Videos

Early collaboration with microbiology laboratories, reflex testing algorithms, and mechanism-based teaching help ensure that new antimicrobials reach the right patients and that resistance results are interpreted correctly.

Securing formulary access to novel gram-negative agents depends on local epidemiology, outcome data, and electronic order safeguards, communicated clearly to committees that often lack infectious diseases expertise.

Cefiderocol's first-line recommendation for Stenotrophomonas maltophilia rests on compelling preclinical data that historic agents lack, but sparse clinical evidence supports initial combination therapy in critically ill patients.

After distinguishing true infection from colonization, the updated guidance positions sulbactam-durlobactam combined with a carbapenem as the clearly preferred regimen for carbapenem-resistant Acinetobacter baumannii.

Because multiple overlapping mechanisms drive resistance in Pseudomonas aeruginosa, clinicians must test every relevant novel agent, with ceftolozane-tazobactam favored for difficult-to-treat resistant pneumonia.

Ceftazidime-avibactam and meropenem-vaborbactam remain reliable options for KPC producers, ceftazidime-avibactam is favored for OXA-48-like enzymes, and the US withdrawal of imipenem-relebactam narrows the available choices.

Cefepime-zidebactam pairs a familiar cephalosporin with a beta-lactam enhancer that targets a second penicillin-binding protein, producing encouraging preclinical activity against carbapenem-resistant organisms ahead of clinical availability.

Penicillin-binding protein 3 alterations in NDM-producing E. coli can compromise both aztreonam-avibactam and cefiderocol simultaneously, while tetracycline derivatives retain a narrow role in carefully selected scenarios.

In critically ill patients receiving continuous renal replacement therapy, aggressive early dosing guided by effluent rate and close pharmacist partnership helps protect drug exposure when MICs already approach the breakpoint.

Aztreonam-avibactam pairs a monobactam spared by NDM with an inhibitor of its companion enzymes, offering optimized pharmacodynamics and simpler administration, though NDM-specific clinical data remain limited.

NDM has diversified and disseminated faster than any prior carbapenemase through mobile genetic elements and distinctive enzyme properties, yet KPC persists, requiring clinicians to account for both in therapeutic planning.

Rapid molecular testing from positive blood cultures delivers actionable resistance data within hours, and knowing when each result arrives, and which are suppressed, shortens the time to effective therapy.

Empiric use of novel agents should follow patient-level risk and unit-level epidemiology, while a shared vocabulary for carbapenem-resistant Enterobacterales and their carbapenemases underpins every subsequent treatment decision.

Overall gram-negative resistance rates have plateaued, but the carbapenemases driving carbapenem resistance have shifted, with NDM expanding alongside KPC and reshaping treatment considerations across the Enterobacterales.

Los Angeles has been experiencing this challenging bacteria in recent years with the potential of it becoming carbapenem-resistant in the future. Shaun Yang, PhD, D(ABMM), FIDSA, MLS(ASCP), provides commentary about his team's work in this area and the role of genomic sequencing to uncover this troublesome pathogen.

Cefiderocol MICs fell against Pseudomonas aeruginosa and Klebsiella pneumoniae, and the drug showed marked synergy with LL-37 against resistant Acinetobacter baumannii. Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, discusses her team's findings around this therapy and these pathogens.

Shionogi data presented at IDWeek 2026 demonstrated a 76.7% clinical response with cefiderocol in carbapenem-resistant respiratory infections and high in vitro activity against resistant P aeruginosa VAP isolates. Christine Slover, PharmD, vice president, Infectious Diseases US Medical Affairs, Shionogi, offers insights on the data as well as clinical considerations for providers when weighing the antibiotic for patients.

In the sixth and final episode, the clinicians unpack the most debated change in the guidance, the move to cefiderocol monotherapy as the preferred option for invasive S maltophilia infections, and invite community feedback.

In part 5 of the series, the clinicians explain the shift toward sulbactam-durlobactam for invasive carbapenem-resistant Acinetobacter baumannii infections and how hospitals with low CRAB volume can still plan for access.

In the fourth episode of a 6-part series, the clinicians compare agents for DTR P aeruginosa and explain why local antibiogram data should guide empiric choices.

In the third episode, the clinicians compare aztreonam-avibactam with cefiderocol for NDM-producing Enterobacterales, weigh formulary needs against local epidemiology, and discuss stewardship planning for emerging agents.

In part 2 of a 6-part series, the clinicians explain why the 2026 guidance now organizes CRE treatment by carbapenemase type and why meropenem-vaborbactam earned a slight edge for KPC producers.

This is the first in a series of discussions between medical peers on the 2026 IDSA guidance for antimicrobial-resistant gram-negative infections, beginning with current clinical challenges and new options for ESBL- and AmpC-producing organisms.

Karen B. Jacobson, MD, MPH, of Kaiser Permanente Northern California, presented data at IDWeek 2026 showing 58.2% of children younger than five years exposed to active hepatitis B in the home were exposed by someone other than their birth mother, a risk maternal screening alone would miss under the CDC’s revised birth dose recommendation.

In the phase 3b ENCORE trial, adding amikacin liposome inhalation suspension (ALIS) to azithromycin and ethambutol significantly improved culture conversion in newly diagnosed MAC lung disease, while treatment-emergent amikacin (2.2%) and macrolide (1.1%) resistance stayed rare. Kevin Winthrop, MD, provides insights around the study.

Projected disease burden from declining childhood vaccine coverage shows increases in vaccine-preventable diseases. Benjamin Lopman, PhD, provides insights on how VaxImpactMap works and the potential long-term disease consequences of decreased immunization rates.

UTI guidelines are moving away from complicated or uncomplicated infections to localized or systemic classification terminologies. Guidelines author Zachary Nelson, PharmD, MPH, BCIDP, provides further insights on the changes including applying antibiograms, potential costs, and whether clinicians will embrace these new classifications.

Lori Handy, MD, provides guidance in these areas, including presentation before rash onset, when patients should be considered for the inpatient setting, and what treatment looks like.