From the Research
Treatment for MDR, XDR, and PDR Gram-negative bacteria (GNB) should prioritize a multifaceted approach with targeted antimicrobial therapy, focusing on combination therapy for MDR and XDR infections, and potentially triple combination therapy for PDR infections, as supported by the most recent study 1. The approach to treating MDR, XDR, and PDR GNB infections involves:
- Combination therapy for MDR GNB infections, typically including a carbapenem (such as meropenem or imipenem) plus either polymyxins (such as colistin) or tigecycline, as recommended by recent studies 1, 2.
- For XDR infections, newer agents like ceftazidime-avibactam, ceftolozane-tazobactam, or meropenem-vaborbactam may be effective, depending on the specific resistance patterns, as suggested by studies 3, 4.
- PDR infections present the greatest challenge and may require triple combination therapy, potentially including high-dose polymyxins, fosfomycin, and another agent based on synergy testing, as indicated by recent research 2, 5. Key considerations in the treatment of these infections include:
- Source control through drainage of abscesses or removal of infected devices
- Antimicrobial stewardship
- Infection prevention measures
- Consultation with infectious disease specialists
- The importance of appropriate empiric therapy guided by local resistance patterns and subsequent de-escalation based on culture results, as emphasized by studies 1, 5.