Infectious diseases physicians and pharmacists review the 2026 IDSA guidance on antimicrobial-resistant gram-negative infections, from the rise of NDM carbapenemases and mechanism-directed therapy to DTR Pseudomonas, CRAB, and Stenotrophomonas, and share practical strategies for diagnostics, renal dosing, formulary access, laboratory readiness, and stewardship
Overall gram-negative resistance rates have plateaued, but the carbapenemases driving carbapenem resistance have shifted, with NDM expanding alongside KPC and reshaping treatment considerations across the Enterobacterales.
Empiric use of novel agents should follow patient-level risk and unit-level epidemiology, while a shared vocabulary for carbapenem-resistant Enterobacterales and their carbapenemases underpins every subsequent treatment decision.
