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Alternative strategies are therefore critically needed. We investigated the in vitro activity of aztreonam in combination with three marketed \u03b2-lactamase inhibitors (avibactam, vaborbactam, relebactam) against 48 well-characterized ATM-resistant MBL-producing\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    , including 34 ATM-AVI-resistant isolates. Among ATM-AVI-susceptible isolates, ATM-relebactam and ATM-vaborbactam showed reduced activity compared with ATM-AVI (MIC\n                    <jats:sub>50\/90<\/jats:sub>\n                    1\/4\u00a0mg\/L), with MIC\n                    <jats:sub>50\/90<\/jats:sub>\n                    values of 8\/64\u00a0mg\/L and 64\/256\u00a0mg\/L, respectively. Among ATM-AVI-resistant isolates, none of the combinations restored aztreonam susceptibility. CMY-type enzymes seem to play a pivotal role in the failure of both relebactam and vaborbactam to restore aztreonam susceptibility in our collection of isolates.\n                  <\/jats:p>","DOI":"10.1007\/s10096-026-05538-w","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:08:23Z","timestamp":1782220103000},"page":"2875-2880","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["In vitro activity of \u03b2-lactamase inhibitors avibactam, relebactam and vaborbactam in combination with aztreonam against metallo-\u03b2-lactamase producing Escherichia coli clinical 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