The impact of ceftazidime-avibactam on 30-day mortality in the treatment of OXA-48 producing Enterobacterales infections - a systematic review and meta-analysis

Sep 29, 2026

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A systematic review and meta-analysis evaluates whether ceftazidime-avibactam improves 30-day all-cause mortality in patients with OXA-48-producing Enterobacterales infections compared with alternative best available therapy (BAT). Observational studies reporting 30-day mortality were identified from six databases with independent review and standardized data extraction. Five studies were included with no low risk of bias. Primary results indicate lower 30-day mortality with ceftazidime-avibactam, while clinical success at end of therapy also favors treatment. Findings require further high-quality research.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Objectives

Methods

Results

Conclusions

Introduction

Carbapenem-resistant Enterobacterales and public health impact

Carbapenemases and the OXA-48 group

Clinical relevance and diagnostic considerations

Evidence gaps for cephalosporin-based treatment

JAC Antimicrob Resist [https://doi.org/10.1093/jacamr/dlaf238](https://doi.org/10.1093/jacamr/dlaf238) JACAntimicrobial Resistance The impact of ceftazidime-avibactam on 30-day mortality in the treatment of OXA-48 producing Enterobacterales infections: a systematic review and meta-analysis Ashley Li-Ann Foo1, Barnaby Young1,2,3,4, Oon Tek Ng1,2,3,4 and Shawn Vasoo1,2,3* 1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; 2Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore; 3Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; 4Communicable Disease Agency Research Group, Communicable Diseases Agency, Singapore *Corresponding author. E-mail: [shawn.vasoo@nhghealth.com.sg](shawn.vasoo@nhghealth.com.sg) Objectives: To assess the impact of ceftazidime-avibactam on 30-day all-cause mortality in patients with OXA- 48 producing Enterobacterales infections, in comparison to alternative best available therapy (BAT) . Methods: Systematic review and meta-analysis of observational studies comparing 30-day mortality outcomesin patients infected with OXA-48 producing Enterobacterales, treated with ceftazidime-avibactam versus BAT. Clinical success (improvement in symptoms/signs of infection) at the end of therapy was assessed as a secondary outcome. We searched six electronic databases (PubMed, EMBASE, CINAHL, Scopus, CENTRAL, Web of Science). Two independent authors carried out the title and abstract review, full text review and data extraction. Results: We included five observational studies for our final analysis. None of the studies had a low risk of bias. We calculated effect estimates and used a random effects meta-analysis to generate pooled estimates. Our primary analysis found that ceftazidime-avibactam was associated with lower 30-day mortality (OR 0.46, 56/ 249, 22.5% versus 97/265, 36.6%, 95% CI 0.29–0.71). Our secondary analysis for the outcome of clinical success was assessable for three studies and also showed benefit (OR 3.6, 95% CI 1.85–6.9). Adjusted analyses could not be performed. Conclusions: Ceftazidime-avibactam seemed to be associated with a lower 30-day mortality and more favourable clinical outcomes compared with BAT in the treatment of OXA-48 Enterobacterales infections. Although these findings provide tentative support for current ESCMID/IDSA antibiotic use guidelines for the use of ceftazidime-avibactam for OXA-48 Enterobacterales infections, further high-quality research is required to confirm this and evaluate its role in relation with other emerging novel therapies. Introduction Multi-drug resistant Gram-negative bacteria (MDR-GNB) pose a significant public health threat, constituting the majority of the urgent threats listed in the Center for Disease Control and Prevention (CDC)’s 2019 Antibiotic Resistance Report.1 A subset of MDR-GNBs are Carbapenem-resistant Enterobacterales (CRE), which are defined as Enterobacterales that are resistant to at least one carbapenem, and this is often mediated by the presence of a carbapenemase.2 In 2017, there were an estimated 13 100 caseso∼f CRE among hospitalized patients in the USA, which have led to 1100 deaths.3 A recent meta-analysis also found that mortality is twice in high in patients with CRE bacteraemia compared with carbapenem-susceptible Enterobacterales, with mortality rates of up to 44% being attributable to carbapenem resistance.4 This underscores the significance of CRE as a public health concern. Carbapenem resistance is mediated by three main groups of carbapenemases as defined by the Ambler classification: Class A, e.g. Klebsiella pneumoniae carbapenemase (KPC); Class B, metallo-beta lactamases such as New Delhi metallo-beta lactamase (NDM); and Class D, oxacillinases (e.g. the OXA-48 group) .5 Class D OXA-48 carbapenemases were first isolated and identified in Turkey,6 however, plasmid-mediated dissemination of OXA-48 genes has led to it

FAQs

What was the primary objective of the review?

To assess the impact of ceftazidime-avibactam on 30-day all-cause mortality in patients with OXA-48-producing Enterobacterales infections compared with alternative best available therapy.

How were studies selected and analyzed?

The review included observational studies comparing 30-day mortality outcomes for ceftazidime-avibactam versus BAT. Searches were conducted in six electronic databases, and independent reviewers performed title/abstract review, full-text screening, and data extraction. Random-effects meta-analysis was used to pool effect estimates.

What did the results show for 30-day mortality and clinical success?

The primary analysis found ceftazidime-avibactam was associated with lower 30-day mortality. The secondary analysis of clinical success at end of therapy, assessable for three studies, also showed benefit.

What conclusions were drawn and what further research is needed?

Ceftazidime-avibactam appeared associated with lower 30-day mortality and more favorable clinical outcomes compared with BAT. The evidence is considered tentative, and further high-quality research is needed to confirm findings and clarify its role versus emerging therapies.

Sep 29, 2026

Uploaded by awa