{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:11:57Z","timestamp":1793034717454,"version":"4.5.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u2018Nucleu\u2019"},{"name":"Program"},{"DOI":"10.13039\/501100012550","name":"National Research, Development and Innovation Plan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012550","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018987","name":"Ministry of Research, Innovation and Digitalization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018987","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sectorial"},{"name":"Program for Research and Development"},{"DOI":"10.13039\/501100022612","name":"Ministry of Defence","doi-asserted-by":"publisher","award":["PSCD-I-2024-30"],"award-info":[{"award-number":["PSCD-I-2024-30"]}],"id":[{"id":"10.13039\/501100022612","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Klebsiella pneumoniae is a major cause of healthcare-associated infections in Romania, where carbapenem resistance rates exceed 63%. The dissemination of clones co-producing multiple carbapenemases poses a critical challenge to infection control and antimicrobial management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the molecular characteristics of carbapenem-resistant K. pneumoniae (CRKp) isolates and to assess their epidemiological relevance in a Romanian tertiary-care hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Non-duplicate CRKp isolates collected between July 2023 and May 2025 were included. Identification and antimicrobial susceptibility testing were performed according to EUCAST 2025 criteria. Isolates with reduced carbapenem susceptibility underwent WGS using Oxford Nanopore technology. MLST, resistome, virulome and plasmid profiling were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 101 CRKp isolates were included. In 55.4% (n = 56) of strains the resistance genotype displayed both blaNDM-5 and blaOXA-48-like genes. WGS identified ST383 as the dominant sequence type (n = 31; 30.7%), with 93.5% (29\/31) of ST383 clones co-harbouring blaNDM-5 and blaOXA-48 along with blaCTX-M-15 genes, primarily located on mosaic resistance\u2013virulence plasmids, with evidence of chromosomal integration. Cefiderocol susceptibility was 90.3% by broth microdilution. All tested ST383 isolates remained susceptible to aztreonam\u2013avibactam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ST383 emerged as the dominant carbapenemase-producing K. pneumoniae lineage and represents the first documented identification in Romania of strains co-harbouring blaNDM-5 and blaOXA-48, highlighting the emergence of a high-risk clone with substantial dissemination potential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag079","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:20:43Z","timestamp":1777638043000},"source":"Crossref","is-referenced-by-count":5,"title":["Emergence of ST383 carbapenem-resistant\n                    <i>Klebsiella pneumoniae<\/i>\n                    harbouring\n                    <i>bla<\/i>\n                    NDM-5 and\n                    <i>bla<\/i>\n                    OXA-48 carbapenemase genes in a Romanian tertiary-care hospital"],"prefix":"10.1093","volume":"8","author":[{"given":"Valeriu","family":"Gheorghi\u021b\u0103","sequence":"first","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Infectious Diseases IV, , Bucharest ,","place":["Romania"]},{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9222-7400","authenticated-orcid":false,"given":"Ana","family":"Dobrin","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Infectious Diseases IV, , Bucharest ,","place":["Romania"]},{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violeta","family":"Melinte","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Infectious Diseases IV, , Bucharest ,","place":["Romania"]},{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Adelina","family":"Radu","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Infectious Diseases IV, , Bucharest ,","place":["Romania"]},{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"V\u0103c\u0103roiu","sequence":"additional","affiliation":[{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina-Florentina","family":"Talpo\u0219i","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Infectious Diseases IV, , Bucharest ,","place":["Romania"]},{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Infectious Diseases Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiberiu-Sebastian","family":"Holban","sequence":"additional","affiliation":[{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Microbiology Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anamaria","family":"Dobrot\u0103","sequence":"additional","affiliation":[{"name":"\u2018Agrippa Ionescu\u2019 Clinical