{"id":17075,"date":"2026-09-09T10:37:57","date_gmt":"2026-09-09T03:37:57","guid":{"rendered":"https:\/\/vinphaco.net\/?p=17075"},"modified":"2026-09-09T10:42:25","modified_gmt":"2026-09-09T03:42:25","slug":"treatment-strategies-for-drug-resistant-gram-negative-infections-updates-from-the-2026-idsa-guidance","status":"publish","type":"post","link":"https:\/\/vinphaco.net\/fr\/treatment-strategies-for-drug-resistant-gram-negative-infections-updates-from-the-2026-idsa-guidance\/","title":{"rendered":"Treatment Strategies for Drug-Resistant Gram-Negative Infections: Updates from the 2026 IDSA Guidance"},"content":{"rendered":"

Against the backdrop of antimicrobial resistance (AMR) emerging as a global health crisis, with projections suggesting that it could cause up to 10 million deaths annually by 2050, updating evidence-based treatment regimens has become a critical task for healthcare professionals. In response to this need, the Infectious Diseases Society of America (IDSA)<\/strong> has published the 2026 update to its Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections<\/strong>, replacing previous versions.<\/p>\n

This article provides an in-depth review of antibiotic selection recommendations for six key groups of drug-resistant Gram-negative bacteria, emphasizing the need to individualize treatment based on bacterial identification and the specific underlying resistance mechanism.<\/p>\n

    \n
  1. Extended-Spectrum \u03b2-Lactamase-Producing Enterobacterales (ESBL-E)<\/strong><\/li>\n<\/ol>\n

    ESBL-E are bacteria that inactivate most penicillins, cephalosporins, and aztreonam.<\/p>\n

      \n
    • Urinary tract infections (UTIs):<\/strong> For uncomplicated urinary tract infections (uUTIs), preferred options include nitrofurantoin and TMP-SMX<\/strong>. Single-dose aminoglycosides (amikacin, gentamicin, tobramycin, or plazomicin)<\/strong> are also recommended because of the extremely high concentrations these agents achieve in the urine.<\/li>\n
    • Invasive infections:<\/strong> Carbapenems<\/strong> (meropenem, imipenem, or ertapenem) remain the first-line treatment for infections outside the urinary tract. However, in critically ill patients or those with hypoalbuminemia (<2.5 g\/dL), meropenem or imipenem<\/strong> is preferred over ertapenem because of concerns regarding altered pharmacokinetics of highly protein-bound drugs.<\/li>\n
    • Important note on piperacillin-tazobactam:<\/strong> The 2026 IDSA Guidance recommends avoiding this agent for invasive ESBL-E infections even when antimicrobial susceptibility testing (AST) indicates susceptibility. This recommendation is based on clinical trial data showing higher mortality compared with carbapenems.<\/li>\n<\/ul>\n
        \n
      1. AmpC \u03b2-Lactamase-Producing Enterobacterales (AmpC-E)<\/strong><\/li>\n<\/ol>\n

        The recommendations focus on species at moderate risk of inducible AmpC production, including E. cloacae<\/em>, K. aerogenes<\/em>, and C. freundii<\/em>.<\/p>\n

          \n
        • Preferred strategy:<\/strong> Cefepime<\/strong> is the preferred antibiotic when the MIC is \u22648 \u00b5g\/mL because of its stability against AmpC-mediated hydrolysis.<\/li>\n
        • Avoid ceftriaxone:<\/strong> Ceftriaxone (as well as cefotaxime and ceftazidime) should be avoided for invasive infections caused by these species because of the risk of resistance emerging during therapy (approximately 20%).<\/li>\n<\/ul>\n
            \n
          1. Carbapenem-Resistant Enterobacterales (CRE)<\/strong><\/li>\n<\/ol>\n

            Treatment of CRE depends largely on the specific carbapenemase mechanism involved:<\/p>\n

              \n
            • KPC-producing CRE:<\/strong> Newer agents such as ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam<\/strong> are preferred options. Among these, meropenem-vaborbactam is slightly favored because available data indicate a lower rate of emergence of resistance during treatment (<3%) compared with ceftazidime-avibactam (approximately 10%).<\/li>\n
            • MBL-producing CRE (e.g., NDM):<\/strong> Aztreonam-avibactam and cefiderocol<\/strong> are the two preferred first-line options. If aztreonam-avibactam is unavailable, ceftazidime-avibactam plus aztreonam<\/strong> may be used in combination.<\/li>\n
            • OXA-48-like-producing CRE:<\/strong> Ceftazidime-avibactam<\/strong> is preferred because avibactam has potent inhibitory activity against OXA-48, whereas vaborbactam and relebactam do not.<\/li>\n<\/ul>\n
                \n
              1. Difficult-to-Treat Resistant Pseudomonas aeruginosa<\/em> (DTR P. aeruginosa<\/em>)<\/strong><\/li>\n<\/ol>\n

                This group includes strains that are nonsusceptible to traditional antibiotics, including carbapenems and piperacillin-tazobactam.<\/p>\n

                  \n
                • First-line options:<\/strong> Ceftolozane-tazobactam, ceftazidime-avibactam, and imipenem-relebactam<\/strong> are preferred options for infections outside the urinary tract.<\/li>\n
                • Preferred option for pneumonia:<\/strong> Ceftolozane-tazobactam<\/strong> is favored by IDSA experts for the treatment of pneumonia caused by DTR P. aeruginosa<\/em> because of its favorable penetration into the epithelial lining fluid of the lungs (50% compared with 30% for the other agents).<\/li>\n
                • MBL mechanism:<\/strong> For MBL-producing strains (VIM, IMP, or NDM), cefiderocol<\/strong> is the only preferred antibiotic with demonstrated efficacy.<\/li>\n<\/ul>\n
                    \n
                  1. Carbapenem-Resistant Acinetobacter baumannii<\/em> (CRAB)<\/strong><\/li>\n<\/ol>\n

