{
  "abstract": "Carbapenemase-producing Enterobacterales (CPE) pose a major therapeutic challenge because antimicrobial susceptibility measured at standard inoculum may not reflect activity at higher bacterial burdens. This Mini Review examines the biological basis, carbapenemase dependence, and agent-specific expression of inoculum effects among contemporary β-lactams. Increasing bacterial density can enhance β-lactamase burden and extracellular carbapenemase activity, alter the effective drug-to-enzyme relationship, and interact with permeability defects, bacterial physiology, and antimicrobial exposure. Available evidence shows substantial heterogeneity across carbapenemases and agents. Ceftazidime-avibactam appears comparatively stable in several CPE studies, whereas cefiderocol, aztreonam-avibactam, and other β-lactam/β-lactamase inhibitor combinations can show marked density-dependent reductions in activity under specific conditions. However, in vitro MIC increases do not consistently translate into reduced in vivo efficacy. Standardized testing approaches, mechanism-informed susceptibility assessment, and clinically relevant pharmacokinetic and pharmacodynamic studies are needed to clarify the therapeutic significance of inoculum-dependent β-lactam activity.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi Meghe, Wardha, India",
    "Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi Meghe, Wardha, India",
    "Central Research Laboratory and Molecular Diagnostics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi Meghe, Wardha, India",
    "School of Allied Health Sciences, Datta Meghe Institute of Higher Education & Research, Sawangi Meghe, Wardha, India"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tokeshwar Kumar Sahu"
    },
    {
      "affs": [
        1
      ],
      "name": "Pravin Gadkari"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Jaishriram Rathored"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bxf6n2akea6jd.bib",
  "cited_by": 0,
  "doi": "10.3389/fmicb.2026.1964408",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697603/",
  "id": "bxf6n2akea6jd",
  "issns": [
    "1664-302X"
  ],
  "landing_url": "https://doi.org/10.3389/fmicb.2026.1964408",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Mini Review"
    ],
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7221504638",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697603/pdf/?tool=EBI",
  "pmcid": "PMC13697603",
  "pmid": "42936378",
  "published": "2026-10-12",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/bxf6n2akea6jd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:38Z",
      "native_id": "PMC13697603",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fmicb.2026.1964408"
    },
    {
      "first_seen": "2026-10-30T12:19:12Z",
      "native_id": "10.3389/fmicb.2026.1964408",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fmicb.2026.1964408/full"
    },
    {
      "first_seen": "2026-10-30T12:21:25Z",
      "native_id": "PMC:PMC13697603",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13697603"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-302X",
      "subfield": "microbiology"
    }
  ],
  "title": "Inoculum-dependent activity of contemporary β-lactam agents against carbapenemase- producing Enterobacterales",
  "title_text": "Inoculum-dependent activity of contemporary β-lactam agents against carbapenemase- producing Enterobacterales",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:37Z",
  "url": "https://research.draconitic.com/paper/bxf6n2akea6jd",
  "venue": "Frontiers in Microbiology",
  "versions": []
}