MDRO Flashcards
ESBL infections treatment
Question 1: What Are Preferred Antibiotics for the Treatment of Uncomplicated Cystitis Caused by ESBL-E?
Recommendation: Nitrofurantoin and trimethoprim-sulfamethoxazole are preferred treatment options for uncomplicated cystitis caused by ESBL-E.
Amoxicillin-clavulanate, single-dose aminoglycosides, and oral fosfomycin (for E. coli only).
Question 2: What Are Preferred Antibiotics for the Treatment of Pyelonephritis and Complicated Urinary Tract Infections Caused by
ESBL-E?
Recommendation: Ertapenem, meropenem, impenem-cilasta ciprofloxacin, levofloxacin, or trimethoprim -sulfamethoxaz are preferred treatment options for pyelonephritis and cUTIs caused by ESBL-E.
Question 3: What Are Preferred Antibiotics for the Treatment of Infections
Outside of the Urinary Tract Caused by ESBL-E?
Recommendation: A carbapenem is preferred for the treatment of infections outside of the urinary tract caused by ESBL-E. After appropriate clinical response is achieved, transitioning to oral fluoroquinolones or trimethoprim-sulfamethoxazole should be considered, if susceptibility is demonstrated.
Question 4: Is There a Role for Piperacillin-Tazobactam in the Treatment of Infections Caused by ESBL-E?
Recommendation: If piperacillin-tazobactam was initiated as empiric therapy for uncomplicated cystitis caused by an organism later identified as an ESBL-E and clinical improvement occurs, no change or extension of antibiotic therapy is neces-sary. The panel suggests carbapenems, fluoroquinolones, or trimethoprim-sulfamethoxazole rather than piperacillin-tazobactam for the treatment of ESBL-E pyelonephritis and cUTI, with the understanding that the risk of clinical failure with piperacillin-tazobactam may be low. Piperacillin-tazo-bactam is not recommended for the treatment of infections outside of the urinary tract caused by ESBL-E, even if susceptibility to piperacillin-tazobactam is demonstrated.
Question 5: Is There a Role for Cefepime in the Treatment of Infections
Caused by ESBL-E?
Recommendation: Cefepime is not recommended for the treatment of nonurinary infections caused by ESBL-E, even if susceptibility to the agent is demonstrated. If cefepime was initiated as empiric therapy for uncomplicated cystitis caused by an organism later identified as an ESBL-E and clinical improvement occurs, no change or extension of antibiotic therapy is necessary. The panel recommends avoiding cefepime for the treatment of pyelonephritis and cUTI. Cefepime is also not recommended for the treatment of infections outside of the urinary tract caused by ESBL-E, even if susceptibility to cefepime is demonstrated.
Question 6: Is There a Role for the Cephamycins in the Treatment of Infections Caused by ESBL-E?
Recommendation: Cephamycins are not recommended for the treatment of ESBL-E infections until more clinical outcomes data using cefoxitin or cefotetan are available and optimal dosing has been defined.
CRE urinary infection treatment
Question 1: What Are Preferred Antibiotics for the Treatment of
Uncomplicated Cystitis Caused by CRE?
Recommendation: Ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, or a single-dose of an amino-glycoside are preferred treatment options for uncomplicated cystitis caused by CRE. Standard infusion meropenem is a preferred treatment option for cystitis caused by CRE resistant to ertapenem (ie, ertapenem MICs >2 mcg/mL) but susceptible to meropenem (ie, meropenem MICs <1 mcg/mL), when carba-penemase testing results are either not available or negative. If none of the preferred agents are active, ceftazidime-avibactam, meropenem-vaborbactam, impenem-cilastatin-relebactam, or cefiderocol are alternative options for uncomplicated CRE cystitis.
Question 2: What Are Preferred Antibiotics for the Treatment of Pyelonephritis and Complicated Urinary Tract Infections Caused by CRE?
Recommendation: Ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole are preferred treatment options for pyelonephritis and cUTI caused by CRE if susceptibility is demonstrated. Extended-infusion meropenem is a preferred treatment option for pyelonephritis and cUTIs caused by CRE resistant to ertapenem (ie, ertapenem MICs ≥2 mcg/mL) but susceptible to meropenem (ie, meropenem MICs S1 mcg/mL), when carbapenemase testing results are either not available or negative. Ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, and cefiderocol are also preferred treatment options for pyelonephritis and cUTIs caused by CRE resistant to both ertapenem and meropenem.
Question 3: What Are Preferred Antibiotics for the Treatment of Infections
Outside of the Urinary Tract Caused by CRE Resistant to Ertapenem but Susceptible to Meropenem, When Carbapenemase Testing Results Are Either Not Available or Negative?
Recommendation: Extended-infusion meropenem is the preferred treatment for infections outside of the urinary tract caused by CRE resistant to ertapenem (ie, ertapenem MICs ≥2 mcg/mL) but susceptible to meropenem (ie, meropenem MICs <1 mcg/mL), when carbapenemase testing results are either not available or negative.
CRE non- urinary tract infection
Question 4: What Are the Preferred Antibiotics for the Treatment of Infections Outside of the Urinary Tract Caused by CRE Resistant to Both Ertapenem and Meropenem, When Carbapenemase Testing Results Are Either Not Available or Negative?
