Screening and comparison of in vitro-induced resistant and clinically resistant Stenotrophomonas maltophilia strains for eravacycline resistance-related genes

Eravacycline resistance in <i>Sm</i> is primarily driven by dysregulation of the <i>smeDEF</i> efflux complex, with <i>in vitro</i>-induced strains relying on CNV amplification and/or coding mutations, while clinical isolates combine these with accessory pathways. This work provides the evidence for CNV as a core resistance driver and highlights evolutionary divergence under clinical pressure, informing future antibiotic development and resistance surveillance strategies.