RT Journal Article T1 European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine). A1 Paul, Mical A1 Carrara, Elena A1 Retamar, Pilar A1 Tängdén, Thomas A1 Bitterman, Roni A1 Bonomo, Robert A A1 de Waele, Jan A1 Daikos, George L A1 Akova, Murat A1 Harbarth, Stephan A1 Pulcini, Celine A1 Garnacho-Montero, José A1 Seme, Katja A1 Tumbarello, Mario A1 Lindemann, Paul Christoffer A1 Gandra, Sumanth A1 Yu, Yunsong A1 Bassetti, Matteo A1 Mouton, Johan W A1 Tacconelli, Evelina A1 Rodríguez-Baño, Jesús K1 Acinetobacter baumannii K1 Carbapenem-resistant bacteria K1 ESCMID K1 GRADE K1 Multidrug resistant bacteria AB These ESCMID guidelines address the targeted antibiotic treatment of third-generation cephalosporin-resistant Enterobacterales (3GCephRE) and carbapenem-resistant Gram-negative bacteria, focusing on the effectiveness of individual antibiotics and on combination versus monotherapy. An expert panel was convened by ESCMID. A systematic review was performed including randomized controlled trials and observational studies, examining different antibiotic treatment regimens for the targeted treatment of infections caused by the 3GCephRE, carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii. Treatments were classified as head-to-head comparisons between individual antibiotics and between monotherapy and combination therapy regimens, including defined monotherapy and combination regimens only. The primary outcome was all-cause mortality, preferably at 30 days and secondary outcomes included clinical failure, microbiological failure, development of resistance, relapse/recurrence, adverse events and length of hospital stay. The last search of all databases was conducted in December 2019, followed by a focused search for relevant studies up until ECCMID 2021. Data were summarized narratively. The certainty of the evidence for each comparison between antibiotics and between monotherapy and combination therapy regimens was classified by the GRADE recommendations. The strength of the recommendations for or against treatments was classified as strong or conditional (weak). The guideline panel reviewed the evidence per pathogen, preferably per site of infection, critically appraising the existing studies. Many of the comparisons were addressed in small observational studies at high risk of bias only. Notably, there was very little evidence on the effects of the new, recently approved, β-lactam/β-lactamase inhibitors on infections caused by carbapenem-resistant Gram-negative bacteria. Most recommendations are based on very-low- and low-certainty evidence. A high value was placed on antibiotic stewardship considerations in all recommendations, searching for carbapenem-sparing options for 3GCephRE and limiting the recommendations of the new antibiotics for severe infections, as defined by the sepsis-3 criteria. Research needs are addressed. YR 2021 FD 2021-12-16 LK http://hdl.handle.net/10668/22122 UL http://hdl.handle.net/10668/22122 LA en DS RISalud RD Apr 10, 2025