[Consensus on the diagnosis and treatment of carbapenemase-producing enterobacterial infections].

Abstract

The Ministry of Health of the Province of Buenos Aires is committed to address the growing problem of antimicrobial resistance. For this reason, the Program for Healthcare-Associated Infections and Antimicrobial Resistance (HCAI/AMR) has developed these diagnostic and treatment recommendations for Carbapenem-Resistant Enterobacteriaceae (CRE), considering the availability of antibiotics, the available scientific evidence and the cost of these supplies. Along the document the diagnostic processes of the different mechanisms of resistance of CRE are explained, and the key points for preparing a cumulative sensitivity report of prevalent pathogens in the different hospitals are detailed, a previously unregistered document in our environment. Novel B-lactam/B-lactamase inhibitors (BL/BLI) are recommended for initial empirical therapy in patients with septic shock and certain epidemiological conditions of each institution, with central venous catheters or endovascular devices-associated bacteremias, endocarditis, mediastinitis, intra-abdominal infections, and post-neurosurgical infections; and regardless of the source of infection in both neonates and immunocompromised hosts. BL/BLI is recommended as directed therapy for confirmed microbiological CRE infections for: septic shock, bacteremia/infections with any focus and INCREMENT score = 8, bacteremia in severely immunocompromised or neonatal patients, endocarditis/non-removed endovascular focus (implant), mediastinitis, and post-neurosurgical CNS infection. These recommendations should be complemented by the implementation of Antimicrobial Stewardship Programs and intensified surveillance in critical areas according to the guidelines of the National Program for Healthcare-Associated Infection Control.

Desde el Ministerio de Salud de la Provincia de Buenos Aires se propone dar solución a la creciente problemática de la resistencia antimicrobiana. Por esto, el Programa de Infecciones Asociadas al Cuidado de la Salud (IACS) y Resistencia Antimicrobiana ha confeccionado el presente consenso de diagnóstico y tratamiento de enterobacterias productoras de carbapenemasas (EPC), teniendo en cuenta la disponibilidad de antibióticos, el costo de estos insumos y la evidencia científica disponible. En el documento se explica el proceso de diagnóstico de los distintos mecanismos de resistencia de las EPC y se detallan los puntos clave para realizar un informe acumulado de sensibilidad de patógenos prevalentes en los distintos hospitales, información local no registrada adecuadamente hasta el momento. Adicionalmente, se recomiendan nuevos betalactámicos con inhibidores de betalactamasas (BL/IBL) para el tratamiento empírico inicial en pacientes con shock séptico en presencia de: determinadas condiciones epidemiológicas y focos asociados como bacteriemia asociada a catéter venoso central o dispositivos endovasculares, endocarditis, mediastinitis, foco intraabdominal, infecciones postneuroquirúrgicas; e independient