Treatment Options for Metallo-Beta-Lactamase-Producing Enterobacterales in the Era of Increasing Resistance

The escalating global burden of antimicrobial resistance constitutes a public health crisis. The World Health Organization reports that epidemiological models project 10 million deaths attributable to this issue annually by 2050. Among resistant pathogens, metallo-β-lactamase (MBL)-producing organisms represent a clinical challenge, given their consistent association with high rates of morbidity and mortality. This review summarizes effective treatment options against MBL-producing Enterobacterales. In clinical practice, a pragmatic therapeutic decision rule can be applied: when aztreonam-avibactam (ATM-AVI) is accessible and in vitro susceptibility is confirmed, it should be regarded as the preferred targeted regimen for infections caused by MBL-producing Enterobacterales. In settings where ATM-AVI is unavailable, the combination of ceftazidime-avibactam with aztreonam (CAZ-AVI + ATM) remains the treatment of choice, an approach endorsed by current recommendations from the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Critical evaluation of the published evidence is essential to inform the selection of optimal therapeutic regimens for affected patients. Novel antimicrobial agents are currently under clinical development and may broaden the therapeutic toolkit in the near future.