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

Purpose of review: Infections caused by New Delhi metallo-β-lactamase (NDM) and OXA-48-producing Enterobacterales pose a critical threat due to increasing global prevalence and limited therapeutic options. This review provides an updated overview of evolving epidemiological trends, clinical implications, and both current and emerging treatment options. Recent findings: In the past decade, the epidemiology of carbapenem-resistant Enterobacterales (CRE) has changed, with NDM and OXA-48 replacing KPC in several regions. Outcomes of infections caused by NDM-producing CRE remain poor, due to limited treatment options. Ceftazidime/avibactam and aztreonam is the first-line therapeutic option, whereas cefiderocol represents an alternative if susceptibility is confirmed. Resistance to both aztreonam/avibactam and cefiderocol has been reported among NDM-5-producing Escherichia coli , raising concerns in the scientific community. New agents, including cefepime-zidebactam and cefepime-taniborbactam, are currently in development and may expand the future treatment landscape. For OXA-48-producing CRE, ceftazidime/avibactam and cefiderocol are currently available therapeutic options, whereas cefepime/enmetazobactam may become available in the next future. Summary: Optimal management of NDM- and OXA-48-producing Enterobacterales requires individualized approach guided by pathogen type, resistance profile, and patient characteristics. Improved diagnostics and surveillance are essential to guide early treatment, while novel agents may enhance therapeutic options in the near future.