Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli |
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| Institution: | 1. Department of Infectious Diseases, Children''s Hospital of Fudan University, National Children''s Medical Center, Shanghai 200032, China;2. The Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Ningbo, China;3. Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK;4. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China;5. Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China;6. Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;7. Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People''s Republic of China, Shanghai 200040, China;8. Department of Infectious Diseases, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;9. Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China;10. Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China;11. Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;12. Department of Infectious Diseases, Tianjin First Center Hospital, Tianjin 300192, China;13. Department and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China;14. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;15. Department of Pharmacy, The Third Hospital of Changsha, Changsha 410015, China;p. Pharmaceutical Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;q. Department of Critical Care Medicine,State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;r. Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China;s. Divison of Infectious Diseases, The First Hospital of China Medical University, Shenyang 110001, China;t. Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China;u. Infection Control Center, Xiangya Hospital, Central South University, Changsha 410008, China;v. Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China;w. Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China;x. Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China;y. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People''s Hospital, Beijing 100044, China;z. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;11. Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China |
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| Abstract: | The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases. |
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| Keywords: | Carbapenem-resistant gram-negative bacillus Antimicrobial susceptibility testing Antimicrobial therapy Infection control |
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