{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:56:39Z","timestamp":1791381399725,"version":"4.3.3"},"reference-count":38,"publisher":"Akademiai Kiado Zrt.","issue":"3","content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMICR"],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"Abstract<\/jats:title>\n \n Multidrug-resistant (MDR) Gram-negative pathogens continue to threaten patient outcomes in intensive care units (ICUs) worldwide, particularly in regions where genomic surveillance is limited. Understanding intra-host genomic diversity and mobility of resistance determinants remain essential for mitigating global antimicrobial resistance (AMR) threats. Whole genome sequencing and molecular analysis were performed on three selected isolates to identify resistance and virulence determinants. The\u00a0isolates exhibited complex and heterogenous resistomes shaped by extensive antimicrobial exposure during prolonged ICU care. Two genetically distinct\n Klebsiella pneumoniae<\/jats:italic>\n strains (ST11 and ST15) demonstrating intra-patient strain diversity, an emerging trend in high-risk clinical settings globally, along with an\n Acinetobacter baumannii<\/jats:italic>\n strain (ST944) were recovered from the same patient. Key resistance genes linked to mobile genetic elements (MGEs) were identified, including\n bla<\/jats:italic>\n CTX-M-15<\/jats:sub>\n and\n bla<\/jats:italic>\n NDM-5<\/jats:sub>\n in\n K. pneumoniae<\/jats:italic>\n ST11 and\n bla<\/jats:italic>\n ADC-152<\/jats:sub>\n in\n A. baumannii<\/jats:italic>\n . A plasmid-associated contig harbouring\n bla<\/jats:italic>\n DHA-1<\/jats:sub>\n and\n qnr<\/jats:italic>\n resistance genes represented a \u2018high-risk\u2019 mobile platform with international similarity in\n K. pneumoniae<\/jats:italic>\n , highlighting the global circulation of resistance plasmids. Virulence profiling revealed conserved and unique determinants, including biofilm, siderophore, and secretion loci, with one isolate carrying a complete\n Yersiniabactin<\/jats:italic>\n locus associated with MGEs. This study provides the first genome-resolved case from the Caribbean demonstrating intra-host co-existence of globally important MDR lineages and plasmid-mediated dissemination of key resistance genes. Within the global AMR challenge, this analysis offers novel insight into the convergence of resistance and virulence traits and highlights the value of localized genomic surveillance in understanding pathogen adaptation, mobility, and persistence under high antimicrobial pressure. These findings emphasize the importance of incorporating genomic data from diverse geographic regions into global AMR networks to better manage MDR ESKAPE pathogens in ICU environments.\n <\/jats:p>","DOI":"10.1556\/030.2026.03025","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T12:52:44Z","timestamp":1782219164000},"page":"299-306","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Genome-resolved analysis of multidrug-resistant ESKAPE pathogens reveals Klebsiella pneumoniae diversity and plasmid-mediated resistance in a patient in intensive care"],"prefix":"10.1556","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4166-4032","authenticated-orcid":true,"given":"Aarti","family":"Pustam","sequence":"first","affiliation":[{"name":"Department of Life Sciences. Faculty of Science and Technology. The University of the West Indies, St. Augustine, Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev P.","family":"Nagassar","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sangre Grande Hospital, The Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaraj","family":"Jayaraman","sequence":"additional","affiliation":[{"name":"Department of Life Sciences. Faculty of Science and Technology. The University of the West Indies, St. Augustine, Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-0457","authenticated-orcid":true,"given":"Adesh","family":"Ramsubhag","sequence":"additional","affiliation":[{"name":"Department of Life Sciences. Faculty of Science and Technology. The University of the West Indies, St. Augustine, Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"Global antimicrobial resistance surveillance system (GLASS) report","author":"World Health Organization","year":"2020","unstructured":"World Health Organization. Global antimicrobial resistance surveillance system (GLASS) report. Geneva: World Health Organization; 2020."},{"issue":"3","key":"B2","series-title":"Lancet Infect Dis","first-page":"318","article-title":"Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria","volume":"18","author":"Tacconelli E","year":"2018","unstructured":"Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et\u00a0al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria. 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