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IDSA Releases Guidance On Treatment Of Antimicrobial-Resistant Infections

Timely recommendations for treating three common pathogens keep global health issue at forefront

ARLINGTON, Va. – New guidance from the Infectious Diseases Society of America offers timely practice advice for the clinical treatment of three of the most common drug-resistant pathogens.

Antibiotics save countless lives, but bacteria and other microbes can evolve in ways that enable them to resist a drug’s intended effect. Misuse or overuse of antibiotics has resulted in widespread antimicrobial resistance (AMR), and experts say the COVID-19 pandemic could make it much worse.

AMR pathogens caused more than 2.8 million infections and over 35,000 deaths annually in the United States from 2012 through 2017, according to the Centers for Disease Control and Prevention.

Developed by a panel of six infectious diseases specialists with clinical and research expertise in the treatment of AMR bacterial infections, this first-in-a-series guidance addresses three groups of AMR Gram-negative bacteria that pose particular therapeutic challenges and have been designated as urgent or serious threats by CDC:

  • Extended-spectrum β-lactamase producing Enterobacterales (ESBL-E)
  • Carbapenem-resistant Enterobacterales (CRE)
  • Difficult-to-treat resistance (DTR)-Pseudomonas aeruginosa

The AMR field is rapidly evolving, and the treatment of these infections is complex. Updates to this AMR treatment guidance document will occur regularly through an iterative review process that will incorporate new evidence Furthermore, the panel will expand recommendations to include other problematic Gram-negative pathogens in future iterations.

“Clinicians rely on evidence-based guidelines from other clinicians who have considered the literature and available data,” says Cornelius J. Clancy, M.D., a panel co-chair, VA Pittsburgh Healthcare System’s chief of infectious diseases, and an associate professor of medicine and director of the XDR Pathogen Lab at the University of Pittsburgh. “This guidance provides clinicians with real-word recommendations on how to deal with real-world problems.”

Experts acknowledge that the ability to address rapidly evolving topics such as AMR is limited by prolonged timelines needed to generate new or updated clinical practice guidelines. As an alternative and a complement to comprehensive clinical management guidelines, which can take several years to produce and publish, IDSA endorsed developing more narrowly focused guidance documents for the treatment of some infectious diseases. These documents will address specific clinical questions for difficult-to-manage infections that are not covered by present guidelines. 

“Clinicians will find this to be an easy-to-use resource,” says Pranita Tamma, M.D., a panel co-chair and director of the Pediatric Antimicrobial Stewardship Program at Johns Hopkins University School of Medicine. “Infectious diseases physicians are taking the lead in providing practical recommendations for reducing resistance, and the development of this guidance affirms the specialty’s commitment to preparing clinicians for high-quality patient care.”

The Dual Pandemic of COVID-19 and AMR

Experts say the risk posed by AMR pathogens is compounded by the COVID-19 pandemic because patients who are hospitalized after contracting the novel coronavirus can become further sickened by infections that are difficult to treat without antibiotics.

“Antibiotics are unique among drugs in medicine, and we have an imperative to use them responsibly to limit the emergence of resistance. Now there’s pressure on [antibiotic] stewardship programs to help clinicians come up with a plan to use antibiotics responsibly to treat COVID patients,” says Dr. Clancy.

Because COVID-19 patients are often given a broad spectrum of antibiotics when they enter a hospital, it changes their microbiomes – a major concern of physicians. Infectious diseases experts say they are constantly learning more about the complications of this new disease, as well as how and when to use antibiotics to treat infections in patients with COVID-19.

“More and more, as we get through this pandemic, we’re going to see AMR raise its ugly head,” says Thomas M. File, Jr., M.D., president of IDSA. “Now more than ever, it’s important for us to prioritize antimicrobial stewardship—we can’t forget that this, too, is a global health crisis.”

IDSA Centers of Excellence

The development of this guidance is only one facet of IDSA’s continued organizational commitment to AMR and stewardship. IDSA’s Antimicrobial Stewardship Centers of Excellence program recognizes institutions that have created stewardship programs led by infectious diseases physicians and ID-trained pharmacists that are of the highest quality. A total of 101 programs nationwide have received the designation since the program’s launch in 2017.

The guidance panel was co-chaired by Drs. Tamma and Clancy. Other members of the panel include Samuel L. Aitken, PharmD, MPH; Robert A. Bonomo, M.D.; David van Duin, M.D., Ph.D.; and Amy J. Mathers, M.D.

IDSA has published more than 50 treatment guidelines on various conditions and infections, ranging from HIV/AIDS to skin and soft tissue infections.

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