Aligning treatment with risk factors, patient profiles, and MBL status
Panelists discuss the critical need for a coordinated, multidisciplinary approach to managing infections caused by metallo-β-lactamase (MBL)–producing organisms, emphasizing early identification, containment, careful selection of limited therapeutic options, and stewardship-guided use of novel agents to preserve their long-term effectiveness.
When dealing with rising antimicrobial resistance, particularly the emergence of MBLs, a structured and coordinated response is critical. The identification of an MBL-producing organism should immediately trigger collaboration between microbiology, infection prevention, and clinical teams. Initial steps include confirming whether the patient has a true infection vs colonization and implementing strict containment protocols to limit the spread to other patients or hospital units. This level of resistance often means that standard empiric therapies are no longer effective, requiring more specialized interventions.
The type of MBL identified—such as New Delhi metallo-β-lactamases or other variants—can significantly influence treatment decisions. Unlike more common carbapenem-resistant organisms, MBL producers are susceptible to far fewer agents. Therapeutic options are limited and may include specific newer combinations, sometimes in dual-drug regimens, based on the resistance mechanism involved. Due to the complexity of matching drugs to resistance patterns, decision support tools like antimicrobial “stoplight” charts and susceptibility testing become vital. Even newer agents may face emerging resistance, so confirmation of activity through lab testing is essential before committing to a treatment course.
In critically ill or immunocompromised patients, especially those with recent broad-spectrum antibiotic exposure or prolonged hospitalizations, the threshold to escalate empiric therapy may be lower. However, the decision to use a novel agent still hinges primarily on risk factors such as prior culture data, regional resistance patterns, and exposure history rather than illness severity alone. This helps ensure the careful stewardship of last-line antibiotics, balancing the need for immediate effective therapy with the long-term goal of preserving these agents’ usefulness. Even in high-risk populations, empiric use of newer drugs is typically reserved for situations where there is strong evidence or history suggesting standard therapies will fail.
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