Evidence map›Paper›PMID 41436714›Full record

ArticleInfection2026

Emergence of resistance to novel β-lactam/β-lactamase inhibitor combinations in KPC-producing Klebsiella pneumoniae: clinical and genomic insights from consecutive bloodstream infections.

Matteo Boattini, Sara Comini, Guido Ricciardelli, Lisa Pastrone, Roberto Casale, Luisa Guarrasi, Rossana Cavallo, Cristina Costa, Paolo Gaibani, Gabriele Bianco

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Targeting KPC-ProducingMicroorganisms · 2026
    Article
  2. Article
  3. Dual action of herbal compounds inFrontiers in immunology · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Matteo BoattiniDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Sara CominiOperative Unit of Clinical Pathology, Carlo Urbani Hospital, Ancona, Italy.
Guido RicciardelliDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Lisa PastroneDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Roberto CasaleDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Luisa GuarrasiDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Rossana CavalloDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Cristina CostaDepartment of Public Health and Paediatrics, University of Torino, Turin, Italy.
Paolo GaibaniMicrobiology and Virology Unit, Department of Pathology, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy.
Gabriele BiancoDepartment of Experimental Medicine, University of Salento, Via Provinciale Monteroni N. 165, 73100, Lecce, Italy. gabriele.bianco@unisalento.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeNovel β-lactam/β-lactamase inhibitor combinations (BL/BLICs) such as ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), imipenem/relebactam (IMP/REL) and aztreonam/avibactam (ATM/AVI) have expanded therapeutic choices against KPC-producing K. pneumoniae. However, emerging resistance threatens their long-term efficacy. We investigated the prevalence, genomic mechanisms, and clinical correlates of resistance to these agents among KPC-producing K. pneumoniae bloodstream isolates.

methodsConsecutive KPC-producing K. pneumoniae bloodstream isolates collected between 2021 and 2024 at a tertiary university hospital were tested for susceptibility to novel BL/BLICs and comparators. Whole-genome sequencing (WGS) was performed on isolates resistant to any BL/BLIC to characterise genetic backgrounds. Clinical data from corresponding patients were analysed to explore risk factors and outcomes.

resultsAmong 178 K. pneumoniae isolates, ATM/AVI, IMP/REL and MEM/VAB retained excellent in vitro activity (≥ 96% susceptible), while 11% were resistant to CAZ/AVI. One hundred fifty-four (86.5%) were susceptible to all BL/BLICs, whereas 24 (13.5%) displayed resistance to at least one agent, most commonly CAZ/AVI. WGS revealed a genetically diverse population mainly comprising high-risk clones ST512 and ST101. Resistance was driven by KPC variants (KPC-31, KPC-167, KPC-93, KPC-49, KPC-14, KPC-121, KPC-33) and porin disruptions (OmpK36 insertions, OmpK35 loss). Most patients (91%) had prior colonisation and recent β-lactam exposure; median time to resistance emergence was 47 days. The 28-day mortality among patients with BL/BLIC-resistant infections was 21.7%.

conclusionResistance to novel BL/BLICs among KPC-producing K. pneumoniae is emerging in Italian hospitals, largely mediated by bla

Indexed as

Anti-Bacterial AgentsBacteremiabeta-Lactamase Inhibitorsbeta-Lactamasesbeta-LactamsKlebsiella InfectionsKlebsiella pneumoniaeAdultAgedAged, 80 and overAzabicyclo CompoundsCeftazidimeDrug CombinationsDrug Resistance, Multiple, BacterialFemaleHumansAnti-Bacterial Agentsavibactam, ceftazidime drug combinationAzabicyclo Compoundsbeta-Lactamase Inhibitorsbeta-Lactamasesbeta-LactamsCeftazidimeDrug CombinationsAztreonam/avibactamCeftazidime/avibactamImipenem/relebactamKPC variantMeropenem/vaborbactamNovel β-lactam/β-lactamase inhibitor

Identifiers

PMID41436714
PMCPMC13021700

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.