From the Research
Treatment of infections caused by bacteria with NDM and OXA-48 carbapenemase genes should prioritize ceftazidime-avibactam for OXA-48 producers and ceftazidime-avibactam plus aztreonam or cefiderocol for NDM producers, as supported by the most recent and highest quality study 1. The choice of antibiotic regimen is crucial in managing these infections, considering the extensive resistance profiles of NDM and OXA-48 producing bacteria.
- The most effective treatment options include:
- Combination therapy with colistin or polymyxin B and meropenem at high doses, plus either tigecycline, fosfomycin, or aminoglycosides like amikacin, may also be considered, especially for severe infections 1, 2.
- Newer agents such as aztreonam-avibactam combinations show promise against NDM producers, but more research is needed to confirm their efficacy 2.
- The emergence of OXA-48 and NDM carbapenemases in clinical isolates of Klebsiella pneumoniae is a significant concern, with high prevalence rates reported in various studies 3, 4.
- Treatment duration and dosing adjustments should be tailored based on the infection site, severity, and patient's renal function, with source control being crucial for successful treatment 1, 2.
- Infectious disease consultation is essential to guide the final antibiotic selection, considering the complex resistance profiles and the need for individualized treatment plans 1, 2.
- Recent studies have highlighted the potential of new β-lactamase inhibitors, such as xeruborbactam, durlobactam, and avibactam, in addressing the clinical challenges posed by OXA-48-mediated antimicrobial resistance 5.