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

Abstract

The Infectious Diseases Society of America (IDSA) is committed to delivering timely, evidence-informed guidance on the management of antimicrobial-resistant (AMR) infections. This updated IDSA AMR Guidance document provides treatment suggestions for infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa with difficult-to-treat resistance (DTR P. aeruginosa), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. This update replaces earlier versions of the IDSA AMR Treatment Guidance. A panel of six infectious diseases specialists with expertise in AMR convened to address important questions regarding the treatment of infections due to ESBL-E, AmpC-E, CRE, DTR P. aeruginosa, CRAB, and S. maltophilia. Given geographic variability in AMR epidemiology and antibiotic availability, the IDSA AMR Guidance focuses on clinical practice in the United States. Preferred and alternative treatment strategies are outlined with accompanying rationales, based on pathogen identification and in vitro susceptibility data. Suggestions addressing empiric therapy, transition to oral therapy, duration of treatment, and other management considerations are briefly discussed. While applicable to both adult and pediatric populations, specific dosing guidance is only provided for adults. The field of AMR is highly dynamic. This document is current as of March 1, 2026 and will be updated periodically. The most up-to-date version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance/.