![]() This guidance, with infection control to arrest increases in MDR, should be used to improve the outcome of infections with such strains. The diagnosis and treatment of both presumptive and confirmed cases of infection by GNB should be improved. Local and national surveillance of antibiotic use, resistance and outcomes should be supported and antibiotic prescribing guidelines should be informed by these data. Antimicrobial stewardship programmes should be instituted in all care settings, based on resistance rates and audit of compliance with guidelines, but should be augmented by improved surveillance of outcome in Gram-negative bacteraemia, and feedback to prescribers. Broth microdilution methods should be adopted for colistin susceptibility testing. Meropenem- or imipenem-resistant Enterobacteriaceae should have their carbapenem MICs tested urgently, and any carbapenemase class should be identified: mandatory reporting of these isolates from all anatomical sites and specimens would improve risk assessments. Susceptibility testing of MDR GNB causing infection to guide treatment needs critical enhancements. We found there are very few good-quality comparative randomized clinical trials to support treatment regimens, particularly for licensed older agents. The clinical efficacy of different agents is critically reviewed. The guidance includes recommendations for stakeholders (including prescribers) and antibiotic-specific recommendations. ![]() Published guidelines were used as part of the evidence base and to support expert consensus. Methods for systematic review were NICE compliant and in accordance with the SIGN 50 Handbook critical appraisal was applied using AGREE II. ![]() The guidance has been derived from current peer-reviewed publications and expert opinion with open consultation. The treatment options available in hospitals using intravenous antibiotics and in primary care using oral agents have been reviewed, ending with a consideration of antibiotic stewardship and recommendations. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed. We give a new definition of multiresistance. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection.
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