Evidence-based Practice Guidelines for the Dx and Treatment of MDR Enterobacteriaceae #Carbapenemase via @SEIMC_

 

A carbapenemase-producing Enterobacteriaceae and antibiotics. Who is who? Edward Spera Gallery / The Chase-Cheetah & Gazelle

A carbapenemase-producing Enterobacteriaceae and antibiotics. Who is who?
Edward Spera Gallery / The Chase-Cheetah & Gazelle

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) has just released its “Practice Guidelines for the Diagnosis and Antimicrobial Treatment of Invasive Infections Due to Multidrug-resistant Enterobacteriaceae”, which are freely available (see here). These Guidelines focus on:

  • Microbiological diagnosis and antimicrobial therapy of
  • Invasive infections whatever their source: focal or generalised infections causing a systemic inflammatory response syndrome (sepsis), including bacteraemic infections, needing hospital admission and/or intravenous antibiotic therapy.
  • Caused by extended spectrum β-lactamase (ESBL), AmpC or carbapenemase-producing Enterobacteriaceae (CPE)

 

SEIMC committed this task to a multidisciplinary group of Spanish clinicians and clinical microbiologists with expertise in this field, who:

  • selected a number of clinically relevant questions by consensus considering their perceived clinical importance
  • and performed a systematic review of the literature was performed in PubMed for each of them. Data were extracted using structured forms. The quality of evidence and the strength of recommendations were evaluated and decided by the authors according to the methodology previously used by the Infectious Diseases Society of America

 

The document addresses the following clinically relevant questions:

A) Diagnosis

  • Which phenotypic methods should be used to detect ESBL?
  • Which phenotypic methods should be used to detect carbapenemase enzymes?
  • What is the performance of rapid tests to detect ESBL and carbapenemase enzymes in several specific situations?

 

B) Therapy

  • When should empirical treatment of MDR Enterobacteriaceae be considered?
  • Are carbapenems the drugs of choice for the treatment of invasive infections caused by ESBL-producing Enterobacteriaceae?
  • Which carbapenem should be used for ESBL-producers?
  • Are there alternatives to carbapenems for invasive infections due to ESBL-producers?
  • Should combination therapy be used for invasive infections caused by CPE?
  • When and how should carbapenems be used for infections by CPE?
  • Which is the best combination for invasive infections caused by CPE?
  • When and how should colistin be used in the treatment of MDR Enterobacteriaceae?
  • When and how should fosfomycin be used in the treatment of invasive infections caused by MDR Enterobacteriaceae?
  • When and how should aminoglycosides be used in the treatment of invasive infections caused by MDR Enterobacteriaceae?
  • Is aztreonam useful for the treatment of invasive infections caused by MBL-producing Enterobacteriaceae?
  • Are cephalosporins useful for the treatment of invasive infections caused by OXA-48-producing Enterobacteriaceae?
  • When and how should tigecycline be used in invasive infections caused by MDR Enterobacteriaceae?

 

I truly expect that these guidelines assist physicians in the management of patients with these difficult to treat infections.

 

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