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MICs were determined using Sensititre\u2122 DKMNG panels. Whole-genome sequencing of 8 parental strains and 31 mutant derivatives was performed with Illumina.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All parental strains were susceptible to ceftazidime-avibactam (MIC\u200a\u2264\u200a0.5\/4\u20132\/4\u2005mg\/L) and either susceptible or resistant to meropenem (MIC 0.5 to &amp;gt;16\u2005mg\/L) and imipenem (MIC\u200a\u2264\u200a0.5 to &amp;gt;16\u2005mg\/L). MICs of ceftazidime-avibactam for the mutants increased up to 4 to &amp;gt;16\u2005mg\/L, while MICs of meropenem and imipenem for most mutants either increased up to &amp;gt;16\u2005mg\/L or remained unchanged. Whole-genome sequencing of the mutants identified alterations in genes coding for proteins related to AcrAB-TolC (AcrB, AcrR), PBPs (PBP2, PBP3), porins (OmpK36, EnvZ) or the stress or stringent responses (RseB, CpxA, SpoT). No mutations were detected in genes coding for OXA-48-like enzymes or other \u03b2-lactamases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ceftazidime-avibactam can select in vitro mutants of OXA-48-like carbapenemase-producing K. pneumoniae resistant to this combination and, in some cases, also to carbapenems. No mutations related to ceftazidime-avibactam resistance were found in genes coding OXA-48-like enzymes, but they were detected in genes related to active efflux, PBPs, permeability or proteins of the stress and stringent responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkaf360","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T11:57:18Z","timestamp":1757591838000},"page":"3265-3272","source":"Crossref","is-referenced-by-count":4,"title":["Mechanisms of resistance to ceftazidime\/avibactam in mutants derived\n                    <i>in vitro<\/i>\n                    from\n                    <i>Klebsiella pneumoniae<\/i>\n                    producing OXA-48-like enzymes"],"prefix":"10.1093","volume":"80","author":[{"given":"T","family":"Blanco-Mart\u00edn","sequence":"first","affiliation":[{"name":"Unidad de Gesti\u00f3n Cl\u00ednica de Microbiolog\u00eda, Hospital Universitario Reina Sof\u00eda , C\u00f3rdoba 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