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Four cases of aztreonam\u2013avibactam-resistant (AZAR) NDM-producing\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      , recovered from three blood cultures and one rectal surveillance culture in a hospital of Paris, prompted an investigation based on whole-genome sequencing. The three isolates responsible for bloodstream infection, which were clonally related, belonged to the ST405 and produced NDM-5, DHA-1, CTX-M-15, and TEM-1 \u03b2-lactamases. They also had a penicillin-binding protein 3 (PBP3) modified by the insertion of four amino acids (YRIK). On the other hand, the isolate recovered from the rectal swab belonged to another sequence type (ST2083). It produced NDM-5, CMY-42, and TEM-1 \u03b2-lactamases and had an altered PBP3 by the insertion of four other residues (YRIN). Epidemiological investigation identified endoscopic retrograde cholangiopancreatography as a potential risk factor, leading to the detection of three additional patients infected with the ST405 clone after exposure to the same duodenoscope. The outcome of the bloodstream infections was favorable except for one patient. In total, seven patients infected or colonized by AZAR NDM-5-producing\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      were identified over a 5-month period in 2025, six with duodenoscope exposure.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>\n                        <jats:bold>IMPORTANCE<\/jats:bold>\n                      <\/jats:title>\n                      <jats:p>\n                        This study underlines the emergence of aztreonam\u2013avibactam resistance among NDM-producing\n                        <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                        isolates in France. To our knowledge, this report describes the first clonal outbreak due to aztreonam\u2013avibactam-resistant NDM-producing\n                        <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                        .\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01672-26","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:00:31Z","timestamp":1786626031000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Outbreak of aztreonam\u2013avibactam-resistant NDM-5-producing\n                    <i>Escherichia coli<\/i>\n                    isolates in a hospital of Paris"],"prefix":"10.1128","volume":"14","author":[{"given":"V\u00e9ronique","family":"Faraut Derouin","sequence":"first","affiliation":[{"name":"H\u00f4pitaux Universitaires Paris Centre, Site Cochin, Service 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