Table 1.
Differences between CRAB treatment guidelines.
| ESCMID Guidelines (April 2022) | IDSA Guidance (July 2023) | |
|---|---|---|
| Combination antibiotic regimen | For severe and high-risk CRAB infection | For moderate–severe CRAB infection |
| Ampicillin/sulbactam | For patients with CRAB susceptible to sulbactam and HAP/VAP (1 g sulbactam component q6h) |
Back-bone treatment for all CRAB infection (6–9 g sulbactam component daily) |
| Polymyxins | Either colistin or polymyxin B: for patients with CRAB resistant to sulbactam susceptible to polymyxins; in combination with one other in vitro active agent for severe, susceptible to polymyxins, CRAB infection |
Polymyxin B in combination with at least one other agent for the treatment of CRAB infections (Colistin only for CRAB UTIs) |
| Tetracycline derivatives | High-dose tigecycline: for patients with CRAB resistant to sulbactam susceptible to tigecycline; in combination with one other in vitro active agent for severe, susceptible to tigecycline, CRAB infection |
High-dose minocycline (preferred option) or high-dose tigecycline in combination with at least one other agent for the treatment of CRAB infections |
| Cefiderocol | Not recommended | In combination with at least one other agent for the treatment of CRAB infections refractory to other antibiotics (or when the use of other antibiotics is precluded) |
| Aminoglycosides | In combination with one other in vitro active agent for severe, susceptible to aminoglycosides, CRAB infection | Not recommended |
| High-dose extended-infusion meropenem | In combination with one other in vitro active agent for severe CRAB infections with a meropenem MIC < 8 mg/L | Not recommended |
Legend. CRAB: carbapenem-resistant Acinetobacter baumannii; ESCMID: European Society of Clinical Microbiology and Infectious Diseases; IDSA: Infectious Diseases Society of America; HAP: health-care associated pneumonia; VAP: ventilator-associated pneumonia; UTIs: urinary tract infections. High-dose tigecycline: 200 mg as a loading dose followed by 100 mg q12h; High-dose minocycline: 200 mg q12h. High-dose extended-infusion meropenem: 2 g over 3 h infusion q8h.