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Antimicrobial resistance is one of the major threats to global health, leading to increasingly difficult or untreatable common infections, resulting in increased medical costs, longer hospital stays and increased mortality. Globally, infection rates caused by multidrug-resistant bacteria (MDRO) are on the rise, and although some new antibiotics have emerged in recent years, there are still limited drugs with anti-MDRO activity.
A team of experts from Taiwan developed recommendations for the treatment of MDRO infections, recommending antibiotic treatment for carbapenem-resistant infections caused by Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter enterobacter, and Vancomycin-resistant Enterococcus.
Carbapenem-resistant Acinetobacter baumannii (CRAB)
CRAB pneumonia
Colistin, with or without carbapenems, is recommended and is an adjunct inhaled colistin for the treatment of CRAB pneumonia. （2C）
Tigecycline monotherapy for CRAB pneumonia is not recommended. （1C）
CRAB Hematological Infection (BSI)
A colistin-carbapenem-based combination of crAB-BSI is recommended. （2C）
Carbapenem-resistant Pseudomonas aeruginosa (CRPA)
CRPA sensitive to other antibacterial drugs
CrPA infections that are sensitive to other antimicrobial agents are recommended for anti-Pseudomonas penicillin or cephalosporins or fluoroquinolones with or without aminoglycosides. （2D）
Refractory resistant Pseudomonas aeruginosa (DTR-PA) infection
Colistin-based treatments are recommended for DTR-PA infection. （2C）
For severely ill patients, a colistin loading dose of 9 MU (5 mg/kg) is recommended, followed by a maintenance dose of 4.5 MU [2.5 mg× (1.5 × CrCl+30)] twice daily. （1C）
Renal function should be monitored during treatment with colistin. （1C）
Colistin-based combination therapy is controversial. （2D）
Novel β lactam/β lactamase inhibitors for the treatment of DTR-PA infection
Novel β lactam/β lactamase inhibitors including ceftazidine-avibatam, ceftolozane-tazobactam, and imipenem-cilastatin-rebactam may be considered for the treatment of DTR-PA infection. （2C）
Novel β lactam/β lactamase inhibitor antimicrobial susceptibility testing is recommended to guide the treatment of CRPA infection. （2D）
Carbapenem-resistant Enterobacter (CRE)
CRE-induced BSI
A polymyxin-based combination therapy regimen is recommended for the treatment of CRE-induced BSI. （2D）
Combination antimicrobial therapy should be based on the results of susceptibility tests. （2D）
Ceftazidine-avibatam 2.5 g IV q8h infusion time of more than 3 h is recommended for the treatment of CRE-BSI. （2D）
Meropenem-fabolbactam 4 g IV q8h infusion time of more than 3 h or imipenem-cilastatin-rebactam 1.25 g IV q6h is recommended for the treatment of CRE-BSI. （2C）
Complicated urinary tract infections (cUTI) caused by CRE
Ceftazidime-avibatam 2.5 g IV q8h is recommended for the treatment of cUTI caused by CRE. （2D）
Meropenem-fabolbraten 4 g IV q8h infusion time of more than 3 h or imipenem-cilastatin-rebactam 1.25 g IV q6h is recommended for the treatment of cUTI caused by CRE. （2C）
Prazomicin 15 mg/kg IV q12 h is recommended for the treatment of cUTI caused by CRE. （2D）
Single-dose aminoglycosides is recommended for patients with CRE-induced uncomplicated cystitis. （2D）
Single-dose aminoglycosides are recommended as an alternative for patients with CRES-induced cUTI. （2D）
CRE causes complex intra-abdominal infection (cIAI)
Ceftazidium-avibatam 2.5 g IV q8h combined with metronidazole is recommended for the treatment of cIAI caused by CRE. （2D）
Tigecycline loading dose of 100 mg IV, followed by 50 mg IV q12 h or escaling of yracycline 1 mg/kg for more than 60 min IV q12 h, is recommended for the treatment of CRE-induced cIAI. （2D）
Polymyxin-based combination therapy regimens are recommended for the treatment of CRE-induced cIAI, and combination antimicrobial therapy should be performed based on the results of susceptibility tests. （2D）
Vancomycin-resistant Enterococcus (VRE)
Linezolid 600 mg IV or PO/12 h is recommended for the treatment of enterococcal infection. The duration of treatment depends on the site of infection and the clinical response. （1C）
High-dose daptomycin 8-12 mg/kg IV once daily or in combination with β lactams (e.g., penicillin) or cephalosporins or carbapenems are recommended for the treatment of VRE bacteremia. （2C）
Tigecycline loading dose of 100 mg IV followed by 50 mg IV q12 h is recommended for the treatment of intra-abdominal infections caused by VRE. （2D）
A single dose of fosfomycin 3 g PO is recommended for the treatment of simple urinary tract infections caused by VRE. （2D）
Nitrofurantoin 100 mg/6 h PO is recommended for the treatment of isolated urinary tract infections caused by VRE. （2D）
High-dose ampicillin (18-30 g IV divided doses daily) or amoxicillin 500 mg IV or PO/8 h daily is recommended for the treatment of isolated urinary tract infections caused by VRE. （2D）
参考资料：Sy CL, Chen PY,et al. Recommendations and guidelines for the treatment of infections due to multidrug resistant organisms. J Microbiol Immunol Infect. 2022 Mar 16:S1684-1182(22)00025-1. doi: 10.1016/j.jmii.2022.02.001.
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