A state-of-the-art review details the management of multidrug-resistant gram-negative (MDR-GN) infections. “The addition of novel therapies directed at emerging MDR-GN infections has led to safer treatment algorithms and improved outcomes,” the authors write. “However, with the increasing utilization of these newer therapies in clinical practice, there is a growing need for clinical and therapeutic recommendations in managing patients with MDR-GN pathogens.”
Identifying patients at risk for MDR-GN infections, developing an empirical treatment framework for suspected MDR-GN pathogens, and working as a multidisciplinary team are key steps in managing these infections. “MDR-GN infections have a significant impact on patients’ survival, especially those who are critically ill,” the authors write. “Identifying these infections, the source of infection, and assessing a patient’s risk for MDR-GN are complex tasks, especially in emergent settings. The complexity of these tasks can result in delays in administration of effective antimicrobials and increased mortality rates. Although rapid diagnostic testing (RDT) can promptly identify some MDR-GN organisms and has the potential to expedite effective antibiotic therapy, its widespread availability remains limited. Delays in standard susceptibility testing for newer agents and a general lack of up-to-date knowledge of frontline providers with regards to treatment choices and interpretation of microbiology results, further contribute to the complexity. To improve empiric treatment of MDR-GN infections, multiple factors should be considered, including recognizing the patient-level risk of infections due to MDR-GN, up-to-date knowledge of the national and local antimicrobial resistance epidemiology and treatment options, improving and anticipating diagnosis through RDT platforms and ensuring rapid de-escalation to targeted therapy after diagnosis is confirmed.”