Escalating Carbapenem Resistance and Stewardship Responses

A single-hospital retrospective study found 85.4% carbapenem resistance among Gram-negative bloodstream isolates, with particularly high resistance in Acinetobacter and Klebsiella; amikacin and colistin retained limited activity. New work shows environmental plasmid transfer can produce more than 10,000-fold resistance changes in cystic-fibrosis pathogens, while a preclinical TimP extracellular-vesicle strategy restored polymyxin activity in resistant E. coli; clinical translation remains unproven. Twelve randomized trials involving 3,750 patients support delayed antibiotic prescribing to reduce use without meaningful outcome loss.