Management of infections caused by WHO critical priority Gram-negative pathogens in Arab countries of the Middle East: a consensus paper
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Elsevier B.V.
Abstract
Antimicrobial resistance is an important global issue that impacts the efficacy of established antimicrobial therapy. This is true globally and within the Arab countries of the Middle East, where a range of key Gram-negative pathogens pose challenges to effective therapy. There is a need to establish effective treatment recommendations for this region given specific challenges to antimicrobial therapy, including variations in the availability of antimicrobials, infrastructure and specialist expertise. This consensus provides regional recommendations for the first-line treatment of hospitalized patients with serious infections caused by World Health Organization critical priority Gram-negative pathogens Acinetobacter baumannii and Pseudomonas aeruginosa resistant to carbapenems, and Enterobacteriaceae resistant to carbapenems and third-generation cephalosporins. A working group comprising experts in infectious disease across the region was assembled to review contemporary literature and provide additional consensus on the treatment of key pathogens. Detailed therapeutic recommendations are formulated for these pathogens with a focus on bacteraemia, nosocomial pneumonia, urinary tract infections, skin and soft tissue infections, and intra-abdominal infections. First-line treatment options are provided, along with alternative agents that may be used where variations in antimicrobial availability exist or where local preferences and resistance patterns should be considered. These recommendations take into consideration the diverse social and healthcare structures of the Arab countries of the Middle East, meeting a need that is not filled by international guidelines. There is a need for these recommendations to be updated continually to reflect changes in antimicrobial resistance in the region, as well as drug availability and emerging data from clinical trials. © 2020 The Authors
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Keywords
Acinetobacter spp, Enterobacteriaceae, Gram-negative bacterial infection, Multi-drug resistance, Pseudomonas spp, Acinetobacter baumannii, Anti-bacterial agents, Antimicrobial stewardship, Bacteremia, Carbapenem-resistant enterobacteriaceae, Consensus development conferences as topic, Cross infection, Drug resistance, multiple, bacterial, Gram-negative bacterial infections, Humans, Intraabdominal infections, Middle east, Pneumonia, bacterial, Pseudomonas aeruginosa, Soft tissue infections, Urinary tract infections, Amikacin, Aminoglycoside, Avibactam plus ceftazidime, Aztreonam, Carbapenem, Ceftolozane plus tazobactam, Ciprofloxacin, Colistin, Cotrimoxazole, Doripenem, Doxycycline, Ertapenem, Fosfomycin, Gentamicin, Imipenem, Levofloxacin, Meropenem, Minocycline, Piperacillin plus tazobactam, Plazomicin, Polymyxin b, Quinolone, Rifampicin, Sultamicillin, Tigecycline, Tobramycin, Antiinfective agent, Acinetobacter infection, Antibiotic therapy, Bacterium culture, Broth dilution, Drug megadose, Drug monitoring, Enterobacteriaceae infection, Genotyping technique, Hospital acquired pneumonia, Hospital patient, Human, Immunoaffinity chromatography, Loading drug dose, Monotherapy, Priority journal, Pseudomonas infection, Review, Skin and soft tissue infection, Skin infection, Soft tissue infection, Systematic review, Urinary tract infection, World health organization, Abdominal infection, Bacterial pneumonia, Consensus development, Drug effect, Gram negative infection, Microbiology, Multidrug resistance