Patients with risk factors for infection with multidrug-resistant gram-negative bacteria

The need for input from an infectious diseases physician or clinical microbiologist to determine the appropriate treatment for a patient with risk factors for infection with a multidrug-resistant gram-negative bacterium depends on infection severity and the patient’s specific risk factors.

Patients who are not severely unwell can be treated according to the empirical antibiotic regimens recommended in the clinical topics. Prioritise the collection of samples from potentially infected sites for culture and susceptibility testing, and closely monitor the patient while awaiting testing results. Do not delay therapy while waiting for results.

Patients who are severely unwell should be urgently referred to an infectious diseases physician or clinical microbiologist for antibiotic choice. Prompt referral is particularly important for severely unwell patients with either of the following risk factors because treatment with activity against carbapenem-resistant bacteria may be required:

• has recently (eg within the past 6 months) been hospitalised or a resident of a long-term care facility overseas
• is known to be colonised with a carbapenem-resistant bacterium.

For guidance on information to obtain to inform decision making, see Factors that influence the likely susceptibility of multidrug-resistant gram-negative bacteria. Also consider the availability of local or jurisdictional protocols, including advice on infection control strategies.