Introduction <p>Oxacillinase-48 (OXA-48)-producing carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) infections have been increasingly reported in Taiwan. Real-world studies regarding effective treatments for these infections are limited, and recommendations from international guidelines are controversial. The aim of this study was to compare clinical outcomes of OXA-48-producing CRKP bacteremia between patients treated with ceftazidime/avibactam (CZA) and those receiving other active therapies.</p> Methods <p>Unique adult patients with OXA-48-producing CRKP bacteremia who received CZA or other therapies in vitro for at least 3&#xa0;days between June 2017 and December 2024 at Taipei Veterans General Hospital were enrolled. Clinical characteristics and outcomes were compared among the treatment groups. OXA-48 strains were detected using polymerase chain reaction (PCR) followed by Sanger sequencing.</p> Results <p>Of 45 patients included in this study, 18 were treated with CZA, and 27 were treated with other active therapies. Four patients received combination therapy. Most strains were OXA-48 producers (<i>n</i> = 42), and the rest were OXA-181 producers. No significant difference in 30-day mortality rate was observed between the treatment groups (22.2% versus 33.3%, <i>p</i> = 0.420), and even in critically ill patients (28.6% versus 43.8%, <i>p</i> = 0.389). Acute Physiology and Chronic Health Evaluation II (APACHE II) score (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01–1.15, <i>p</i> = 0.028) was an independent risk factor for 30-day mortality, and colistin-based therapy (HR 3.02, 95% CI 1.00–9.13, <i>p</i> = 0.050) showed marginal significance with 30-day mortality. CZA use was not associated with 30-day mortality.</p> Conclusions <p>Our findings revealed that CZA and other active therapies showed similar outcomes, but colistin-based regimens should be used cautiously.</p>