                    CRAB is one of the most challenging pathogens to treat because of its diverse resistance mechanisms.<\/p>\n

                      \n
                    • Preferred regimen:<\/strong> A combination of sulbactam-durlobactam and a carbapenem<\/strong> (imipenem or meropenem). Durlobactam protects sulbactam from hydrolysis, allowing sulbactam to target PBP1 and PBP3, while the carbapenem provides additional activity through binding to PBP2.<\/li>\n
                    • Alternative options:<\/strong> If sulbactam-durlobactam is unavailable, combination therapy with agents such as cefiderocol, minocycline, or polymyxin B<\/strong> may be considered.<\/li>\n<\/ul>\n
                        \n
                      1. Stenotrophomonas maltophilia<\/em><\/strong><\/li>\n<\/ol>\n
                          \n
                        • Preferred option:<\/strong> Cefiderocol monotherapy<\/strong> is the preferred option based on animal-model data demonstrating superior bactericidal activity and nearly 100% in vitro susceptibility.<\/li>\n
                        • Alternative options:<\/strong> Combination antibiotic therapy (such as aztreonam-avibactam, levofloxacin, minocycline, or TMP-SMX<\/strong>) is recommended until the patient’s clinical condition stabilizes.<\/li>\n<\/ul>\n

                          Appropriate Use of Antibiotics<\/strong><\/p>\n

                          Summary Table of Preferred Antibiotic Options for Invasive Infections<\/strong><\/p>\n

                          The following table summarizes common drug-resistant pathogens and the antibiotics recommended by the 2026 IDSA Guidance (applicable to patients with normal renal and hepatic function).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
                          Pathogen<\/strong><\/td>\nPreferred Antibiotics<\/strong><\/td>\nAlternative Antibiotics<\/strong><\/td>\n<\/tr>\n<\/thead>\n
                          ESBL-E (Invasive)<\/strong><\/td>\nCarbapenems (meropenem, imipenem, ertapenem)<\/td>\nCefepime-enmetazobactam<\/td>\n<\/tr>\n
                          AmpC-E (Invasive)<\/strong><\/td>\nCefepime (if MIC \u22648 \u00b5g\/mL)<\/td>\nCarbapenems<\/td>\n<\/tr>\n
                          CRE (KPC)<\/strong><\/td>\nCeftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam<\/td>\nAztreonam-avibactam, cefiderocol<\/td>\n<\/tr>\n
                          CRE (NDM\/MBL)<\/strong><\/td>\nAztreonam-avibactam, cefiderocol<\/td>\nCeftazidime-avibactam + aztreonam<\/td>\n<\/tr>\n
                          DTR P. aeruginosa<\/em><\/strong><\/td>\nCeftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam<\/td>\nCefiderocol<\/td>\n<\/tr>\n
                          CRAB (Invasive)<\/strong><\/td>\nSulbactam-durlobactam + carbapenem<\/td>\nCefiderocol, minocycline, polymyxin B (in combination)<\/td>\n<\/tr>\n
                          S. maltophilia<\/em><\/strong><\/td>\nCefiderocol<\/td>\nAztreonam-avibactam, levofloxacin<\/strong>, minocycline, TMP-SMX (in combination)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                          Conclusion<\/strong><\/p>\n

                          The 2026 IDSA Guidance emphasizes that antimicrobial resistance is a rapidly evolving field. Antibiotic selection should be based not only on pathogen identification but also on drug penetration at the site of infection and the patient’s safety profile.<\/p>\n

                          Note:<\/strong> This guidance reflects the available evidence and expert consensus as of March 1, 2026<\/strong>. Clinicians should consult specific dosing recommendations and contraindications based on each patient’s individual clinical condition.<\/p>\n

                          As a leading pharmaceutical supply partner, we are proud to provide products containing active ingredients included among the antibiotics recommended by IDSA, such as aminoglycosides (amikacin, tobramycin, and netilmicin) and levofloxacin<\/strong>, supporting healthcare professionals in the global fight against multidrug-resistant pathogens.<\/p>\n

                          References<\/strong><\/p>\n

                          Tamma PD, Bonomo RA, Heil EL, Justo JA, Satlin MJ, Mathers AJ. Infectious Diseases Society of America 2026 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clinical Infectious Diseases<\/em>. Published online August 8, 2026. doi:10.1093\/cid\/ciag481.<\/p>\n","protected":false},"excerpt":{"rendered":"

                          Against the backdrop of antimicrobial resistance (AMR) emerging as a global health crisis, with projections suggesting that it could cause up to 10 million deaths annually by 2050, updating evidence-based treatment regimens has become a critical task for healthcare professionals. In response to this need, the Infectious Diseases Society of America (IDSA) has published the…<\/p>\n","protected":false},"author":5,"featured_media":17076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[294],"tags":[],"class_list":["post-17075","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-informations-medicales"],"acf":[],"_links":{"self":[{"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/posts\/17075","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/comments?post=17075"}],"version-history":[{"count":2,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/posts\/17075\/revisions"}],"predecessor-version":[{"id":17085,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/posts\/17075\/revisions\/17085"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/media\/17076"}],"wp:attachment":[{"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/media?parent=17075"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/categories?post=17075"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vinphaco.net\/fr\/wp-json\/wp\/v2\/tags?post=17075"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}