New evidence for managing Gram-negative bloodstream infections

Amir Nutman, Chaitanya Tellapragada, Christian G. Giske, Dafna Yahav*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE of reviewGram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI.Recent findingsNew rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened (≤7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined.SummaryRDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.

Original languageEnglish
Pages (from-to)599-610
Number of pages12
JournalCurrent Opinion in Infectious Diseases
Volume34
Issue number6
DOIs
StatePublished - 1 Dec 2021

Keywords

  • Gram-negative bacteremia
  • antibiotic stewardship
  • follow-up blood cultures
  • oral step-down
  • rapid diagnostic tests

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