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Linked pairs were compared for antimicrobial resistance and biofilm formation and underwent comparative genomic analysis via whole-genome sequencing, comparative average nucleotide identity and core genome single nucleotide polymorphism (SNP) analysis.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results.<\/jats:bold>\n                    Five isolate pairs (three\n                    <jats:italic>E. coli<\/jats:italic>\n                    , two\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ) showed high relatedness, supporting the GIT origin of bloodstream infection. Isolates within pairs had identical virulence genes, whereas phenotypic assays revealed changes in antimicrobial susceptibility, with one pair undergoing changes in resistance gene profiles and increased biofilm formation in four out of five isolates.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion.<\/jats:bold>\n                    This study provides insight into within-host evolution from gastrointestinal colonization to bloodstream invasion in Gram-negative pathogens. Convergence on metabolic adaptation and biofilm formation suggests that these traits may be advantageous in healthcare-associated GNBSI. Further studies involving larger cohorts alongside functional validation of mutations are needed to better understand GNBSI pathogenesis.\n                  <\/jats:p>","DOI":"10.1099\/jmm.0.002147","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:15:53Z","timestamp":1775664953000},"source":"Crossref","is-referenced-by-count":0,"title":["From colonization to invasion: genomic and phenotypic comparison of faecal and bloodstream isolates from the same patients"],"prefix":"10.1099","volume":"75","author":[{"given":"Aakash","family":"Khanijau","sequence":"first","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, 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