2024 IDSA Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections

2024更新summery：

1. ESBL-E: Carbapenems are often the first-line choice due to their efficacy against ESBL-producing organisms. Cefepime and Ceftazidime-Avibactam are alternatives. Ceftolozane-tazobactam 有效但保留給both DTR P. aeruginosa and ESBL-E.
2. AmpC-E: Carbapenems and Cefepime are preferred for their resistance to degradation by AmpC enzymes. Piperacillin-Tazobactam can be considered if susceptibility is confirmed.
3. CRE: Ceftazidime-Avibactam and Meropenem-Vaborbactam are the top choices for CRE due to their effectiveness against these highly resistant organisms. Traditional carbapenems are not effective against CRE.
4. DTR P. aeruginosa: Ceftolozane-Tazobactam and Ceftazidime-Avibactam are effective against most resistant P. aeruginosa strains. Other options may work if susceptibility is demonstrated.
5. CRAB: Treatment includes Colistin and Sulbactam as first-line agents, with Tigecycline and Minocycline as alternatives. Imipenem is generally not recommended due to resistance.
6. Stenotrophomonas maltophilia: TMP-SMX is the treatment of choice, with Levofloxacin and Minocycline as secondary options. Beta-lactams are not effective.

心因性休克的新指引 (2024更新)

What’s new in cardiogenic shock?

Society for Cardiovascular Angiography and Intervention (SCAI) 最近提出了新的心因性休克的分類，根據心因性休克的clinical、biological 和hemodynamic signs，分為嚴重程度逐漸增加的五個階段 (A-E)：

▲A new classification for cardiogenic shock. 2023

▲ 2024更新 A, B, Diagrams showing SCAI shock classification pyramid (A) and the dynamic evolution of cardiogenic shock and progression or recovery through SCAI shock stages (B). AMI = acute myocardial infarction; CA = cardiac arrest; CS = cardiogenic shock; HF = heart failure; MCS = mechanical circulatory support; SCAI = Society for Cardiovascular Angiography and Interventions; Tx = treatment. (Reproduced with permission from Naidu et al.12)

Culprit‑lesion‑only or multivessel percutaneous coronary intervention (PCI)?

歐洲心臟學會 (European Society of Cardiology, ESC) 指引建議不要在心因性休克情況下立即進行immediate multivessel PCI