Management of Infections Caused by Multidrug-resistant Gram-negative Pathogens: Recent Advances and Future Directions

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Pharmacology

Background:

• Increasing global incidence of multidrug-resistant Gram-negative (MDR-GN) bacteria.
• Association of MDR-GN infections with delayed treatment, increased morbidity, and mortality.
• Challenges in treating MDR-GN pathogens with existing antibiotics.

Purpose of the Study:

• To review risk factors for MDR-GN infections.
• To propose an algorithm for empirical treatment of suspected MDR-GN pathogens.
• To provide treatment recommendations for specific MDR-GN pathogens in hospitalized patients.

Main Methods:

• Literature review of risk factors for MDR-GN infections.
• Development of an empirical treatment algorithm.
• Formulation of first- and second-line treatment recommendations for specific MDR-GN pathogens.

Main Results:

• Identification of key risk factors for MDR-GN infections.
• An algorithm for empirical antibiotic selection in suspected MDR-GN cases.
• Specific treatment recommendations for extended-spectrum β-lactamases producing Enterobacterales, carbapenem-resistant Enterobacterales, MDR Pseudomonas aeruginosa, and MDR Acinetobacter baumannii.

Conclusions:

• Urgent need for updated clinical and therapeutic recommendations for MDR-GN infections.
• The proposed algorithm and treatment options aim to guide clinicians in managing severe MDR-GN infections.
• Focus on bloodstream infections, nosocomial pneumonia, and urinary tract infections caused by these challenging pathogens.