{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:59:57Z","timestamp":1788303597460,"version":"build-2803163510"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Global surveillance indicates rising ceftazidime-avibactam resistance among carbapenem-resistant\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (CRKP), with sequence type 11 predominating in China. The contribution of\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>KPC<\/jats:sub>\n                      variants and porin alterations to high-level resistance remains significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employed whole-genome sequencing and functional analyses to characterise a CZA-resistant ST11 CRKP isolate recovered from a patient without prior exposure to ceftazidime-avibactam or carbapenems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The isolate harboured\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>KPC-33<\/jats:sub>\n                      on a non-conjugative plasmid and multiple non-synonymous mutations in the porin gene ompK37, concomitant with high-level resistance to ceftazidime-avibactam and carbapenems while retaining susceptibility to tigecycline, polymyxin B and amikacin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>KPC-33<\/jats:sub>\n                      coupled with OmpK37 alterations underpins dual resistance to ceftazidime-avibactam and carbapenems in ST11 CRKP, underscoring the need for genomic surveillance and rapid detection of this resistance mechanism.\n                    <\/jats:p>\n                  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