{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:20:53Z","timestamp":1790266853006,"version":"4.1.0"},"reference-count":13,"publisher":"Akademiai Kiado Zrt.","issue":"3","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2025,10,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CRKP) poses a growing threat in Greek hospitals, with increasing reports of multidrug- and pandrug-resistant strains; however, molecular data from regional centers remain limited. This study aimed to investigate the molecular epidemiology, resistance mechanisms, and transmission dynamics of CRKP isolates collected at the General Hospital of Volos, Central Greece, between 2022 and 2024. Thirty-seven non-duplicate CRKP isolates were analyzed. Identification and antibiotic susceptibility testing were performed using VITEK\u00ae 2, disk diffusion, Etest\u00ae, and broth microdilution. Carbapenemase production was assessed using the NG-Test\u00ae Carba-5. Eight isolates underwent multilocus sequence typing (MLST). All isolates were resistant to carbapenems, cephalosporins, and fluoroquinolones; furthermore, 40% were colistin-resistant. The dominant carbapenemase genes were <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub> (45.9%), <jats:italic>bla<\/jats:italic><jats:sub>KPC-2<\/jats:sub> (18.9%), and <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> (27.0%), with co-expression of multiple carbapenemases in 30% of the isolates. MLST revealed the high-risk clones ST11, ST15, and ST323, and three intra-intensive care unit (ICU) transmission clusters. The emergence of dual-carbapenemase and colistin-resistant clones underscores the need for local genomic surveillance, improved infection control, and access to newer antimicrobials in non-tertiary settings.<\/jats:p>","DOI":"10.1556\/030.2025.02655","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:29:09Z","timestamp":1752755349000},"page":"212-219","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":8,"title":["Shifting molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in a regional Greek hospital: Department-specific trends and\u00a0national context (2022\u20132024)"],"prefix":"10.1556","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5339-7529","authenticated-orcid":true,"given":"Pandora","family":"Tsolakidou","sequence":"first","affiliation":[{"name":"Microbiology Department, Hospital of Volos, Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Tsikrikonis","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital of Volos, Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kontantina","family":"Tsaprouni","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital of Volos, Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Souplioti","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital of Volos, Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eumorfia","family":"Sxoina","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital of Volos, Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"1","key":"B1","series-title":"BMC Infect Dis","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1186\/s12879-023-08563-8","article-title":"Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia","volume":"23","author":"Hafiz TA","year":"2023 Sep 5","unstructured":"Hafiz TA, Alanazi S, Alghamdi SS, Mubaraki MA, Aljabr W, Madkhali N, et al. Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia. BMC Infect Dis 2023 Sep 5; 23 (1): 579. PMID: 37670240; PMCID: PMC10481561. 10.1186\/s12879-023-08563-8"},{"key":"B2","series-title":"The Microbe","doi-asserted-by":"publisher","DOI":"10.1016\/j.microb.2025.100333","article-title":"A growing threat in the era of antimicrobial resistance","volume":"7","author":"Asokan S","year":"2025","unstructured":"Asokan S, Jacob T, Jacob J, AlSosowaa AA, Cherian T, Peijnenburg WJGM, et al. A growing threat in the era of antimicrobial resistance. The Microbe 2025; 7: 100333. ISSN 2950-1946. 