{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:59:32Z","timestamp":1792004372675,"version":"4.4.0"},"reference-count":32,"publisher":"American Society for Microbiology","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Pfizer Pharmaceutical","award":["ATLAS"],"award-info":[{"award-number":["ATLAS"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Carbapenem-resistant Enterobacterales (CRE) pose significant treatment challenges. While ceftazidime\u2013avibactam (CZA) is commonly used, resistance rates have been increasing. Aztreonam\u2013avibactam (ATM\u2013AVI) may represent a promising alternative. A total of 109,603 Enterobacterales isolates were collected from 307 sites across 63 countries between 2019 and 2023 as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program. CRE were defined as isolates with a meropenem minimal inhibitory concentration (MIC) \u22652 mg\/L. Susceptibility testing was conducted according to the Clinical and Laboratory Standards Institute (CLSI) 2025 guidelines, and \u03b2-lactamase genes were identified by multiplex PCR and sequencing. Of the total Enterobacterales isolates, 7,520 (7.6%) were identified as CRE, with\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      species accounting for the majority (76.3%, 5,735\/7,520). CZA susceptibility was 49.1% (3,696\/7,520), with a significant increase in resistance from 42.1% (540\/1,283) in 2019 to 61.0% (875\/1,435) in 2023 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Although CRE prevalence was highest in Asia (12.2%, 2,850\/23,295), the highest rate of CZA resistance was observed in Africa\/Middle East (73.9%, 557\/754). In contrast, ATM\u2013AVI demonstrated the highest\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      activity, with 97.4% (7,324\/7,520) of CRE isolates exhibiting MICs \u22644 mg\/L. This activity remained strong against carbapenemase-producing strains, including metallo-\u03b2-lactamase (MBL) producers. However, reduced susceptibility was observed in\n                      <jats:italic toggle=\"yes\">Escherichia<\/jats:italic>\n                      (80.2%, 556\/693) and\n                      <jats:italic toggle=\"yes\">Proteus<\/jats:italic>\n                      (88.9%, 56\/63) species. Notably, resistance to ATM\u2013AVI among carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Escherichia<\/jats:italic>\n                      species was geographically clustered in India, where 9.9% (36\/364) of isolates were resistant. In conclusion, ATM\u2013AVI exhibits potent activity against global CRE, including MBL producers, and outperforms other \u03b2-lactam\/\u03b2-lactamase inhibitor combinations. However, emerging resistance in\n                      <jats:italic toggle=\"yes\">Escherichia<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Proteus<\/jats:italic>\n                      species\u2014particularly with regional clustering\u2014highlights the importance of continued global surveillance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01549-25","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T13:56:30Z","timestamp":1771422990000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":6,"title":["<i>In vitro<\/i>\n                    activity of aztreonam\u2013avibactam and distribution of carbapenemase genes in ceftazidime\u2013avibactam-resistant carbapenem-resistant Enterobacterales: data from the global Antimicrobial Testing Leadership and Surveillance, 2019\u20132023"],"prefix":"10.1128","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6346-082X","authenticated-orcid":true,"given":"Yu-Lin","family":"Lee","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01abtsn51","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Disease, Department of Internal Medicine, Chung Shan Medical University Hospital","place":["Taichung, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/059ryjv25","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Medicine, Chung Shan Medical University","place":["Taichung, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/03e29r284","id-type":"ROR","asserted-by":"publisher"}],"name":"PhD Program in Medical Biotechnology, Institute of Genomics and Bioinformatics, National Chung-Hsing University","place":["Taichung, 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