{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T10:44:07Z","timestamp":1755600247169,"version":"3.41.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100003392","name":"Fujian Natural Science Foundation","doi-asserted-by":"publisher","award":["2020J05258"],"award-info":[{"award-number":["2020J05258"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Science and Technology Program of Fujian province","award":["2020GGA006"],"award-info":[{"award-number":["2020GGA006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To investigate alternative resistance mechanisms among seven ceftazidime\u2013avibactam (CZA)-resistant carbapenem-resistant Klebsiella pneumoniae (CRKP) strains lacking common antimicrobial resistance genes (ARGs) using whole genome sequencing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and Results<\/jats:title>\n                  <jats:p>ARG and virulence factors (VFs) were screened using the ARG database CARD and the VF database, respectively, and identified using genomic annotation data with BLAST+. Six strains were ST11 sequence types (STs), and one was ST2123. ST11 strains harbored more ARGs than the ST2123 strains. All seven strains carried multiple ARGs with efflux-mediated antibiotic resistance, including oqxA, oqxB, tet (A), qacEdltal, CRP, H-NS, Kpn-E, F, G, H, acrA, LptD, acrB, acrD, cpxA, mdtB, and mdtC. These efflux-mediated ARGs were identified in most strains and even all strains. Whole genome sequencing revealed that the ST11 strain carried multiple potential prophages, genomic islands, and integrative and conjugative elements, while the ST2123 strain carried an independent potential prophages and a genomic island.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Whole genome sequencing analysis revealed that these seven CZA-resistant CRKP strains lacking common ARGs exhibited efflux-mediated antibiotic resistance-associated ARGs. The main mechanism by which CRKP resists CZA is antibiotic inactivation. Except for tet (A), no ARGs and validation experiments related to efflux were found. This study's results provide a new possibility for the resistance mechanism of CRKP to CZA, and we will verify this conclusion through experiments in the future.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jambio\/lxae135","type":"journal-article","created":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T02:18:30Z","timestamp":1717813110000},"source":"Crossref","is-referenced-by-count":1,"title":["Whole genome sequencing analysis of seven unknown resistance mechanisms of carbapenem-resistant <i>Klebsiella pneumoniae<\/i> strains resistance to ceftazidime\u2013avibactam"],"prefix":"10.1093","volume":"135","author":[{"given":"Yabin","family":"Chen","sequence":"first","affiliation":[{"name":"Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University , Quanzhou, Fujian 350525 , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxin","family":"Huang","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical 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