{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:31:13Z","timestamp":1768321873794,"version":"3.49.0"},"reference-count":66,"publisher":"Akademiai Kiado Zrt.","issue":"1","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2024,3,26]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cefiderocol (CFDC) is a first-in-class siderophore cephalosporin with potent activity against multidrug-resistant Gram-negative bacteria including carbapenem-resistant <jats:italic>Acinetobacter baumannii<\/jats:italic>. The present study aimed to explore the CFDC resistance mechanisms of an extensively drug-resistant <jats:italic>A. baumannii<\/jats:italic> isolate from Bulgaria. The <jats:italic>A. baumannii<\/jats:italic> Aba52 strain (designated Aba52) was obtained in 2018 from a\u00a0blood sample of a critically ill patient. The methodology included antimicrobial susceptibility testing, whole-genome sequencing (WGS), reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), multilocus sequence typing, and phylogenomic analysis. The isolate demonstrated high-level resistance to CFDC (MIC = 64\u2009mg L<jats:sup>\u22121<\/jats:sup>), resistance to carbapenems, aminoglycosides, fluoroquinolones, sulfamethoxazole-trimethoprim, and tigecycline, as well as susceptibility only to colistin. WGS-based resistome analysis revealed the existence of <jats:italic>bla<\/jats:italic><jats:sub>OXA-23<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>OXA-66<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>ADC-73<\/jats:sub>. Seven non-conservative missense mutations affecting iron transport-related genes were detected: <jats:italic>exbD4<\/jats:italic> (p.Ser61Pro), <jats:italic>tonB2<\/jats:italic> (p.Ala268Val), <jats:italic>bauA<\/jats:italic> (p.Thr61Ala), <jats:italic>ftsI<\/jats:italic> (p.Ala515Val), <jats:italic>piuA<\/jats:italic> (p.Gly216Val), and <jats:italic>feoB<\/jats:italic> (p.Ser429Pro and p.Thr595Ala). A variety of virulence factors associated with adherence, biofilm formation, enzyme production, immune invasion, iron uptake, quorum sensing, and two-component regulatory systems were identified, suggesting a significant pathogenic potential of Aba52. The performed RT-qPCR analysis showed diminished (0.17) and absent expression of the <jats:italic>pirA<\/jats:italic> and <jats:italic>piuA<\/jats:italic> genes, respectively, encoding TonB-dependent siderophore receptors. Aba52 belonged to the widespread high-risk sequence type ST2 (Pasteur scheme). To the best of our knowledge, this is the first documented case of CFDC-resistant <jats:italic>A. baumannii<\/jats:italic> in Bulgaria even though, CFDC has never been applied in our country. The emerging resistance highlights the crucial need for nationwide surveillance targeting the implementation of novel antibiotics.<\/jats:p>","DOI":"10.1556\/030.2024.02201","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T15:55:13Z","timestamp":1706025313000},"page":"25-36","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":4,"title":["First detection of a cefiderocol-resistant and extensively drug-resistant Acinetobacter baumannii clinical isolate in Bulgaria"],"prefix":"10.1556","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5197-1849","authenticated-orcid":true,"given":"Tanya","family":"Strateva","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slavil","family":"Peykov","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"},{"name":"Department of Genetics, Faculty of Biology, Sofia University \u201cSt. Kliment Ohridski\u201d, Sofia, Bulgaria"},{"name":"BioInfoTech Laboratory, Sofia Tech Park, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","series-title":"Antibiotics (Basel)","first-page":"119","article-title":"Insights into Acinetobacter baumannii: a review of microbiological, virulence, and resistance traits in a threatening nosocomial pathogen","volume":"9","author":"Ayoub Moubareck C","year":"2020","unstructured":"Ayoub Moubareck C, Hammoudi Halat D. 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