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Diagnosis and management of infections caused by multidrug-resistant bacteria: guideline endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI) and the Italian Society of Microbiology (SIM)

医学 观察研究 重症监护医学 抗菌管理 鲍曼不动杆菌 指南 抗生素 抗生素耐药性 内科学 铜绿假单胞菌 微生物学 病理 生物 遗传学 细菌
作者
Giusy Tiseo,Gioconda Brigante,Daniele Roberto Giacobbe,Alberto Enrico Maraolo,Floriana Gona,Marco Falcone,Maddalena Giannella,Paolo Grossi,Federico Pea,Gian María Rossolini,Maurizio Sanguinetti,Mario Sarti,Claudio Scarparo,Mario Tumbarello,Mario Venditti,Pierluigi Viale,Matteo Bassetti,Francesco Luzzaro,Francesco Menichetti,Stefania Stefani,M. Tinelli
出处
期刊:International Journal of Antimicrobial Agents [Elsevier]
卷期号:60 (2): 106611-106611 被引量:52
标识
DOI:10.1016/j.ijantimicag.2022.106611
摘要

Management of patients with infections caused by multidrug-resistant organisms is challenging and requires a multidisciplinary approach to achieve successful clinical outcomes. The aim of this paper is to provide recommendations for the diagnosis and optimal management of these infections, with a focus on targeted antibiotic therapy. The document was produced by a panel of experts nominated by the five endorsing Italian societies, namely the Italian Association of Clinical Microbiologists (AMCLI), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Society of Microbiology (SIM), the Italian Society of Infectious and Tropical Diseases (SIMIT) and the Italian Society of Anti-Infective Therapy (SITA). Population, Intervention, Comparison and Outcomes (PICO) questions about microbiological diagnosis, pharmacological strategies and targeted antibiotic therapy were addressed for the following pathogens: carbapenem-resistant Enterobacterales; carbapenem-resistant Pseudomonas aeruginosa; carbapenem-resistant Acinetobacter baumannii; and methicillin-resistant Staphylococcus aureus. A systematic review of the literature published from January 2011 to November 2020 was guided by the PICO strategy. As data from randomised controlled trials (RCTs) were expected to be limited, observational studies were also reviewed. The certainty of evidence was classified using the GRADE approach. Recommendations were classified as strong or conditional. Detailed recommendations were formulated for each pathogen. The majority of available RCTs have serious risk of bias, and many observational studies have several limitations, including small sample size, retrospective design and presence of confounders. Thus, some recommendations are based on low or very-low certainty of evidence. Importantly, these recommendations should be continually updated to reflect emerging evidence from clinical studies and real-world experience.
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