Guiding empirical therapy through patient risk assessment

EP: 1.Pathogen prevalence, emerging threats, and regional resistance patterns

EP: 2.The role of rapid diagnostics and collaboration in antibiotic stewardship

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EP: 3.Guiding empirical therapy through patient risk assessment

EP: 4.Aligning treatment with risk factors, patient profiles, and MBL status

EP: 5.Approaches to challenging cases with limited therapies

EP: 6.Strategies for addressing MBL infections with targeted antibiotic combination therapy, and clinical insights from the REVISIT study

EP: 7.Evidence and trials informing treatment of resistant Gram-negative infections

EP: 8.Integration of susceptibility testing and local surveillance to inform antibiotic use

EP: 9.Challenges and opportunities in implementing new antibiotics with QIDP and Fast Track status

EP: 10.Guiding appropriate use of colistin and polymyxins

EP: 11.Optimizing formulary decisions and new drug approval through data and team collaboration

EP: 12.Approaches to equitable and responsible antibiotic management

In this segment, the discussion turns to practical strategies for selecting empiric antibiotic therapy amid growing multidrug resistance. The panel emphasizes that treatment decisions must balance clinical urgency with responsible antibiotic use. Clinicians are advised to first confirm whether a patient is truly infected or merely colonized, as unnecessary antibiotic use accelerates resistance. Patient history, such as recent hospitalizations, intensive care unit (ICU) stays, or exposure to long-term care facilities, also guides whether broad-spectrum agents are necessary. Local resistance patterns and antibiograms remain central tools for selecting empiric therapy, particularly when targeting organisms like Escherichia coli, Klebsiella, or Pseudomonas.

The group acknowledges that in high-prevalence areas or in patients with known risk factors, standard empiric regimens like cefepime or meropenem may not provide sufficient coverage. In such cases, newer agents like ceftazidime-avibactam or cefiderocol may be considered empirically, though typically only in critically ill patients with strong indicators for resistant organisms. Rapid diagnostics and historical cultures are key to determining when to escalate empirically. However, there is consensus that these newer agents should not be used broadly for all patients, due to concerns over resistance development, cost, and limited access.

Institutions have taken a cautious approach to integrating these new antibiotics, often restricting their use through stewardship programs. At facilities like Johns Hopkins, advanced resistance screening—including rectal swabs for ICU and immunocompromised patients—helps identify colonized individuals who may benefit from more aggressive empiric therapy. Patients from regions with high resistance prevalence, such as South Asia or the Middle East, are also screened on admission. Ultimately, the panel agrees that the complexity of resistance mechanisms demands oversight from trained stewardship teams to ensure that novel agents are used appropriately and preserved for future effectiveness.