Global Survey on the Management of Multidrug-resistant Gram-negative Bacilli: Divergence of Practice Between High-Income Countries and the Rest of the World

BACKGROUND: Multidrug-resistant gram-negative bacterial (MDR GNB) infections are associated with high mortality. The evidence base for the management of these infections is weak. Major international bodies have recently offered guidance on managing these infections. Their impact on real-life practice is unknown. METHODS: We conducted an online survey utilizing a 123-item questionnaire among healthcare professionals managing patients with serious MDR GNB infections via national societies and professional networks. RESULTS: A total of 1320 respondents from 76 countries completed the survey. The primary area of practice was adult infectious diseases (56.2%; 739/1320), followed by clinical microbiology (13.0%; 171/1320). There were significant differences among preferred first-choice agents (assuming all drugs were available) across infection syndromes in all regions (eg, polymyxins as first choice for carbapenem-resistant Enterobacterales [CRE] KPC; 5/381 in high-income countries [HICs] vs 24/390 in the rest of the world; P < .001), but more pronounced in low- and middle-income countries (LMICs). The greatest disparities in antibiotic availability were seen with cefiderocol, ceftolozane-tazobactam, eravacycline, meropenem-vaborbactam, and imipenem-cilastatin-relebactam. CONCLUSIONS: Management practices for carbapenem-resistant gram-negative pneumonia and bacteremia vary widely, complicated by limited access to new antimicrobial agents in the LMICs. Evaluations of the potential impact of these new antimicrobial agents on the outcome of infections in LMICs are urgently needed.