{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:08:27Z","timestamp":1791331707871,"version":"4.3.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the in vitro activity of aztreonam\/avibactam against Enterobacterales from European medical centres during the 5-year period prior to its approval for clinical use in Europe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty thousand seventy-four Enterobacterales isolates were consecutively collected in 2019\u20132023 from 19 medical centres in Eastern Europe and Mediterranean region (E-EU; n\u200a=\u200a8074) and 27 medical centres in Western Europe (W-EU; n\u200a=\u200a22\u200a000) and susceptibility tested by broth microdilution. Carbapenem-resistant Enterobacterales (CRE) and isolates with elevated MICs (&amp;gt;4\u2005mg\/L) for aztreonam\/avibactam were molecularly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Aztreonam\/avibactam was active against 99.8% and &amp;gt;99.9% of Enterobacterales from E-EU and W-EU, respectively and exhibited potent activity against CRE isolates (MIC50\/90, 0.25\/0.5\u2005mg\/L; 99.6%\/99.7% susceptible in E-EU\/W-EU). Cefiderocol was active against 74.8%\/87.6% of CREs from E-EU\/W-EU. Ceftazidime\/avibactam, meropenem\/vaborbactam, and imipenem\/relebactam retained moderate activity against CRE isolates from W-EU (68.3\u201380.3% susceptibility) but showed limited activity against CRE isolates from E-EU (45.1\u201363.0% susceptible). The occurrence of carbapenemases varied markedly among the countries evaluated. In general, the MBLs predominated in E-EU and the KPCs prevailed in W-EU. Decreased susceptibility to aztreonam\/avibactam was predominantly due to PBP3 alterations and production of CMY and\/or CTX-M \u03b2-lactamases among Escherichia coli, and hyperexpression of ampC plus porin alterations in Enterobacter cloacae species complex and Klebsiella aerogenes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this investigation provide a valuable benchmark for monitoring the in vitro activity of aztreonam\/avibactam after its clinical approval in Europe and emphasizes the importance of comprehensive surveillance programmes to monitor the emergence of high-risk clones and resistance mechanisms to newly approved antimicrobial agents.<\/jats:p>\n                  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