{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:09:19Z","timestamp":1791529759773,"version":"4.3.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"Supplement_5","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100009053","name":"DBT-Wellcome Trust India Alliance","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multidrug-resistant gram-negative bacterial (MDR GNB) infections are associated with high mortality. The evidence base for the management of these infections is weak. Major international bodies have recently offered guidance on managing these infections. Their impact on real-life practice is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an online survey utilizing a 123-item questionnaire among healthcare professionals managing patients with serious MDR GNB infections via national societies and professional networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1320 respondents from 76 countries completed the survey. The primary area of practice was adult infectious diseases (56.2%; 739\/1320), followed by clinical microbiology (13.0%; 171\/1320). There were significant differences among preferred first-choice agents (assuming all drugs were available) across infection syndromes in all regions (eg, polymyxins as first choice for carbapenem-resistant Enterobacterales [CRE] KPC; 5\/381 in high-income countries [HICs] vs 24\/390 in the rest of the world; P &amp;lt; .001), but more pronounced in low- and middle-income countries (LMICs). The greatest disparities in antibiotic availability were seen with cefiderocol, ceftolozane\u2013tazobactam, eravacycline, meropenem\u2013vaborbactam, and imipenem\u2013cilastatin\u2013relebactam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Management practices for carbapenem-resistant gram-negative pneumonia and bacteremia vary widely, complicated by limited access to new antimicrobial agents in the LMICs. Evaluations of the potential impact of these new antimicrobial agents on the outcome of infections in LMICs are urgently needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag025","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:33:44Z","timestamp":1768566824000},"page":"S105-S115","source":"Crossref","is-referenced-by-count":3,"title":["Global Survey on the Management of Multidrug-resistant Gram-negative Bacilli: Divergence of Practice Between High-Income Countries and the Rest of the World"],"prefix":"10.1093","volume":"82","author":[{"given":"Abi","family":"Manesh","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu ,","place":["India"]},{"name":"ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore , Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah T","family":"Aslan","sequence":"additional","affiliation":[{"name":"University of Queensland Centre for Clinical Research , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8517-8259","authenticated-orcid":false,"given":"Mithun","family":"Mohan George","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7541-6615","authenticated-orcid":false,"given":"Helmi","family":"Sulaiman","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya , Kuala Lumpur ,","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Huttner","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3533-6351","authenticated-orcid":false,"given":"Amy J","family":"Mathers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases & International Health, University of Virginia School of Medicine , Charlottesville, Virginia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5331-4837","authenticated-orcid":false,"given":"Alexandre P","family":"Zavascki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul , Porto Alegre ,","place":["Brazil"]},{"name":"Infectious Diseases Service, Hospital Moinhos de Vento , Porto Alegre ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0216-9550","authenticated-orcid":false,"given":"Yin","family":"Mo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University Medicine Cluster, National University Hospital , Singapore ,","place":["Singapore"]},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore ,","place":["Singapore"]},{"name":"Saw Swee Hock School of Public Health, National University of Singapore , Singapore ,","place":["Singapore"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3181-9791","authenticated-orcid":false,"given":"Dafna","family":"Yahav","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Sheba Medical Center , Ramat Gan ,","place":["Israel"]},{"name":"Faculty of Medicine, Tel-Aviv University , Tel Aviv ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6573-9584","authenticated-orcid":false,"given":"Emanuele","family":"Rando","sequence":"additional","affiliation":[{"name":"Dipartimento di Sicurezza e Bioetica \u2013 Sezione di Malattie Infettive, Universit\u00e0 Cattolica del Sacro Cuore , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-8081","authenticated-orcid":false,"given":"Tom","family":"Boyles","sequence":"additional","affiliation":[{"name":"Clinical HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7682-5859","authenticated-orcid":false,"given":"Minggui","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Antibiotics, Huashan Hospital, Fudan University , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4925-3155","authenticated-orcid":false,"given":"Prasannakumar","family":"Palanikumar","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4040-5649","authenticated-orcid":false,"given":"George M","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2079-4437","authenticated-orcid":false,"given":"David L","family":"Paterson","sequence":"additional","affiliation":[{"name":"ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore , Singapore ,","place":["Singapore"]},{"name":"Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"2026060203212651800_ciag025-B1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1128\/AAC.01169-07","article-title":"Clinical and economic impact of common multidrug-resistant gram-negative bacilli","volume":"52","author":"Giske","year":"2008","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060203212651800_ciag025-B2","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet Lond Engl"},{"key":"2026060203212651800_ciag025-B3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1473-3099(16)30257-2","article-title":"Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study","volume":"17","author":"Grundmann","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2026060203212651800_ciag025-B4","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum beta-lactamases: a clinical update","volume":"18","author":"Paterson","year":"2005","journal-title":"Clin Microbiol Rev"},{"key":"2026060203212651800_ciag025-B5","first-page":"e02097","article-title":"Emergence of ceftazidime-avibactam resistance due to plasmid-borne blaKPC-3 mutations during treatment of carbapenem-resistant Klebsiella pneumoniae