{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:26:12Z","timestamp":1790825172012,"version":"4.1.0"},"reference-count":72,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer Inc.","doi-asserted-by":"crossref","award":["70161611"],"award-info":[{"award-number":["70161611"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              New \u03b2-lactam\u2013\u03b2-lactamase inhibitor combinations represent last-resort antibiotics to treat infections caused by multidrug-resistant\n              <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n              . Carbapenemase gene acquisition can limit their spectrum of activity, and reports of resistance toward these new molecules are increasing. In this multi-center study, we evaluated the prevalence of resistance to ceftazidime\u2013avibactam (CZA) and comparators among\n              <jats:italic>P. aeruginosa<\/jats:italic>\n              clinical isolates from bloodstream infections, hospital-acquired or ventilator-associated pneumonia, and urinary tract infections, circulating in Southern Italy. We also investigated the clonality and content of relevant \u03b2-lactam resistance mechanisms of CZA-resistant (CZA\n              <jats:sup>R<\/jats:sup>\n              ) isolates. A total of 120\n              <jats:italic>P<\/jats:italic>\n              .\n              <jats:italic>aeruginosa<\/jats:italic>\n              isolates were collected. CZA was among the most active \u03b2-lactams, retaining susceptibility in the 81.7% of cases, preceded by cefiderocol (95.8%) and followed by ceftolozane\u2013tazobactam (79.2%), meropenem\u2013vaborbactam (76.1%), imipenem\u2013relebactam (75%), and aztreonam (69.6%). Among non-\u03b2-lactams, colistin and amikacin were active against 100% and 85.8% of isolates respectively. In CZA\n              <jats:sup>R<\/jats:sup>\n              strains subjected to whole-genome sequencing (\n              <jats:italic>n<\/jats:italic>\n              = 18), resistance was mainly due to the expression of metallo-\u03b2-lactamases (66.6% VIM-type and 5.5% FIM-1), followed by PER-1 (16.6%) and GES-1 (5.5%) extended-spectrum \u03b2-lactamases, mostly carried by international high-risk clones (ST111 and ST235). Of note, two strains producing the PER-1 enzyme were resistant to all \u03b2-lactams, including cefiderocol. In conclusion, the CZA resistance rate among\n              <jats:italic>P. aeruginosa<\/jats:italic>\n              clinical isolates in Southern Italy remained low. CZA\n              <jats:sup>R<\/jats:sup>\n              isolates were mostly metallo-\u03b2-lactamases producers and belonging to ST111 and ST253 epidemic clones. It is important to implement robust surveillance systems to monitor emergence of new resistance mechanisms and to limit the spread of\n              <jats:italic>P. aeruginosa<\/jats:italic>\n              high-risk clones.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              Multidrug-resistant\n              <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n              infections are a growing threat due to the limited therapeutic options available. Ceftazidime\u2013avibactam (CZA) is among the last-resort antibiotics for the treatment of difficult-to-treat\n              <jats:italic>P. aeruginosa<\/jats:italic>\n              infections, although resistance due to the acquisition of transferable \u03b2-lactamase genes is increasing. With this work, we report that CZA represents a highly active antipseudomonal \u03b2-lactam compound (after cefiderocol), and that metallo-\u03b2-lactamases (VIM-type) and extended-spectrum \u03b2-lactamases (GES and PER-type) production is the major factor underlying CZA resistance in isolates from Southern Italian hospitals. In addition, we reported that such resistance mechanisms were mainly carried by the international high-risk clones ST111 and ST235.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.04266-23","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T13:00:42Z","timestamp":1719493242000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":22,"title":["Resistance to ceftazidime\u2013avibactam and other new \u03b2-lactams in\n            <i>Pseudomonas aeruginosa<\/i>\n            clinical isolates: a multi-center surveillance study"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7638-1538","authenticated-orcid":false,"given":"Felice","family":"Valzano","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Foggia, Foggia, 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