{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:52:41Z","timestamp":1791341561822,"version":"4.3.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100024838","name":"Samsung Medical Center","doi-asserted-by":"publisher","award":["SMO126011"],"award-info":[{"award-number":["SMO126011"]}],"id":[{"id":"10.13039\/501100024838","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024838","name":"Samsung Medical Center","doi-asserted-by":"publisher","award":["SMO126045"],"award-info":[{"award-number":["SMO126045"]}],"id":[{"id":"10.13039\/501100024838","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024838","name":"Samsung Medical Center","doi-asserted-by":"publisher","award":["SMX126086"],"award-info":[{"award-number":["SMX126086"]}],"id":[{"id":"10.13039\/501100024838","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-carbapenemase-producing Enterobacterales with isolated ertapenem resistance (ETP-mono-R) may represent an early stage in the evolution toward broader carbapenem resistance, but whether further resistance induction occurs and its underlying mechanisms remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Resistance induction was assessed in 3 Escherichia coli, 4 Klebsiella pneumoniae, and 2 Enterobacter cloacae isolates through serial exposure to subinhibitory concentrations of meropenem (MEM), imipenem, ceftazidime-avibactam, or colistin (COL), with antibiotic-free passaging for reversion. Resistance induction under MEM + COL was evaluated separately. Whole-genome sequencing, targeted porin-gene Sanger sequencing, and transcriptional analysis were used to characterize resistance mechanisms across induction stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Subinhibitory MEM exposure rapidly selected for carbapenem resistance through porin-associated alterations in a species-specific manner. E. coli accumulated loop-region mutations in ompC, while K. pneumoniae predominantly developed disruptive mutations in ompK36, both accompanied by marked transcriptional downregulation. In contrast, E. cloacae retained wild-type porins but showed increased MEM MICs, suggesting a non-porin-mediated mechanism. Subinhibitory exposure to COL alone rapidly induced colistin resistance but was associated with decreased carbapenem MICs. Co-exposure to MEM and COL significantly delayed resistance development and reduced MIC increases (all P &amp;lt; .05). Targeted sequencing of 26 non-carbapenemase-producing K. pneumoniae isolates resistant to all carbapenems revealed widespread disruptive ompK36 alterations, including the S337P substitution identified experimentally, consistent with a shared permeability-loss pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In ETP-mono-R Enterobacterales, subinhibitory carbapenem exposure promotes carbapenem resistance, with porin-associated mechanisms predominating in E. coli and K. pneumoniae. Co-exposure to COL attenuates this process, suggesting a potential strategy to delay the emergence of carbapenem resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag469","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:03:55Z","timestamp":1789473835000},"source":"Crossref","is-referenced-by-count":0,"title":["Meropenem\u2013Colistin Combination Mitigates Porin-Associated Carbapenem Resistance Development in Ertapenem-Mono-Resistant Enterobacterales"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2117-710X","authenticated-orcid":false,"given":"Jin Yang","family":"Baek","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["South Korea"]},{"name":"Asia Pacific Foundation for Infectious Diseases (APFID) , Seoul ,","place":["South 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Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-5305","authenticated-orcid":false,"given":"Tae Yeul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8999-7561","authenticated-orcid":false,"given":"Hee Jae","family":"Huh","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["South 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