infections","volume":"61","author":"Shields","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060203212651800_ciag025-B6","doi-asserted-by":"crossref","first-page":"e00406","DOI":"10.1128\/AAC.00406-17","article-title":"Mortality associated with bacteremia due to colistin-resistant Klebsiella pneumoniae with high-level meropenem resistance: importance of combination therapy without colistin and carbapenems","volume":"61","author":"Machuca","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060203212651800_ciag025-B7","doi-asserted-by":"crossref","first-page":"ciad428","DOI":"10.1093\/cid\/ciad428","article-title":"Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections","author":"Tamma","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026060203212651800_ciag025-B8","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant gram-negative bacilli (endorsed by European society of intensive care medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"2026060203212651800_ciag025-B9","doi-asserted-by":"crossref","first-page":"e466","DOI":"10.1016\/S2214-109X(23)00019-0","article-title":"An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations","volume":"11","author":"Charani","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2026060203212651800_ciag025-B10"},{"key":"2026060203212651800_ciag025-B11"},{"key":"2026060203212651800_ciag025-B12","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1093\/cid\/ciab612","article-title":"Patient access in 14 high-income countries to new antibacterials approved by the US Food and Drug Administration, European Medicines Agency, Japanese Pharmaceuticals and Medical Devices Agency, or Health Canada, 2010\u20132020","volume":"74","author":"Outterson","year":"2022","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"2026060203212651800_ciag025-B13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jac\/dkad291","article-title":"Strategies to improve antibiotic access and a way forward for lower middle-income countries","volume":"79","author":"Wasan","year":"2024","journal-title":"J Antimicrob Chemother"},{"key":"2026060203212651800_ciag025-B14","doi-asserted-by":"crossref","first-page":"e444","DOI":"10.1016\/S1473-3099(19)30284-1","article-title":"Non-inferiority versus superiority trial design for new antibiotics in an era of high antimicrobial resistance: the case for post-marketing, adaptive randomised controlled trials","volume":"19","author":"Lanini","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2026060203212651800_ciag025-B15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/cid\/cix783","article-title":"Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae","volume":"66","author":"van Duin","year":"2018","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"2026060203212651800_ciag025-B16","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s40121-018-0214-1","article-title":"Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections: the TANGO II randomized clinical trial","volume":"7","author":"Wunderink","year":"2018","journal-title":"Infect Dis Ther"},{"key":"2026060203212651800_ciag025-B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijid.2021.05.079","article-title":"Effectiveness of ceftazidime\u2013avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia","volume":"109","author":"Hakeam","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2026060203212651800_ciag025-B18","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1093\/cid\/ciz530","article-title":"RESTORE-IMI 1: a multicenter, randomized, double-blind trial comparing efficacy and safety of imipenem\/relebactam vs colistin plus imipenem in patients with imipenem-nonsusceptible bacterial infections","volume":"70","author":"Motsch","year":"2020","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"2026060203212651800_ciag025-B19","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1093\/jac\/dkaa503","article-title":"Ceftazidime\/avibactam in the era of carbapenemase-producing Klebsiella pneumoniae: experience from a national registry study","volume":"76","author":"Karaiskos","year":"2021","journal-title":"J Antimicrob Chemother"},{"key":"2026060203212651800_ciag025-B20","first-page":"66","article-title":"Clinical management of severe infections caused by carbapenem-resistant gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations","volume":"28","author":"Carrara","year":"2022","journal-title":"Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis"},{"key":"2026060203212651800_ciag025-B21","first-page":"1070","article-title":"Antibiotic treatment of infections caused by carbapenem-resistant gram-negative bacilli: an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals","volume":"24","author":"Papst","year":"2018","journal-title":"Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis"},{"key":"2026060203212651800_ciag025-B22","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S1473-3099(18)30099-9","article-title":"Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant gram-negative bacteria: an open-label, randomised controlled trial","volume":"18","author":"Paul","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2026060203212651800_ciag025-B23","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2200131","article-title":"Colistin monotherapy versus combination therapy for carbapenem-resistant organisms","volume":"2","author":"Kaye","year":"2023","journal-title":"NEJM Evid"},{"key":"2026060203212651800_ciag025-B24","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/S1473-3099(23)00184-6","article-title":"Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK)","volume":"23","author":"Kaye","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"2026060203212651800_ciag025-B25","doi-asserted-by":"crossref","first-page":"ofab026","DOI":"10.1093\/ofid\/ofab026","article-title":"Colistin nephrotoxicity: meta-analysis of randomized controlled trials","volume":"8","author":"Eljaaly","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026060203212651800_ciag025-B26","doi-asserted-by":"crossref","first-page":"R73","DOI":"10.1186\/cc4915","article-title":"RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis","volume":"10","author":"Hoste","year":"2006","journal-title":"Crit Care Lond Engl"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/Supplement_5\/S105\/68447050\/ciag025.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/Supplement_5\/S105\/68447050\/ciag025.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:21:37Z","timestamp":1780384897000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/82\/Supplement_5\/S105\/8699688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":26,"journal-issue":{"issue":"Supplement_5","published-online":{"date-parts":[[2026,6,2]]},"published-print":{"date-parts":[[2026,6,2]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag025","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6,15]]},"published":{"date-parts":[[2026,6,2]]}}}