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In vivo adaptive resistance to carbapenem and ceftazidime/avibactam. In general, acquiring blaKPC harboring-plasmid, and specific mutations in porin genes, such as ompK35 and ompK36, contribute to the development of carbapenem resistance in vivo. Acquiring blaNDM harboring-plasmid, specific mutation in blaKPC and upregulation of blaKPC lead to in vivo ceftazidime/avibactam resistance.
