Transplant Infectious Disease

🦠💊 IDSA 2026: Antimicrobial-resistant Gram-negative infections—high-yield pearls for hematology & HSCT! 🧬 Identify the resistance mechanism + confirm susceptibility: “CRE” alone does not identify the optimal antibiotic. 1️⃣ Invasive ESBL infections 💊 Carbapenems preferred. 🚨 In critical illness/hypoalbuminemia, favor meropenem or imipenem–cilastatin over ertapenem. 2️⃣ Inducible AmpC 🦠 Enterobacter cloacae complex, Klebsiella aerogenes & Citrobacter freundii. ✅ Cefepime is suggested. ⚠️ Avoid ceftriaxone for invasive infections due to resistance emergence. 3️⃣ KPC-producing Enterobacterales ✅ Meropenem–vaborbactam, ceftazidime–avibactam or imipenem–relebactam. 📌 Panel slightly favors meropenem–vaborbactam. 4️⃣ NDM-producing Enterobacterales ✅ Aztreonam–avibactam OR cefiderocol. 🔄 If aztreonam–avibactam unavailable: ceftazidime–avibactam + aztreonam. 🚫 Ceftazidime–avibactam alone does not cover NDM! 5️⃣ OXA-48-like Enterobacterales ✅ Ceftazidime–avibactam preferred. 6️⃣ Difficult-to-treat Pseudomonas ✅ Ceftolozane–tazobactam, ceftazidime–avibactam or imipenem–relebactam for infections outside the urinary tract. 🫁 Ceftolozane–tazobactam favored for pneumonia. 7️⃣ Carbapenem-resistant Acinetobacter ✅ Sulbactam–durlobactam + imipenem or meropenem preferred for invasive infection. 8️⃣ Invasive Stenotrophomonas—key pearl! ✅ Cefiderocol monotherapy is preferred in this document. 🔬 Preference rests largely on neutropenic animal models; clinical outcome evidence remains limited. 🔄 TMP–SMX, levofloxacin or minocycline: alternatives as components of combination therapy. 🚫 Ceftazidime is not suggested. 🩸 Hematology takeaways 🔍 Distinguish colonization from infection. 📋 Review prior cultures, recent antibiotics & local resistance patterns. 🎯 Optimize source control, renal dosing & infusion strategy. ⏳ Resistance alone does not mandate longer treatment; consider immune status, source control & response. 📚 US-focused expert guidance; evidence current to 1 March 2026. 🔗 doi.org/10.1093/cid/ciag481