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This study aims to decipher the population structure of 111 extensive drug-resistant\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      isolates from a national study conducted in Bolivia during 2023\u20132024. The antibiotic susceptibility profiles were determined for 15 antipseudomonal agents. All isolates were subjected to whole-genome sequencing (WGS), and, through bioinformatics analysis, sequence types (ST), clonal relatedness, and acquired mutation-driven and transferable resistance mechanisms were elucidated. The most active antipseudomonal agents were colistin (98.2% intermediate, MIC\n                      <jats:sub>50\/90<\/jats:sub>\n                      =1\/2 mg\/L) and cefiderocol (92.7% susceptible, MIC\n                      <jats:sub>50\/90<\/jats:sub>\n                      =0.25\/4 mg\/L) according to the Clinical and Laboratory Standards Institute (CLSI). High resistance rates to ceftazidime\/avibactam (79.3%), ceftolozane\/tazobactam (82.9%), and imipenem\/relebactam (71.2%) were documented. Carbapenemases were found in 60.3%, particularly including metallo-\u03b2-lactamases (MBL), such as SPM-1 (35%), VIM-2 (9%), the co-production of NDM-1 and DIM-1 (4%), or the new IMP variant IMP-111. Extended-spectrum \u03b2-lactamases (ESBLs) were detected in 12% of the isolates, including OXA-17 (7%), PER-1 (3%), and some GES variants. The most commonly detected clone was ST277 (35%) associated with SPM-1, followed by the ST309 (25%) producer of OXA-2 and various GES, and ST235 (20%) related with OXA-17 and new IMP-111. These clones harbored other acquired resistance genes, including emerging 16S rRNA methyltransferases, RmtD and RmtG. The high resistance rates for novel beta-lactams linked to an alarming spread of high-risk clones ST277 and ST235 and the very high prevalence of MBLs and ESBLs raise significant concern. This underscores the urgent need for establishing epidemiological surveillance and infection control strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01163-25","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T19:12:55Z","timestamp":1762888375000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["First nationwide survey on\n                    <i>Pseudomonas aeruginosa<\/i>\n                    in Bolivia: susceptibility profiles, resistome, and genomic epidemiology"],"prefix":"10.1128","volume":"69","author":[{"given":"Neisa","family":"Alvarado-Orosco","sequence":"first","affiliation":[{"name":"UF of Bacteriology, National Center for Tropical Diseases (CENETROP)","place":["Santa Cruz de la Sierra, 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