{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T21:20:11Z","timestamp":1787692811999,"version":"build-2784847793"},"reference-count":46,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties","award":["SZGSP012"],"award-info":[{"award-number":["SZGSP012"]}]},{"name":"Shenzhen Key Medical Discipline Construction Fund","award":["SZXK032"],"award-info":[{"award-number":["SZXK032"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,3,3]]},"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) pose a global public health threat due to multidrug resistance and treatment failure. This study evaluated the effects of aztreonam combined with four \u03b2-lactamase inhibitors (avibactam, clavulanic acid, tazobactam, and sulbactam) on 77 CRE isolates from Shenzhen Children\u2019s Hospital. Among these isolates, 57.1% harbored metallo-\u03b2-lactamases (MBL) genes, and most co-harbored extended-spectrum \u03b2-lactamase (ESBL)\/AmpC genes. Using microbroth dilution, checkerboard assays, and time\u2012kill curves, aztreonam\/clavulanic acid showed potent synergy against MBL\n                      <jats:sup>+<\/jats:sup>\n                      \/AmpC\n                      <jats:sup>\u2212<\/jats:sup>\n                      strains (26\/27), with MIC50\/MIC90 values (\u22640.12\/1 \u00b5g\/mL) comparable to those of aztreonam\/avibactam (\u22640.12\/0.5 \u00b5g\/mL). Aztreonam\/tazobactam exhibited lower synergism, while aztreonam\/sulbactam had indifferent effects. Time\u2012kill assays confirmed the similar bactericidal activity between aztreonam\/clavulanic acid and aztreonam\/avibactam against MBL\n                      <jats:sup>+<\/jats:sup>\n                      \/ESBL\n                      <jats:sup>+<\/jats:sup>\n                      isolates. Although aztreonam\/avibactam maintains broad efficacy, these\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      studies suggest that the aztreonam\/clavulanic acid combination regimen should be further explored as a potential and cost-effective alternative treatment option for MBL\n                      <jats:sup>+<\/jats:sup>\n                      \/AmpC\n                      <jats:sup>\u2212<\/jats:sup>\n                      CRE, which is expected to reduce the economic burden and delay avibactam resistance. These findings support tailored \u03b2-lactamase inhibitor selection on the basis of resistance mechanisms.\n                    <\/jats:p>\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) pose significant risks for pediatric infections, with few safe and affordable therapeutic options available. This study focuses on a practical issue in current clinical research: aztreonam combined with clavulanic acid shows certain\n                        <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                        activity against CRE strains that carry metallo-\u03b2-lactamases gene but lack AmpC enzymes gene\u2014a common profile among pediatric CRE isolates.\n                      <\/jats:p>\n                      <jats:p>Compared to the costly aztreonam\/avibactam, this combination presents a potential low-cost candidate, which may help alleviate economic burdens on healthcare systems and patients if further validated. Additionally, the findings provide reference for reducing over-reliance on newer antibiotics like avibactam, supporting efforts to delay antimicrobial resistance. This work may be of practical use for regions with limited access to high-cost antimicrobials.<\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01408-25","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:01:53Z","timestamp":1769781713000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of the effects of aztreonam combined with four \u03b2-lactamase inhibitors against carbapenem-resistant\n                    <i>Enterobacterales<\/i>"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-9051","authenticated-orcid":false,"given":"Qing","family":"Meng","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Xu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02h8a1848","id-type":"ROR","asserted-by":"publisher"}],"name":"First Clinical Medical College, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wujiao","family":"Li","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunling","family":"Shen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Respiratory Diseases, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]},{"name":"Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuhui","family":"Huang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Fu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lintao","family":"Zhou","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8520-9852","authenticated-orcid":false,"given":"Yunsheng","family":"Chen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Microbiology Laboratory, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"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"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-1334","authenticated-orcid":true,"given":"Heping","family":"Wang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409k5a27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Respiratory Diseases, Shenzhen Children\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30471-7"},{"key":"e_1_3_5_3_2","unstructured":"WHO. 2024. 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