Emergency Hospital Epidemiology Department, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103d\u0103lina-Maria","family":"Muntean","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Parasitology, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Br\u00eendu\u0219a Elena","family":"Lixandru","sequence":"additional","affiliation":[{"name":"Cantacuzino National Military Medical Institute for Research and Development Reference Laboratory for Nosocomial and Antibiotic Resistant Infections, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea Ioan","family":"Popa","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department Microbiology II-Cantacuzino NMMIRD, , Bucharest ,","place":["Romania"]},{"name":"Cantacuzino National Military Medical Institute for Research and Development Reference Laboratory for Enteric Bacterial Infections, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei-Alexandru","family":"Muntean","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department of Parasitology, , Bucharest ,","place":["Romania"]},{"name":"\u2018Carol Davila\u2019 University of Medicine and Pharmacy Department Microbiology II-Cantacuzino NMMIRD, , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026051905145915000_dlag079-B1","author":"National Institute of Public Health, Romania"},{"key":"2026051905145915000_dlag079-B2","author":"European Centre for Disease Prevention and Control"},{"key":"2026051905145915000_dlag079-B3","author":"European Centre for Disease Prevention and Control"},{"key":"2026051905145915000_dlag079-B4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-054971","article-title":"Impact of carbapenem resistance on mortality in patients infected with Enterobacteriaceae: a systematic review and meta-analysis","volume":"11","author":"Zhou","year":"2021","journal-title":"BMJ Open"},{"key":"2026051905145915000_dlag079-B5","doi-asserted-by":"publisher","first-page":"435","DOI":"10.3390\/antibiotics13050435","article-title":"Carbapenem-resistant NDM and OXA-48-like-producing Klebsiella pneumoniae: from menacing superbug to a mundane bacterium; a retrospective study in a Romanian tertiary hospital","volume":"13","author":"Lazar","year":"2024","journal-title":"Antibiotics"},{"key":"2026051905145915000_dlag079-B6","doi-asserted-by":"publisher","first-page":"859","DOI":"10.3390\/pathogens14090859","article-title":"Emergence of carbapenem-resistant Klebsiella pneumoniae in a Romanian infectious diseases hospital","volume":"14","author":"Lazar","year":"2025","journal-title":"Pathogens"},{"key":"2026051905145915000_dlag079-B7","doi-asserted-by":"publisher","first-page":"783","DOI":"10.3390\/antibiotics14080783","article-title":"Epidemiology of carbapenem-resistant Klebsiella pneumoniae carrying MBL and OXA-48-like in a Romanian tertiary hospital: a call to action","volume":"14","author":"Melinte","year":"2025","journal-title":"Antibiotics"},{"key":"2026051905145915000_dlag079-B8","author":"European Centre for Disease Prevention and Control"},{"key":"2026051905145915000_dlag079-B9","doi-asserted-by":"publisher","first-page":"5092","DOI":"10.1038\/s41467-024-49349-z","article-title":"International and regional spread of carbapenem-resistant Klebsiella pneumoniae in Europe","volume":"15","author":"Budia-Silva","year":"2024","journal-title":"Nat Commun"},{"key":"2026051905145915000_dlag079-B10","author":"EUCAST"},{"key":"2026051905145915000_dlag079-B11","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btaf474","article-title":"Autocycler: long-read consensus assembly for bacterial genomes","volume":"41","author":"Wick","year":"2025","journal-title":"Bioinformatics"},{"key":"2026051905145915000_dlag079-B12","doi-asserted-by":"publisher","first-page":"124","DOI":"10.12688\/wellcomeopenres.14826.1","article-title":"Open-access bacterial population genomics: BIGSdb software, the PubMLST. org website and their applications","volume":"3","author":"Jolley","year":"2018","journal-title":"Wellcome Open Res"},{"key":"2026051905145915000_dlag079-B13","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1093\/jac\/dkaa345","article-title":"ResFinder 4.0 for predictions of phenotypes from genotypes","volume":"75","author":"Bortolaia","year":"2020","journal-title":"J Antimicrob Chemother"},{"key":"2026051905145915000_dlag079-B14","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-91456-0","article-title":"AMRFinderPlus and the reference gene catalog facilitate examination of the genomic links among antimicrobial resistance, stress response and virulence","volume":"11","author":"Feldgarden","year":"2021","journal-title":"Sci Rep"},{"key":"2026051905145915000_dlag079-B15","doi-asserted-by":"publisher","first-page":"3895","DOI":"10.1128\/AAC.02412-14","article-title":"In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing","volume":"58","author":"Carattoli","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"2026051905145915000_dlag079-B16","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2025.30.27.2500439","article-title":"Cross-border