{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:39:51Z","timestamp":1791319191736,"version":"4.3.1"},"reference-count":16,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n International guidance recommends ceftazidime-avibactam for OXA-48-type carbapenemase-producing\n Enterobacterales<\/jats:italic>\n (OXA-48-CPE) infections. However, OXA-48-CPE lacking extended spectrum and AmpC \u03b2-lactamases may remain susceptible to third-generation cephalosporins (3GC), potentially allowing treatment without avibactam. OXA-23 also has variable hydrolytic activity against 3GC. This study reviewed the outcomes of OXA-CPE bloodstream infections treated based on phenotypic susceptibility testing. A retrospective review of OXA-48-CPE and OXA-23-CPE bloodstream infections was conducted from February 2022 to July 2024. Data on antimicrobial susceptibility, patient background, infection source, treatments, and outcomes were analyzed. Whole-genome sequencing (WGS) determined the presence of \u03b2-lactamase genes in available isolates. Ten bloodstream infection episodes occurred in nine patients (eight OXA-48-like\n Escherichia coli<\/jats:italic>\n [\n n<\/jats:italic>\n = 4],\n Klebsiella pneumoniae<\/jats:italic>\n [\n n<\/jats:italic>\n = 4], and one OXA-23-CPE\n Proteus mirabilis<\/jats:italic>\n ), with a urinary source in 44.4% (\n n<\/jats:italic>\n = 4). Of the isolates, 5\/9 (55.5%) were 3GC-susceptible. WGS did not identify any extended-spectrum \u03b2-lactamases in these isolates. Three 3GC-susceptible cases (two OXA-48 and one OXA-23) were successfully treated with ceftriaxone. Among the 3GC-resistant cases, two were treated with ceftazidime-avibactam, and two with high-dose meropenem alone or in combination with aztreonam. One recurrence was observed in a case treated with ceftazidime-avibactam. Mortality was low, with one death reported in a patient treated with ceftazidime-avibactam. In this small study, 55.5% of OXA-48-CPE and OXA-23-CPE isolates retained 3GC susceptibility. When used for therapy, 3GC and non-\u03b2-lactam antibiotics demonstrated clinical efficacy where antibiotic susceptibility was demonstrated.\n <\/jats:p>\n \n IMPORTANCE<\/jats:title>\n \n The Infectious Diseases Society of America guidance document recommends the use of ceftazidime-avibactam for the treatment of OXA-48-type carbapenemase-producing\n Enterobacterales<\/jats:italic>\n (OXA-48-CPE). However, this antibiotic is expensive and not always available in some settings. The clinical outcomes of OXA-48-CPE and OXA-23-CPE bloodstream infections when treated with third-generation cephalosporin (3GC) remain unclear. Among 10 episodes in nine patients, we found that five isolates (55.5%) were 3GC-susceptible, with three cases successfully treated with ceftriaxone. Whole-genome sequencing demonstrated the absence of extended-spectrum \u03b2-lactamases in the 3GC-susceptible isolates, which aligns with phenotypic 3GC susceptibility. Mortality was low (1\/9). Many OXA-48-CPE and OXA-23-CPE infections retain 3GC susceptibility, raising the possibility that these agents may be viable alternatives to ceftazidime-avibactam in select cases.\n <\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1128\/spectrum.00273-25","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:02:12Z","timestamp":1748336532000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":5,"title":["Clinical outcomes of phenotype-guided treatment in group D carbapenemase-producing\n Enterobacterales<\/i>\n bacteremia"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3339-7281","authenticated-orcid":true,"given":"Jinghao Nicholas","family":"Ngiam","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05tjjsh18","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Medicine, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7374-8207","authenticated-orcid":true,"given":"Matthew Chung Yi","family":"Koh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05tjjsh18","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Medicine, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas Jian Hao","family":"Chan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05tjjsh18","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Medicine, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9321-3341","authenticated-orcid":true,"given":"Jeanette","family":"Teo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00f200z37","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, National University Hospital","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-6434","authenticated-orcid":false,"given":"Ka Lip","family":"Chew","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00f200z37","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, National University Hospital","place":["Singapore, 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