From: Mechanisms of antimicrobial resistance in Gram-negative bacilli
1. | Carboxy- and ureido-penicillins should be preferred to 3GC to treat wild-type inducible AmpC-producing Enterobacteriaceae (notably Enterobacter sp.) |
2. | The use of cefepime could be considered as a carbapenem-sparing option in infections due AmpC-hyperproducing Enterobacteriaceae |
3. | Carbapenems are the first-line choice for severe ESBL-PE infections |
4. | The efficacy of BLBLI associations has not been adequately investigated in critically ill patients with ESBL-PE infections: piperacillin–tazobactam might be discussed as a carbapenem-sparing regimen for strains with low MICs (≤2 mg/L), using optimized administration (high doses, extended or continuous infusion, therapeutic drug monitoring) and provided that the source of infection is controlled |
5. | In Pseudomonas aeruginosa, the rate of resistance emergence under therapy is notably high with imipenem, which should be used only when other beta-lactams are inactive |
6. | The empirical use of colistin may be considered in ICU with high prevalence of carbapenemase-producing GNB |
7. | Colistin resistance may emerge in carbapenem-resistant GNB after exposure to this drug |
8. | Whether combination therapy prevents the emergence of resistance in non-fermenting GNB is not proven |
9. | In spite of a strong rational, the ecological benefit of de-escalation remains to be confirmed in adequate prospective studies |
10. | The long-term ecological impact of SOD/SDD must be assessed in ICUs with high prevalence of multidrug-resistant GNB |