{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:24:07Z","timestamp":1788269047886,"version":"build-2803163510"},"reference-count":34,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Pfizer Global Medical Grants","award":["78172399"],"award-info":[{"award-number":["78172399"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Metallo-\u03b2-lactamase-producing\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      are distributed worldwide, but some Latin American countries show a higher prevalence. Aztreonam-avibactam (ATM-AVI) may be an option for treating these infections. To evaluate\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      susceptibility to aztreonam (ATM) alone and ATM-AVI in carbapenem-non-susceptible\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      isolates, based on the type of carbapenemase production, we prospectively collected carbapenem-non-susceptible\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      isolates from Peruvian hospitals during 2023\u20132024. Identification and susceptibility testing were performed by commercial panels and disk diffusion. Carbapenemases were detected by immunochromatography. ATM and ATM-AVI MICs were determined using broth microdilution panels with avibactam fixed at 4 \u00b5g\/mL. The non-susceptible isolates to ATM-AVI and those with double production of carbapenemases underwent whole-genome sequencing. A total of 438\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      isolates were analyzed; carbapenemase production was detected in 422 (96.3%) and NDM was the most frequent (61.9%). Coproduction of NDM + KPC in\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      and NDM + OXA-48-like in\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      was observed. Overall, 99.3% were susceptible to ATM-AVI; MIC\n                      <jats:sub>50<\/jats:sub>\n                      and MIC\n                      <jats:sub>90<\/jats:sub>\n                      were 0.12 and 2 \u00b5g\/mL, respectively. Overall,\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      isolates had lower MIC\n                      <jats:sub>50<\/jats:sub>\n                      and MIC\n                      <jats:sub>90<\/jats:sub>\n                      values to ATM-AVI (0.12 and 0.5 \u00b5g\/mL) compared to\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      (0.5 and 4 \u00b5g\/mL). Three\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      isolates were resistant to ATM-AVI (MIC \u2265 8 \u00b5g\/mL), they belonged to ST410, ST167, and ST10 and harbored a YRIN insertion in PBP3 along with CYM-type, PER-type, and CTX-M-type beta-lactamase genes. ATM-AVI demonstrated potent activity against carbapenem-non-susceptible\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      , including those producing NDM, which is the carbapenemase most frequently detected in Peruvian hospitals.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                        isolates cause common illnesses in humans. Carbapenems are the antibiotics used to treat several of these infections, and increasingly, isolates resistant to these antibiotics are found. The most important mechanism of resistance to carbapenem among\n                        <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                        is the production of enzymes called carbapenemases. Our results allowed us to recognize that NDM is the most frequent type of carbapenemase detected. Most of the antimicrobials available do not cover the\n                        <jats:italic toggle=\"yes\">E<\/jats:italic>\n                        nterobacterales carrying NDM carbapenemase. In this scenario, we found that the new combination of drugs, aztreonam-avibactam, has high\n                        <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                        efficacy against most of the carbapenem-resistant isolates and against those isolates carrying NDM carbapenemase.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00762-26","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:00:30Z","timestamp":1785848430000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["<i>In vitro<\/i>\n                    susceptibility testing of aztreonam-avibactam against predominantly NDM-producing\n                    <i>Enterobacterales<\/i>\n                    in Peru"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-1843","authenticated-orcid":true,"given":"Coralith","family":"Garcia","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03yczjf25","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia","place":["Lima, Peru"]},{"id":[{"id":"https:\/\/ror.org\/00mtrzx11","id-type":"ROR","asserted-by":"publisher"}],"name":"Hospital Nacional Cayetano Heredia","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yelinda","family":"Reyes","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03yczjf25","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia","place":["Lima, 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