spread of a mosaic resistance (OXA-48) and virulence (aerobactin) plasmid in Klebsiella pneumoniae: a European antimicrobial resistance genes surveillance network investigation, Europe, February 2019 to October 2024","volume":"30","author":"Linkevicius","year":"2025","journal-title":"Euro Surveill"},{"key":"2026051905145915000_dlag079-B17","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.ijantimicag.2010.07.018","article-title":"Emergence of Klebsiella pneumoniae of a novel sequence type (ST383) producing VIM-4, KPC-2 and CMY-4 \u03b2-lactamases","volume":"36","author":"Papagiannitsis","year":"2010","journal-title":"Int J Antimicrob Agents"},{"key":"2026051905145915000_dlag079-B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106130","article-title":"Detection of a hypermucoviscous Klebsiella pneumoniae co-producing NDM-5 and OXA-48 carbapenemases with sequence type 383, Brescia, Italy","volume":"56","author":"Scaltriti","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"2026051905145915000_dlag079-B19","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000520","article-title":"Corrigendum: genomic evolution and local epidemiology of Klebsiella pneumoniae from a major hospital in Beijing, China","volume":"7","author":"Palmieri","year":"2021","journal-title":"Microb Genom"},{"key":"2026051905145915000_dlag079-B20","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00030-23","article-title":"Genomic epidemiology of carbapenem-resistant Klebsiella pneumoniae in Qatar: emergence and dissemination of sequence type 383 strains","volume":"67","author":"Tsui","year":"2023","journal-title":"Antimicrob Agents Chemother"},{"key":"2026051905145915000_dlag079-B21","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1186\/s12879-024-10056-1","article-title":"Genomic dynamics of high-risk carbapenem-resistant Klebsiella pneumoniae clones carrying hypervirulence determinants in Egyptian clinical settings","volume":"24","author":"Abdelsalam","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026051905145915000_dlag079-B22","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaf397","article-title":"Diffusion of OXA-48- and NDM-5-carrying Klebsiella pneumoniae ST383 clone in central Italy","volume":"81","author":"D\u2019Achille","year":"2026","journal-title":"J Antimicrob Chemother"},{"key":"2026051905145915000_dlag079-B23","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01505-22","article-title":"Antimicrobial activity of cefiderocol against carbapenemase-producing Enterobacter cloacae complex and characterisation of reduced susceptibility associated with metallo-\u03b2-lactamase VIM-1","volume":"67","author":"Lasarte-Monterrubio","year":"2023","journal-title":"Antimicrob Agents Chemother"},{"key":"2026051905145915000_dlag079-B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2025.107553","article-title":"Susceptibility to new antibiotics and genetic characterisation of carbapenemase-producing enterobacterales: low activity of cefiderocol against NDM-producing isolates","volume":"66","author":"Fax\u00e9n","year":"2025","journal-title":"J Antimicrob Chemother"},{"key":"2026051905145915000_dlag079-B25","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00084-22","article-title":"Emergence of high-level cefiderocol resistance in carbapenem-resistant Klebsiella pneumoniae from bloodstream infections in patients with haematological malignancies in China","volume":"10","author":"Lan","year":"2022","journal-title":"Microbiol Spectr"},{"key":"2026051905145915000_dlag079-B26","doi-asserted-by":"publisher","first-page":"760","DOI":"10.3390\/antibiotics14080760","article-title":"Evaluating antimicrobial susceptibility testing methods for cefiderocol: a review and expert opinion on current practices and future directions","volume":"14","author":"Stefani","year":"2025","journal-title":"Antibiotics"},{"key":"2026051905145915000_dlag079-B27","author":"European Centre for Disease Prevention and Control"}],"container-title":["JAC-Antimicrobial Resistance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/8\/3\/dlag079\/68333904\/dlag079.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/8\/3\/dlag079\/68333904\/dlag079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:15:04Z","timestamp":1779182104000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jacamr\/article\/doi\/10.1093\/jacamr\/dlag079\/8687243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/jacamr\/dlag079","relation":{},"ISSN":["2632-1823"],"issn-type":[{"value":"2632-1823","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,4,30]]},"article-number":"dlag079"}}