Gram-negative pathogens accounted for approximately 9% of prosthetic joint infections in this European multicentre study. Two-stage revision achieved the highest treatment success, while ciprofloxacin remained an important option for susceptible isolates.

A large US surveillance study confirmed aztreonam-avibactam as the most active agent against MDR, XDR and CRE Enterobacterales. Meropenem-vaborbactam and ceftazidime-avibactam remained highly effective against KPC-producing isolates, whereas activity against MBL producers was limited.

An online survey of 1,320 clinicians in 76 countries found wide regional variation in first-line choices for MDR GNB, especially in LMICs. Access to newer agents is limited—particularly cefiderocol, ceftolozane–tazobactam, eravacycline, meropenem–vaborbactam, and imipenem–cilastatin–relebactam. Management of carbapenem-resistant gram-negative pneumonia and bacteremia varies substantially, likely driven by constrained drug availability in LMICs; rigorous evaluation of newer agents in these settings is urgently needed.

This review summarizes the pharmacology, efficacy, and safety of approved and emerging BLBLIs, with emphasis on carbapenem-resistant Enterobacterales, difficult-to-treat Pseudomonas aeruginosa, and carbapenem-resistant A.baumannii. BLBLIs have transformed the management of KPC-producing infections, but rising metallo-β-lactamases and gaps against carbapenem-resistant A. baumannii threaten their impact. Future success depends on next-generation inhibitors with broader enzyme coverage, optimized PK/PD-guided dosing, and strong antimicrobial stewardship