Managing Resistant Gram-Negative Infections: Updated IDSA Guidance

Clinical Takeaway

: Newer antibiotics are now preferred for invasive carbapenem-resistant A. baumannii infections, invasive S. maltophilia infections, and highly resistant P. aeruginosa pneumonia.

An overview of Infectious Diseases Society of America 2026 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections

Background

During the past several years, antibiotic resistance has risen dramatically among gram-negative pathogens, and clinical studies have established safe, effective alternatives to colistin–polymyxin. The Infectious Diseases Society of America (IDSA) has updated its consensus guidance accordingly. The update incorporates several newly approved agents, including gepotidacin, pivmecillinam, oral sulopenem, cefepime–enmetazobactam, intravenous fosfomycin, and aztreonam–avibactam. Here, we highlight key changes since the 2024 guidance.

Key Points

AmpC–producing Enterobacterales

Hafnia alvei is now on the lis…

Reviewing Author

George Sakoulas, M.D.

Disclosures

Consultant/Independent ContractorAbbVie

Editorial BoardsAntimicrobial Agents and Chemotherapy

EmployeeSharp Rees-Stealy Medical Group

Speaker’s BureauAbbVie; Paratek; Shionogi; Inoviva; Invivyd