10.1016\/j.microb.2025.100333"},{"key":"B3","series-title":"Carbapenem- and\/or colistin-resistant Klebsiella pneumoniae in Greece: molecular follow-up survey 2022","author":"European Centre for Disease Prevention and Control","year":"2023","unstructured":"European Centre for Disease Prevention and Control. Carbapenem- and\/or colistin-resistant Klebsiella pneumoniae in Greece: molecular follow-up survey 2022. Stockholm: ECDC; 2023."},{"issue":"2","key":"B4","series-title":"Antibiotics (Basel)","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3390\/antibiotics12020234","article-title":"Carbapenem-resistant Klebsiella pneumoniae: virulence factors, molecular epidemiology and latest updates in treatment options","volume":"12","author":"Karampatakis T","year":"2023 Jan 21","unstructured":"Karampatakis T, Tsergouli K, Behzadi P. Carbapenem-resistant Klebsiella pneumoniae: virulence factors, molecular epidemiology and latest updates in treatment options. Antibiotics (Basel) 2023 Jan 21; 12(2): 234. PMID: 36830145; PMCID: PMC9952820. 10.3390\/antibiotics12020234"},{"key":"B5","series-title":"Eurosurveillance","article-title":"Outbreak of KPC-2-producing Klebsiella pneumoniae endowed with Ceftazidime-avibactam resistance mediated through a VEB-1-mutant (VEB-25), Greece, September to October 2019","volume":"25","author":"Galani I","year":"2020","unstructured":"Galani I, Karaiskos I, Souli M, Papoutsaki V, Galani L, Gkoufa A, et\u00a0al. Outbreak of KPC-2-producing Klebsiella pneumoniae endowed with Ceftazidime-avibactam resistance mediated through a VEB-1-mutant (VEB-25), Greece, September to October 2019. Eurosurveillance 2020; 25: 2000028."},{"key":"B6","series-title":"Antibiotics","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3390\/antibiotics14030223","article-title":"Outbreak of high-risk clone ST323 Klebsiella pneumoniae resistant to ceftazidime\u2013avibactam due to acquisition of blaVEB-25 and to cefiderocol due to mutated fiu gene","volume":"14","author":"Galani I","year":"2025","unstructured":"Galani I, Karaiskos I, Souli M, Papoutsaki V, Gkoufa A, Antoniadou A, et al. Outbreak of high-risk clone ST323 Klebsiella pneumoniae resistant to ceftazidime\u2013avibactam due to acquisition of blaVEB-25 and to cefiderocol due to mutated fiu gene. Antibiotics 2025; 14: 223. 10.3390\/antibiotics14030223"},{"issue":"1","key":"B7","series-title":"BMC Infect Dis","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s12879-019-3801-1","article-title":"Nationwide epidemiology of carbapenem resistant Klebsiella pneumoniae isolates from Greek hospitals, with regards to plazomicin and aminoglycoside resistance","volume":"19","author":"Galani I","year":"Feb 15 2019","unstructured":"Galani I, Nafplioti K, Adamou P, Karaiskos I, Giamarellou H, Souli M., Study Collaborators. Nationwide epidemiology of carbapenem resistant Klebsiella pneumoniae isolates from Greek hospitals, with regards to plazomicin and aminoglycoside resistance. BMC Infect Dis Feb 15 2019; 19(1): 167. Erratum in: BMC Infect Dis. 2019 Mar 7; 19(1): 230. 10.1186\/s12879-019-3854-1. PMID: 30770727; PMCID: PMC6377745. 10.1186\/s12879-019-3801-1"},{"key":"B8","series-title":"Future Microbiol","doi-asserted-by":"publisher","first-page":"809","DOI":"10.2217\/fmb-2016-0042","article-title":"Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in Greece","volume":"11","author":"Karampatakis T","year":"2016 Jun","unstructured":"Karampatakis T, Antachopoulos C, Iosifidis E, Tsakris A, Roilides E. Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in Greece. Future Microbiol 2016 Jun; 11: 809\u201323. Epub 2016 May 20. PMID: 27206024. 