The following is a summary of “Place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference,” published in the July 2023 issue of Critical Care by Dequin et al.

Novel beta-lactams (NBs), with or without beta-lactamase inhibitors (BIs), combat carbapenemase-producing Enterobacteriaceae and nonfermenting carbapenem-resistant bacteria. Researchers performed a retrospective study, highlighting the necessity of guidelines due to the risk of resistance emergence to these NBs/BIs.

They formed an ad hoc committee, having no conflict of interest (CoI) with the subject, identified distinct molecules (ceftolozane–tazobactam, ceftazidime–avibactam, imipenem–cilastatin–relebactam, meropenem–vaborbactam, and cefiderocol) and framed 6 fundamental queries. The committee formed sub-questions based on population, intervention, comparison, and outcomes (PICO), assessed literature with keywords, and GRADE methodology. Seven experts responded publicly, including a non-conflicted panel of 10 critical-care physicians and the public. The board worked independently for 48 hours to draft recommendations. Due to a lack of solid studies using clinically significant criteria, recommendations were often based on expert opinions.

The results showed the jury responded to 6 questions with 17 statements. These questions encompassed ICU suitability for probabilistic use of NBs/IBs against Gram-negative bacteria as prioritization factors in documented infections with sensitivities to several molecules, combinatorial possibilities and contexts for these molecules, integration of new molecules into carbapenem-sparing strategies, optimization of administration for critically ill patients using pharmacokinetic and pharmacodynamic data, and dosage adaptations in cases of renal or hepatocellular insufficiency, and obesity.

 They concluded that these recommendations maximize the utilization of NBs/BIs among ICU patients.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01155-4