Table 3 The European Society of Clinical Microbiology and Infectious Disease (ESCMID) stated the new targeted therapy guidelines
Pathogen | Targeted therapy — critical illness | Targeted therapy — noncritical illness | Not recommended antimicrobial |
|---|---|---|---|
3rd-generation cephalosporin-resistant Enterobacteriaceae | Bacteremia and complicated infections: Carbapenems (e.g., imipenem o meropenem) Bacteremia in the absence of septic shock: ertapenem Conditional recommendation, moderate quality of evidence | Piperacillin-tazobactam, amoxicillin/clavulanic acid or quinolones Conditional recommendation, moderate quality of evidence | Tigecycline, cephamycin, cefepime Strong recommendation or conditional recommendation against using, low quality of evidence |
Carbapenem-resistant Enterobacterales (CRE) | Meropenem-vaborbactam or ceftazidime-avibactam Conditional recommendation, moderate and low quality of evidence (respectively) | Individualized (on patient and on infection site) old-generation antimicrobial Aminoglycosides if UTI Conditional recommendation, low quality of evidence | Tigecycline if BSI, HAP/VAP Conditional recommendation against using, low quality of evidence |
Metallo-β-lactamase (MBL)-producing carbapenem-resistant Enterobacterales or resistant to any other antimicrobial | Monotherapy: cefiderocol conditional recommendation, weak quality of evidence Combined therapy: ceftazidime-avibactam + aztreonam Conditional recommendation, moderate quality of evidence | Old-generation antimicrobials, according to GCP |  |
Carbapenem-resistant P. aeruginosa | Ceftolozane-tazobactam if in vitro efficacy Conditional recommendation, very low quality of evidence | Individualized (on patient and on infection site) old-generation antimicrobial | Â |
Carbapenem-resistant A. baumannii | Ampicillin-sulbactam If efficacy in vitro tested in HAP/VAP Conditional recommendation, very low quality of evidence  If non-susceptible to sulbactam: polymyxin or high-dose tigecycline (if with in vitro activity) If critical infection: antimicrobial combination with in vitro tested activity (colistin, aminoglycoside, tigecycline, sulbactam) is suggested Conditional recommendation, very low quality of evidence |  | Combination colistin + meropenem and combination colistin + rifampicin Strong recommendation against using, moderate/high quality of evidence Cefiderocol Conditional recommendation against using, low quality of evidence |