Recent advances in the pharmacological management of infections due to multidrug-resistant Gram-negative bacteria.

INTRODUCTION: The emergence and diffusion of multidrug-resistant Gram-negative bacteria (MDR-GNB) is an unprecedented threat, with prevalences as high as 10-50% being reported in many countries. Areas covered: In the present review, we discuss the management of infections due to MDR-GNB, focusing in particular on current strategies and novel agents with already available results from phase 3 randomized controlled trials. Expert commentary: Some new drugs, such as ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam, which have become available in the past months, have increased our chance of improving survival in severe carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Enterobacteriaceae infections; while others, with potent activity against carbapenem-resistant Acinetobacter baumannii which is currently the highest priority regarding the need for novel agents, will become available in the near future. In the meantime, the focus of both clinical practice and research is slowly but steadily widening from efficacy and tolerability of new treatment options to also future preservation of their antimicrobial activity. This is reflected in clinical practice by more attention paid to antimicrobial stewardship initiatives, and in clinical research by growing interest in exploring resistance development as a major endpoint in both preclinical and clinical studies.