New Treatment Guidelines for Antibiotic Resistant Infections | IDSA Update

The Infectious Diseases Society of America (IDSA) has released timely recommendations on treating some of the most common pathogens in global health.

New guidance from the IDSA comes as, amid the COVID-19 pandemic, some are rushing to "just in case" antibiotic prescribing.

Antibiotics are an important tool, but pathogens can evolve to resist a drug’s intended effect. Inappropriate prescribing of antibiotics has led to what is called antimicrobial resistance (AMR), and experts claim the COVID-19 pandemic could make it much worse.

In the United States alone, AMR pathogens caused more than 2.8 million infections and 35,000 deaths each year from 2012-2017, according to the Centers for Disease Control and Prevention.

The guidance was created by a panel of six infectious diseases specialists with clinical and research expertise in the treatment of AMR bacterial infections.

There will be further guidance in the series, but the first guidance addresses 3 groups of Gram-negative bacteria that pose particular challenges and have been designated as serious threats:

• 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 by nature. Updates to the guidance document will occur through an iterative review process based on any new evidence.

The panel will also expand recommendations to highlight 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, MD, 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.”

These guidelines are intentionally not comprehensive. Experts have pointed out that rapidly evolving topics like AMR can be difficult to create comprehensive guidelines around, given change in the field takes place during deliberation.

"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," the authors wrote.

“Clinicians will find this to be an easy-to-use resource,” said Pranita Tamma, MD, 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.”

COVID-19 and AMR: Dual Pandemics

“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,” said Dr. Clancy.

During the COVID-19 pandemic, patients who are hospitalized after contracting the coronavirus can become further sickened at the hospital with infections that are difficult to treat without antibiotics.

COVID-19 patients are often given a broad spectrum of antibiotics when they enter a hospital, which changes their microbiomes — and could create more problems than are solved by the broad blast of antibiotics.

“More and more, as we get through this pandemic, we’re going to see AMR raise its ugly head,” remarked Thomas M. File, Jr., MD, 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.”