New guidance issued by the IDSA presents suggestions for treating AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia infections. Pranita D. Tamma, MD, and colleagues formulated questions about treatment; answers assumed that the causative organism has been identified and results of antibiotic susceptibility were known. The authors note that empiric treatment decisions should be guided by the most likely pathogen, illness severity, and likely source of infection and refined based on the identity and susceptibility profile of the pathogen and identification of any prominent β-lactamase genes. A distinction between bacterial colonization and infection is important for CRAB and S. maltophilia, as commonly used empiric antibiotic regimens are typically not active against CRAB and S. maltophilia infections. Clinicians are advised that prolonged treatment courses are not necessarily required for antimicrobial-resistant pathogens compared with infections caused by the same species. Host factors related to immune status, ability to attain source control, and general response to therapy should be considered when ascertaining treatment duration.

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