What question did this study set out to answer?

To discuss the clinical implications of PBP3 insertions in Escherichia coli and their role in reducing effectiveness of beta-lactam antibiotics.

April 8, 2026Open Access

Case Commentary: When one target is not enough—PBP3 insertions and target redundancy in Escherichia coli

Key Points

To discuss the clinical implications of PBP3 insertions in Escherichia coli and their role in reducing effectiveness of beta-lactam antibiotics.
Analysis of clinical case involving PBP3 insertions in Escherichia coli
Evaluation of treatment response using imipenem-relebactam and aztreonam
Assessment of penicillin-binding protein targeting strategies
Clinical improvement observed with imipenem-relebactam plus aztreonam treatment
PBP3 insertions contributed to challenges in beta-lactam therapy
Highlighting the need for multi-target treatment approaches to combat antibiotic resistance

Abstract

This challenging clinical case highlights the impact of PBP3 insertions in Escherichia coli, which reduce susceptibility to key β-lactam agents and complicate treatment, particularly in the setting of NDM production (C. Fabrizio, F. Valzano, S. Giuliano, E. Morelli, et al., Antimicrob Agents Chemother 70:e00887-25, 2026, https://doi.org/10.1128/aac.00887-25). Clinical improvement was achieved with imipenem-relebactam plus aztreonam, supporting the idea that targeting multiple penicillin-binding proteins can overcome functional redundancy. These findings emphasize the clinical relevance of PBP3-mediated resistance and the need for treatment strategies that address complex β-lactam resistance in Gram-negative pathogens.

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