How I manage patients with New Delhi metallo-beta-lactamase and OXA-48-producing Enterobacterales infections: a...

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Carbapenem-resistant Enterobacterales (CRE) infections, particularly those caused by New Delhi metallo-β-lactamase (NDM) and OXA-48-producing strains, represent a significant global health challenge.
• The epidemiology of CRE has shifted, with NDM and OXA-48 becoming more prevalent than KPC in certain regions, leading to poorer patient outcomes due to limited treatment options.

Purpose of the Study:

• To provide an updated review of the evolving epidemiological trends of NDM- and OXA-48-producing Enterobacterales.
• To discuss the clinical implications of these infections.
• To summarize current and emerging therapeutic strategies.

Main Methods:

• Literature review of recent epidemiological data.
• Analysis of clinical outcomes associated with NDM- and OXA-48-producing Enterobacterales infections.
• Evaluation of current and investigational treatment options.

Main Results:

• NDM- and OXA-48-producing CRE are increasingly prevalent, with NDM-producing CRE infections associated with poor outcomes.
• Ceftazidime/avibactam and aztreonam are first-line treatments for NDM-producing CRE, with cefiderocol as an alternative; however, resistance is emerging.
• Ceftazidime/avibactam and cefiderocol are options for OXA-48-producing CRE, with new agents like cefepime-zidebactam and cefepime-taniborbactam in development.

Conclusions:

• Management requires an individualized approach based on pathogen and resistance profiles.
• Enhanced diagnostics and surveillance are crucial for early and effective treatment.
• Novel antimicrobial agents hold promise for expanding future therapeutic options against these challenging infections.