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Treating such bacteria presents substantial hurdles for clinicians. The combination of Aztreonam (ATM) and ceftazidime\/avibactam (CAZ\/AVI) is likely the most successful approach. The study evaluated the in vitro activity of CAZ\/AVI in combination with ATM against MBL-producing\u00a0<jats:italic>K. pneumoniae<\/jats:italic>\u00a0clinical isolates collected from Suez Canal University Hospital patients. Carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic> were isolated and identified from different specimens. The presence of metallo-\u03b2-lactamases was detected phenotypically by modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM) testing, and genotypically for the three metallo-\u03b2-lactamase genes: <jats:italic>bla<\/jats:italic>NDM, <jats:italic>bla<\/jats:italic>IMP, and <jats:italic>bla<\/jats:italic>VIM by conventional PCR method. The synergistic effect of CAZ\/AVI with ATM against MBL-producing\u00a0<jats:italic>K. pneumoniae<\/jats:italic>\u00a0was detected by ceftazidime-avibactam combination disks and E-test for antimicrobial susceptibility testing. Out of the 65 K. pneumoniae isolates recovered, 60% (39\/65) were carbapenem-resistant (CRKP). According to the mCIM and eCIM tests, 89.7% (35\/39) of CRKP isolates were carbapenemase-positive, and 68.6% (24\/35) were metallo-\u03b2-lactamase (MBL)-positive. By using the conventional PCR, at least one of the MBL genes was present in each metallo-bata-lactamase-producing isolate: 8.3% carried the <jats:italic>bla<\/jats:italic>VIM gene, 66.7% the <jats:italic>bla<\/jats:italic>NDM, and 91.7% the <jats:italic>bla<\/jats:italic>IMP gene. After doing the disk combination method for ceftazidime-avibactam plus Aztreonam, 62.5% of the isolates shifted from resistance to sensitivity. Also, ceftazidime\/avibactam plus Aztreonam resistance was reduced markedly among CRKP using the E-test. The addition of Aztreonam to ceftazidime\/avibactam is an effective therapeutic option against MBL-producing\u00a0<jats:italic>K. pneumoniae<\/jats:italic>.<\/jats:p>\n          <jats:p>\n            <jats:bold>Clinical Trials Registry<\/jats:bold>: Pan African Clinical Trials Registry. Trial No.: PACTR202410744344899. Trial URL: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/pactr.samrc.ac.za\/TrialDisplay.aspx?TrialID=32000\" ext-link-type=\"uri\">https:\/\/pactr.samrc.ac.za\/TrialDisplay.aspx?TrialID=32000<\/jats:ext-link>\n          <\/jats:p>","DOI":"10.1038\/s41598-025-88965-7","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T18:15:08Z","timestamp":1739297708000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Synergistic combination of ceftazidime and avibactam with Aztreonam against MDR Klebsiella pneumoniae in ICU patients"],"prefix":"10.1038","volume":"15","clinical-trial-number":[{"clinical-trial-number":"pactr202410744344899","registry":"10.18810\/pactr"}],"author":[{"given":"Sally","family":"Khattab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya Mohamed","family":"Askar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidi A. 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