current era of novel agents active against GNB-DTR and showing differential activity against specific determinants of resistance is an unprecedented scenario, in which the clinical reasoning leading to the choice of the empirical therapy for treating severe GNB-DTR infections is becoming more complex, but it also allows for enhanced treatment precision. Novel agents should be used in line with antimicrobial stewardship principles, aimed at reducing selective pressure for antimicrobial resistance. However, this does not mean that they should not be used. Indeed, excesses in restrictive uses may be unethical by precluding access to the most effective and less toxic treatments for patients with severe GNB-DTR infections. Given these premises (the 'how'), empirical treatment with novel agents should be considered in all patients with risk factors for GNB-DTR and severe clinical presentation of acute infection (the 'when'). Furthermore, empirical novel agents should preferably be continued only for a few hours, until de-escalation, modification, or confirmation (as targeted therapy) is made possible by the results of rapid diagnostic tests (the 'how long').
Identifiants
pubmed: 36206149
doi: 10.1097/QCO.0000000000000884
pii: 00001432-202212000-00012
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
568-574Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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