Tamma Pranita D, Aitken Samuel L, Bonomo Robert A, Mathers Amy J, van Duin David, Clancy Cornelius J
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pharmacy, University of Michigan Health, Ann Arbor, Michigan, USA.
Clin Infect Dis. 2023 Jul 18. doi: 10.1093/cid/ciad428.
The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant 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.
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 resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States.
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 also discussed briefly. Suggested approaches apply for both adult and pediatric populations, although suggested antibiotic dosages are provided only for adults.
The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial resistant infections. This document is current as of December 31, 2022 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/.
美国传染病学会（IDSA）致力于提供关于抗微生物药物耐药性感染治疗的最新指南。本指南文件聚焦于由产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）、产AmpCβ-内酰胺酶肠杆菌科细菌（AmpC-E）、耐碳青霉烯类肠杆菌科细菌（CRE）、具有难治性耐药的铜绿假单胞菌（DTR-P. aeruginosa）、耐碳青霉烯类鲍曼不动杆菌（CRAB）和嗜麦芽窄食单胞菌引起的感染。本更新文件取代了该指南文件的先前版本。
由六位在管理抗微生物药物耐药性感染方面具有专业知识的传染病专家组成的小组，针对ESBL-E、AmpC-E、CRE、DTR-P. aeruginosa CRAB和嗜麦芽窄食单胞菌引起的感染治疗提出问题。由于国际上耐药性流行病学和特定抗感染药物可用性存在差异，本文件聚焦于美国的感染治疗。
假设已鉴定出病原体且已知抗生素敏感性结果，提供了首选和替代的建议治疗方法及相应理由。还简要讨论了经验性治疗方法、过渡到口服治疗、治疗持续时间和其他管理考虑因素。建议方法适用于成人和儿童人群，不过仅提供了成人的建议抗生素剂量。
抗微生物药物耐药领域变化迅速。对于抗微生物药物耐药性感染的治疗，建议咨询传染病专家。本文件截至2022年12月31日有效，并将定期更新。本文件的最新版本，包括出版日期，可在www.idsociety.org/practice-guideline/amr-guidance/获取。
