Therapeutic optimization against bacteria carrying metalloenzymes: the battle for class B

The spread of metallo-β-lactamases (MBL)-producing Gram-negative bacilli represents a global health challenge, associated with increased mortality rates. The prevalence of MBL-producing isolates, particularly of New Delhi metallo-β-lactamase (NDM) subclass, is increasing globally. The optimal antibiotic for infections depends on the species and MBL subclass produced. Currently, the antimicrobial cornerstones against these pathogens are aztreonam/avibactam and cefiderocol. Successful therapy requires the early and adequate initiation of antibiotic treatment, optimisation of its pharmacokinetics/pharmacodynamics, and appropriate control of the infection source.