title: Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement.
abstract: Extensively drug-resistant (XDR) Gram-negative bacilli (GNB) are defined as bacterial isolates susceptible to two or fewer antimicrobial categories. XDR-GNB mainly occur in Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The prevalence of XDR-GNB is on the rise in China and in other countries, and it poses a major public health threat as a result of the lack of adequate therapeutic options. A group of Chinese clinical experts, microbiologists and pharmacologists came together to discuss and draft a consensus on the laboratory diagnosis, clinical management and infection control of XDR-GNB infections. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created according to documents from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). Multiple risk factors of XDR-GNB infections are analyzed, with long-term exposure to extended-spectrum antimicrobials being the most important one. Combination therapeutic regimens are summarized for treatment of XDR-GNB infections caused by different bacteria based on limited clinical studies and/or laboratory data. Most frequently used antimicrobials used for the combination therapies include aminoglycosides, carbapenems, colistin, fosfomycin and tigecycline. Strict infection control measures including hand hygiene, contact isolation, active screening, environmental surface disinfections, decolonization and restrictive antibiotic stewardship are recommended to curb the XDR-GNB spread.
authors.forename: X
authors.initials: X
authors.lastname: Guan
authors.forename: L
authors.initials: L
authors.lastname: He
authors.forename: B
authors.initials: B
authors.lastname: Hu
authors.forename: J
authors.initials: J
authors.lastname: Hu
authors.forename: X
authors.initials: X
authors.lastname: Huang
authors.forename: G
authors.initials: G
authors.lastname: Lai
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: Y
authors.initials: Y
authors.lastname: Ni
authors.forename: H
authors.initials: H
authors.lastname: Qiu
authors.forename: Z
authors.initials: Z
authors.lastname: Shao
authors.forename: Y
authors.initials: Y
authors.lastname: Shi
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.forename: R
authors.initials: R
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Wu
authors.forename: C
authors.initials: C
authors.lastname: Xie
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.forename: F
authors.initials: F
authors.lastname: Yang
authors.forename: K
authors.initials: K
authors.lastname: Yu
authors.forename: Y
authors.initials: Y
authors.lastname: Yu
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: C
authors.initials: C
authors.lastname: Zhuo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002681:China; D032921:Consensus; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Enterobacteriaceae infection; XDR; XDR Acinetobacter infection; XDR Pseudomonas aeruginosa infection; multidrug resistant (MDR); pandrug resistant (PDR)