Ceftazidime-Avibactam: Can It Treat OXA-48 Infections?

Why do OXA-48 infections matter after the pandemic?

The CDC's pandemic assessment documents a setback in controlling resistant infections. Its update covering 2021–2022 reported that six types of resistant bacterial infections beginning in hospitals increased by a combined 20% during the pandemic compared with the period before it. The burden peaked in 2021 and remained elevated in 2022. These are historical surveillance findings, rather than a newly measured October 2026 increase. [CDC surveillance update](https://www.cdc.gov/antimicrobial-resistance/data-research/threats/update-2022.html).

One treatment challenge involves Enterobacterales, a bacterial group that includes Klebsiella pneumoniae and Escherichia coli. Some produce OXA-48-like enzymes that break down carbapenems, antibiotics often reserved for serious infections. Current Infectious Diseases Society of America guidance identifies ceftazidime-avibactam as the preferred treatment for invasive infections caused by OXA-48-like-producing Enterobacterales. That recommendation is specific to this resistance mechanism; different mechanisms can require different medicines. [IDSA treatment guidance](https://www.idsociety.org/practice-guideline/amr-guidance/).

Does ceftazidime-avibactam improve survival?

A systematic review published on January 7, 2026, in JAC-Antimicrobial Resistance combined five observational studies of OXA-48-producing Enterobacterales infections. Across the included patients, 30-day mortality was 22.5% with ceftazidime-avibactam and 36.6% with alternative treatment. These percentages describe outcomes in the reviewed groups, not an individual patient's prognosis. [Published systematic review](https://doi.org/10.1093/jacamr/dlaf238).

The distinction between association and proof is essential. Treatment was not randomly assigned, none of the studies was judged to have a low risk of bias, and the reviewers could not produce a pooled analysis adjusted for confounding. Differences in illness severity or treatment selection could therefore influence the apparent benefit. The findings support the drug's clinical role while leaving uncertainty about the size of any survival advantage. [Review methods and limitations](https://doi.org/10.1093/jacamr/dlaf238).

How does the treatment work, and who can receive it?

Ceftazidime disrupts bacterial cell-wall formation. Avibactam blocks certain enzymes that would otherwise disable the antibiotic, including OXA-48-like enzymes. However, the combination alone does not overcome metallo-beta-lactamases such as NDM. Identifying the resistance mechanism and confirming antibiotic susceptibility help establish whether it is an appropriate choice. [IDSA treatment guidance](https://www.idsociety.org/practice-guideline/amr-guidance/).

In the United States, the combination is marketed as Avycaz. Its prescribing information lists complicated urinary tract infections, including kidney infections; hospital-acquired and ventilator-associated bacterial pneumonia; and complicated abdominal infections, for which metronidazole is also required. Approval concerns specified infections caused by susceptible bacteria, rather than every infection carrying an OXA-48 label. [Avycaz prescribing information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=d9c2803f-dc9c-4b19-b4a3-8303bc8c15fd).

Kidney function influences dosing and requires close monitoring when it changes. The label also warns about serious allergic reactions, Clostridioides difficile-associated diarrhea, and neurological reactions, particularly with renal impairment. These considerations make specialist selection and monitoring central to treatment. [Prescribing precautions](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=d9c2803f-dc9c-4b19-b4a3-8303bc8c15fd).