Treatment of Extended Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTRP. aeruginosa)

Nitrofurantoin and trimethoprim-sulfamethoxazole are preferred treatment options for uncomplicated cystitis caused by ESBL-E.

Ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, or a single-dose of an aminoglycoside are preferred treatment options for uncomplicated cystitis caused by CRE. Standard infusion meropenem is a preferred treatment option for cystitis caused by CRE resistant to ertapenem (i.e., ertapenem MICs ≥2 mcg/mL) but susceptible to meropenem (i.e., meropenem MICs ≤1 mcg/mL), when carbapenemase testing results are either not available or negative. If none of the preferred agents are active, ceftazidimeavibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, or cefiderocol are alternative options for uncomplicated CRE cystitis.