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Multidrug resistance (MDR) among gram-negative bacilli poses significant challenges to treatment and antibiotic development. The antibiotic repertoire available to clinicians has now received a boost, with approval of plazomicin for the treatment of complicated urinary tract infection (cUTI), including pyelonephritis. Plazomicin is an aminoglycoside antibiotic with once-daily dosing that has >99% activity against Enterobacteriaceae in the U.S., including extended spectrum beta-lactamase–producing and carbapenem-resistant strains, and most strains that are resistant to generic aminoglycosides (Antimicrob Agents Chemother 2014; 58:2554). The susceptibility breakpoint of plazomicin for Enterobacteriaceae has been set at ≤2 mg/L by the U.S. FDA…