Recommendation:
Ceftazidime-avibactam, meropenem-
vaborbactam, and imipenem-cilastatin-relebactam are the preferred treatment options for infections outside of the urinary tract caused by CRE resistant to both ertapenem (ie, ertapenem MICs >2 mcg/mL) and meropenem (ie, meropenem MICs ≥4 mcg/mL), when carbapenemase testing results are either not available or negative. For patients with CRE infections who within the previous 12 months have received medical care in countries with a relatively high prevalence of metallo-B-lactamase-producing organisms or who have previously had a clinical or surveillance culture where a metallo-B-lactamase-producing isolate was identified, preferred treatment options include the combination of ceftazidime-avibactam plus aztreonam, or cefiderocol as monotherapy, if carbapenemase testing results are not available.
Question 5: What Are the Preferred Antibiotics for the Treatment of Infections Outside of the Urinary Tract Caused by CRE if Carbapenemase
Production is Present?
Recommendation: Meropenem-vaborbactam, ceftazidime-avibactam, and impenem-cilastatin-relebactam are preferred treatment options for KPC-producing infections outside of the urinary tract. Ceftazidime-avibactam in combination with az-treonam, or cefiderocol as monotherapy, are preferred treatment options for NDM and other metallo-B-lactamase-producing in-fections. Ceftazidime-avibactam is the preferred treatment option for OXA-48-like-producing infections.
Question 6: What Is the Likelihood of the Emergence of Resistance of CRE
Isolates to the Newer B-Lactam Agents When Used to Treat CRE
Infections?
Recommendation: The emergence of resistance is a concern with all of the novel B-lactams used to treat CRE infections, but the frequency appears to be the highest for ceftazidime-avibactam.
Question 7: What Is the Role of Tetracycline Derivatives for the Treatment of Infections Caused by CRE?
Recommendation: Although B-lactam agents remain preferred treatment options for CRE infections, tigecycline and eravacy-cline are alternative options when B-lactam agents are either not active or unable to be tolerated. The tetracycline derivatives are not recommended as monotherapy for the treatment of CRE urinary tract infections or bloodstream infections.
Question 8: What Is the Role of Polymyxins for the Treatment of Infections
Caused by CRE?
Recommendation: Polymyxin B and colistin should be avoided for the treatment of infections caused by CRE. Colistin can be considered as an alternative agent for uncomplicated CRE cystitis.
Question 9: What Is the Role of Combination Antibiotic Therapy for the Treatment of Infections Caused by CRE?
Recommendation: Combination antibiotic therapy (ie, the use of a B-lactam agent in combination with an aminoglycoside, fluoroquinolone, or polymyxin) is not routinely recommended for the treatment of infections caused by CRE.
MDR Pseudomonas infection treatment
Question 1: What Are Preferred Antibiotics for the Treatment of Infections
Caused by MDR P. aeruginosa?
Recommendation: When P. aeruginosa isolates test susceptible to traditional non-carbapenem B-lactam agents (ie, piperacillin-tazobactam, ceftazidime, cefepime, aztreonam), the are preferred over carbapenem therapy. For infections caused by P. uginosa isolates not susceptible to any carbapenem -goris susceptible to traditional B-lactams, the administration of a ta. tional agent as high-dose extended-infusion therapy is suggested after antibiotic susceptibility testing results are confirmed. For patients with moderate to severe disease or poor source control with
P. aeruginosa isolates resistant to carbapenems but susceptible to traditional B-lactams, use of a novel B-lactam agent that tests susceptible (eg, ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam) is also a reasonable treatment option.
DTR Pseudomonas UTI treatment
Question 2. What Are Pretersed Andbiotics for the Treatment of Uncomplicated Cystitis Caused by DTR-P. aeruginosa?
Recommendation: Ceftolozane-tazobactam, ceftazidime-avibactam, impenem-cilastatin-relebactam, cefiderocol, or a single-dose of an aminoglycoside are the preferred treatment options for uncomplicated cystitis caused by DTR-P. aeruginosa.
Question What Are Preferred Antibiotics for the Treatment of Pyeloncighritis and Complicated Urinary Tract Infections Caused by
DTR-P. aeruginosa?
Recommendation:
citolozane-tazobactam, ceftazidir
avibactam, impenem-cilastain relebactam, and cefidero are the preferred treatment options for pyelonephritis: cUTI caused by DIR- P. aerúginosa.
DTR Pseudomonas non-UTI treatment
Question 4: What Are Preferred Antibiotics for the Treatment of Infections
Outside of the Urinary Tract Caused by DTR-P. aeruginosa?
Recommendation: Ceftolozane-tazobactam, ceftazidime-avibactam and imipenem-cilastatin-relebactam, as monotherapy, are preferred options for the treatment of infections outside of the urinary tract caused by DTR-P. aeruginosa.
Question 5: What Is the Likelihood of the Emergence of Resistance of
DTR-P. aeruginosa Isolates to the Newer -Lactam Agents When Usaste
Treat DTR-P. aeruginosa infections?
Recommendation: The emergence of resistance is a concern with all of the novel B-lactams used to treat DTR-P. aeruginosa infections, but the frequency appears to be the highest for ceftolozane-tazobactam and ceftazidime-avibactam.
Question 6: What is the Role of Combination Antibiotic Therapy for the Treatment of Infections Caused by DTR-P. aeruginosa?
Recommendation: Combination antibiotic therapy is not routinely recommended for infections caused by DTR-P. aeruginosa if in vitro susceptibility to a first-line antibiotic (ie, ceftolozane-tazobactam, ceftazidime-avibactam, or impenem-cilastatin-relebactam) has been confirmed.
Question 7: What Is the Role of Nebulized Antibiotics for the Treatment of Respiratory Infections Caused by DTR-P. aeruginosa?
Recommendation: The panel does not recommend the routine addition of nebulized antibiotics for the treatment of respiratory infections caused by DTR-P. aeruginosa.