10.2217\/fmb-2016-0042"},{"issue":"3","key":"B9","series-title":"Acta Microbiol Immunol Hung","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1556\/030.2021.01400","article-title":"Spread of NDM-producing Klebsiella pneumoniae in a tertiary Greek hospital","volume":"68","author":"Kontopoulou \u039a","year":"2021","unstructured":"Kontopoulou \u039a, Meletis G, Pappa S, Zotou S, Tsioka K, Dimitriadou P, et al. Spread of NDM-producing Klebsiella pneumoniae in a tertiary Greek hospital. Acta Microbiol Immunol Hung 2021; 68(3): 162\u2013168. 10.1556\/030.2021.01400"},{"issue":"3","key":"B10","series-title":"Recent Pat Antiinfect Drug Discov","doi-asserted-by":"publisher","first-page":"198","DOI":"10.2174\/1574891X14666181126142704","article-title":"Polymyxin resistance mechanisms: from intrinsic resistance to mcr genes","volume":"13","author":"Meletis G","year":"2018","unstructured":"Meletis G, Skoura L. Polymyxin resistance mechanisms: from intrinsic resistance to mcr genes. Recent Pat Antiinfect Drug Discov 2018; 13(3): 198\u2013206. 10.2174\/1574891X14666181126142704"},{"issue":"1","key":"B11","series-title":"Acta Microbiol Immunol Hung","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1556\/030.2025.02499","article-title":"Identification of NDM-1 producing and colistin resistant Klebsiella pneumoniae ST11: a highly drug-resistant strain detected in intensive care unit of a Greek tertiary care hospital","volume":"72","author":"Chatzidimitriou M","year":"2025","unstructured":"Chatzidimitriou M, Tsolakidou P, Kyriazidi MA, Chatzopoulou F, Varlamis S, Mavridou M, et al. Identification of NDM-1 producing and colistin resistant Klebsiella pneumoniae ST11: a highly drug-resistant strain detected in intensive care unit of a Greek tertiary care hospital. Acta Microbiol Immunol Hung 2025; 72(1): 16\u201322. 10.1556\/030.2025.02499"},{"issue":"4","key":"B12","series-title":"Acta Microbiol Immunol Hung","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1556\/030.2024.02468","article-title":"Characterization of a carbapenemase-producing Klebsiella pneumoniae isolate of a patient in an intensive care unit in Greece: a study of resistome, virulome, and mobilome","volume":"71","author":"Tsolakidou P","year":"2024","unstructured":"Tsolakidou P, Papadimitriou A, Kyriazidis KA, Ilias P, Mitka S, Chatzidimitriou M. Characterization of a carbapenemase-producing Klebsiella pneumoniae isolate of a patient in an intensive care unit in Greece: a study of resistome, virulome, and mobilome. Acta Microbiol Immunol Hung 2024; 71(4): 295\u2013298. 10.1556\/030.2024.02468"},{"issue":"2","key":"B13","series-title":"Acta Microbiol Immunol Hung","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1556\/030.2025.02559","article-title":"NDM-1 and VIM-1 dual metallo-beta-lactamase producing Klebsiella pneumoniae ST15 high-risk clone from a blood culture of a patient at Intensive Care Unit in a Greek Tertiary Care Hospital","volume":"72","author":"Tsolakidou P","year":"2025","unstructured":"Tsolakidou P, Kyriazidi MA, Varlamis S, Chatzopoulou F, Frydas I, Kyriazidis KA, et al. NDM-1 and VIM-1 dual metallo-beta-lactamase producing Klebsiella pneumoniae ST15 high-risk clone from a blood culture of a patient at Intensive Care Unit in a Greek Tertiary Care Hospital. Acta Microbiol Immunol Hung 2025; 72(2): 93\u201398. 10.1556\/030.2025.02559"}],"container-title":["Acta Microbiologica et Immunologica Hungarica"],"original-title":[],"link":[{"URL":"https:\/\/akjournals.com\/view\/journals\/030\/72\/3\/article-p212.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/030\/72\/3\/article-p212.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/030\/72\/3\/article-p212.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T07:47:12Z","timestamp":1759996032000},"score":1,"resource":{"primary":{"URL":"https:\/\/akjournals.com\/view\/journals\/030\/72\/3\/article-p212.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":13,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1556\/030.2025.02655","relation":{},"ISSN":["1217-8950","1588-2640"],"issn-type":[{"value":"1217-8950","type":"print"},{"value":"1588-2640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}