# Guideline for antimicrobial treatment of multidrug-resistant Gram-negative infections: practice recommendations of the Brazilian Society of Infectious Diseases

## TL;DR

This paper presents a Brazilian guideline for treating multidrug-resistant Gram-negative infections, tailored to the country's unique healthcare challenges.

## Contribution

The novel contribution is a national consensus guideline addressing MDR-GNB infections specific to Brazil's healthcare landscape.

## Key findings

- The guideline addresses regional disparities in antimicrobial access and resistance patterns in Brazil.
- Recommendations are provided for critical pathogens like CRE, CRAB, and CRPA across various infection sites.
- The document supports clinicians, especially non-specialists, in managing MDR-GNB infections nationwide.

## Abstract

Although international guidelines are available, a national consensus is crucial to address the unique challenges faced in Brazil regarding the management of infections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). These challenges include marked regional disparities in antimicrobial access, variability in pathogen prevalence and resistance patterns, and unequal availability of diagnostic resources. This guideline, developed by a consensus of infectious diseases experts nominated by the Brazilian Society of Infectious Diseases, aims to support clinicians, particularly non-specialists, in the management of MDR-GNB infections across diverse healthcare settings in the country. The document focuses on pathogens classified as critical or high-priority by the World Health Organization (WHO), including Carbapenem-Resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA), ESBL- and AmpC-producing Enterobacterales, as well as Stenotrophomonas maltophilia, and Burkholderia cepacia. Therapeutic recommendations are organized by pathogen and infection site, including respiratory tract, skin and soft tissue, bloodstream, intra-abdominal, and both complicated and uncomplicated urinary tract infections.