Meta-analysis shows carbapenems linked to higher clinical failure in OXA-48-PE infections

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Emerging microbes & infections Published May 24, 2026 Medically reviewed May 24, 2026 Study authors: Dortet Laurent, Moreau Charlotte, Dinh Aurélien, Bonnin Rémy A, Escaut Lélia, Seguret Manon, Weber L… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider prioritizing alternative active agents over carbapenems for OXA-48-PE infections.

This source is a meta-analysis and review evaluating carbapenem therapy versus alternative active therapies for monomicrobial OXA-48-producing Enterobacterales infections. The scope includes a French multicenter retrospective cohort of 59 patients and a systematic review of 817 patients from studies published through 31 December 2024. Additionally, six human comparative studies were pooled for the meta-analysis component.

The analysis reports a 30-day mortality rate of 49.1% in the French cohort and a clinical failure rate of 57.1% for meropenem monotherapy within that same group. In the broader systematic review of 12 clinical studies, crude mortality was 52% for carbapenem therapy versus 30.7% for newer agents. The meta-analysis of six comparative studies found an odds ratio of 2.02 for clinical failure with carbapenems, with a 95% CI of 1.05-3.88.

The authors note limitations regarding the uncertain clinical efficacy of carbapenems despite susceptibility categorization. Safety data, including adverse events and discontinuations, were not reported. The evidence suggests that clinicians should consider prioritizing alternative active agents whenever available for this specific infection type.

Study Details

Study typeMeta analysis

Sample sizen = 59

EvidenceLevel 1

PublishedDec 2026

PMID42095743

View Original Abstract ↓

OXA-48-producing Enterobacterales (OXA-48-PE) represent a growing global health threat. Most of OXA-48-PE remain categorized susceptible to carbapenems, which might encourage their use despite uncertain clinical efficacy. This study evaluated clinical outcomes of infections caused by OXA-48-PE treated with carbapenem compared with alternative active therapies. The analyses were performed at three levels: a descriptive analysis of the French cohort, a comparative descriptive analysis of all published studies, and a meta-analysis restricted to studies providing direct comparisons between carbapenem-based and alternative active regimens. Between September 2021 and March 2023, 59 patients with monomicrobial OXA-48-PE infections were included in a French multicenter retrospective cohort. In parallel, a systematic review was conducted to identify clinical studies published through 31 December 2024, reporting outcomes of OXA-48-PE infections. In the French cohort, the overall 30-day mortality was 49.1%. Clinical failure occurred in 57.1% of patients receiving meropenem monotherapy, including patients infected with isolates exhibiting meropenem MICs within the susceptible range. Across 12 clinical studies (817 patients), carbapenem therapy was associated with high and variable crude mortality (52%), whereas newer agents active against OXA-48-PE, particularly ceftazidime-avibactam, were associated with lower and more consistent crude mortality (30.7%). In the primary meta-analysis of 6 human comparative studies, carbapenem therapy was associated with an increased risk of clinical failure compared with alternative active regimens (OR = 2.02; 95% CI = 1.05-3.88). Despite apparent susceptibility, carbapenem therapy was consistently associated with unfavourable clinical outcomes in OXA-48-PE infections, supporting the prioritization of alternative active agents whenever available.