Choosing Among Preferred Agents for KPC-Producing Enterobacterales

Body:The 2026 guidance lists ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam as preferred options for KPC-producing Enterobacterales infections, noting resistance emergence during therapy in roughly 10% of ceftazidime-avibactam cases versus under 3% for the other two agents. “We felt like we had more data for KPC specifically, NDM specifically, [and] OXA-48–like Enterobacterales. So we separated those out into questions to talk about preferred and alternative suggested treatments,” said Pranita D. Tamma, MD, MHS, of the Department of Pediatrics at the University of Pennsylvania School of Medicine.

Among the three, the panel slightly favored meropenem-vaborbactam, based on observational data showing numerically better outcomes and a lower likelihood of resistance emergence compared with ceftazidime-avibactam.

In this episode, Emily L. Heil, PharmD, MS, FIDP, BCIDP, AAHIVP, professor in the Department of Practice, Sciences, and Health Outcomes Research at the University of Maryland School of Pharmacy and pharmacy director of the Antimicrobial Stewardship Program at the University of Maryland Medical Center, and Tamma discuss the restructured CRE section, the pharmacologic case for a carbapenem backbone, and the need for head-to-head trials of these agents a decade after their approval.