{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:50:09Z","timestamp":1786117809173,"version":"build-2736575974"},"reference-count":46,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      (CRE) present a major global health concern due to rapid spread, high mortality, and limited treatment options. Metallo-\u03b2-lactamase (MBL)-producing CRE, particularly those harboring New Delhi metallo-\u03b2-lactamase (NDM) variants and co-expressing other beta-lactamases, are a significant therapeutic challenge as they exhibit resistance to most \u03b2-lactam\/\u03b2-lactamase inhibitor combinations. This study evaluated the\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      activity of aztreonam-avibactam (ATM-AVI) and comparators against\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      bloodstream isolates (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      = 10,376) collected between 2021 and 2022 across Africa and the Middle East, Asia-Pacific, Europe, and Latin America, as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) Global Surveillance Program. Minimum inhibitory concentrations (MICs) were determined by broth microdilution, with susceptibility interpreted using 2025 European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, as appropriate. ATM-AVI demonstrated robust activity, inhibiting 99.8% of\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      at a concentration of \u22644 mg\/L (EUCAST susceptibility breakpoint) and maintaining activity across resistance phenotypes, including 99.6% of multi-drug resistant (MDR), 98.9% of CRE, and 99.9% of extended-spectrum beta-lactamases (ESBL) screen-positive isolates. Among MBL-positive CRE isolates, 97.0% were susceptible to ATM-AVI at the EUCAST breakpoint (\u22644 mg\/L), compared with 52.7% susceptible to cefiderocol at its EUCAST breakpoint (\u22642 mg\/L). ATM-AVI remained robust against MBL-positive isolates co-carrying ESBLs (97.8%) and other carbapenemases, like\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      carbapenemase (KPC) (100%) and oxacillinase-48 (OXA-48)\/OXA-48-like enzymes (98.2%). Among MBL-positive isolates co-carrying AmpC-type \u03b2-lactamases, 78.7% were susceptible to ATM-AVI at the EUCAST breakpoint. ATM-AVI demonstrated potent activity against\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      , including MDR, CRE, and MBL-positive phenotypes, across regions. Its ability to overcome resistance mediated by multiple \u03b2-lactamases highlights clinical potential for managing severe infections like bloodstream infections (BSIs), and the need for global surveillance data to drive clinical decision-making and regional stewardship programs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      (CRE) are a serious global health threat due to their rapid spread and limited treatment options. This study highlights the promising potential of aztreonam-avibactam (ATM-AVI) as a powerful treatment against these resistant bacteria. ATM-AVI was tested on a large number of bacterial samples from various regions worldwide and showed strong effectiveness, even against strains that are resistant to most other treatments. This is particularly important for managing severe infections, such as bloodstream infections, which can be life-threatening. The study underscores the need for ongoing global surveillance to guide treatment decisions and improve health outcomes. Patients suffering from infections caused by resistant bacteria, as well as healthcare providers, could greatly benefit from the findings of this research, as it offers hope for more effective treatment options.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00241-26","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T01:19:26Z","timestamp":1782868766000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["<i>In vitro<\/i>\n                    activity of aztreonam-avibactam and comparators against\n                    <i>Enterobacterales<\/i>\n                    isolated from bloodstream infections: ATLAS\/ surveillance, 2021\u20132022"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-0434","authenticated-orcid":true,"given":"Gian Maria","family":"Rossolini","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04jr1s763","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Experimental and Clinical Medicine, University of Florence, and Microbiology and Virology Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4493-0619","authenticated-orcid":true,"given":"Fupin","family":"Hu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/013q1eq08","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Antibiotics, Huashan Hospital, Fudan University","place":["Shanghai, China"]},{"id":[{"id":"https:\/\/ror.org\/00mrhvv69","id-type":"ROR","asserted-by":"publisher"}],"name":"Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health","place":["Shanghai, China"]},{"name":"Joint Laboratory of Hospital & Enterprise for Pathogen Diagnosis of Drug-resistant Bacterial Infections and Innovative Drug R&D","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandini","family":"Sethuraman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02ew45630","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Microbiology, Central Reference Laboratory, Apollo Hospitals","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shweta","family":"Kamat","sequence":"additional","affiliation":[{"name":"PPIPL","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naglaa","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Stone","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7535-997X","authenticated-orcid":true,"given":"Katherine K.","family":"Perez","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2017.10.028"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-020-00733-6"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms11061491"},{"key":"e_1_3_4_5_2","unstructured":"World Health Organization. WHO Bacterial Priority Pathogens List 2024: Bacterial Pathogens of Public Health Importance to Guide Research Development and Strategies to Prevent and Control Antimicrobial Resistance. https:\/\/www.who.int\/publications\/i\/item\/9789240093461."},{"key":"e_1_3_4_6_2","unstructured":"Centers for Disease Control and Prevention. 2019. Antibiotic resistance threats in the United States 2019. Atlanta GA. Centers for Disease Control and Prevention. https:\/\/www.cdc.gov\/antimicrobial-resistance\/media\/pdfs\/2019-ar-threats-report-508.pdf."},{"key":"e_1_3_4_7_2","unstructured":"European Centre for Disease Prevention and Control2025. Rapid risk assessment - carbapenem-resistant Enterobacterales \u2013 third update. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/risk-assessment-carbapenem-resistant-enterobacterales-third-update-february-2025_0.pdf."},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-25-02404"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlac106"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1543427"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12111591"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2024.2311213"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2025.107449"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics8030122"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2019.06.008"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14020141"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10081012"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-023-04645-2"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2023.12.027"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlad032"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00499-7"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlaf131"},{"key":"e_1_3_4_23_2","unstructured":"Emblaveo (aztreonam\/avibactam) summary of product characteristics. 2024. 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