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We evaluated the in vitro activity of plazomicin against other aminoglycosides in 122 clinical carbapenem-resistant Enterobacteriaceae isolates using several clinical susceptibility breakpoints. Plazomicin had excellent in vitro activity with 98% overall susceptibility. Amikacin was the next most active with 86% overall susceptibility. This dropped to 55% when switching from Clinical Laboratory and Standards Institute to US Committee on Antimicrobial Susceptibility Testing breakpoints.The relationship between heme metabolism