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However, the increasing number of cases of reported resistance to ceftazidime-avibactam is a concern. OXA-48 is a carbapenemase that has no significant effect on ceftazidime, but is inhibited by avibactam. Since isolates with OXA-48 frequently harbor extended-spectrum \u03b2-lactamases that are inhibited by avibactam, it is likely that ceftazidime-avibactam will be used to treat infections caused by OXA-48-producing\n            <jats:italic>Enterobacterales.<\/jats:italic>\n            Our data show that exposure to ceftazidime-avibactam can lead to changes in OXA-48, resulting in increased ability to hydrolyze ceftazidime and withstand the inhibitory effect of avibactam. Thus, resistance toward ceftazidime-avibactam among OXA-48-producing\n            <jats:italic>Enterobacterales<\/jats:italic>\n            should be monitored. Interestingly, the compromising effect of the amino acid substitutions in OXA-48 on other \u03b2-lactams and the effect of ceftazidime-avibactam exposure on the epidemic OXA-48 plasmid indicate that the evolution of ceftazidime-avibactam resistance comes with collateral effects.\n          <\/jats:p>","DOI":"10.1128\/msphere.00024-19","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T11:25:17Z","timestamp":1553599517000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":85,"title":["OXA-48-Mediated Ceftazidime-Avibactam Resistance Is Associated with Evolutionary Trade-Offs"],"prefix":"10.1128","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2682-2267","authenticated-orcid":false,"given":"Christopher","family":"Fr\u00f6hlich","sequence":"first","affiliation":[{"name":"The Norwegian Structural Biology Centre (NorStruct), Department of Chemistry, UiT\u2014The Arctic 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