{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T04:30:17Z","timestamp":1783225817798,"version":"3.54.6"},"reference-count":55,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Zagreb","award":["10106-24-1294"],"award-info":[{"award-number":["10106-24-1294"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: We conducted this study to evaluate the genotypic and phenotypic profiles of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates, exhibiting resistance to cefiderocol (FDC), focusing on antibiotic susceptibility, \u03b2-lactamase production, the genetic environment of blaCARB and blaESBL genes and molecular epidemiology. FDC is now a last-line antibiotic for severe infections due to CRKP. Methods: Susceptibility to a wide range of antibiotics was determined by the disk diffusion and broth microdilution method. Carbapenemases were screened by a modified Hodge test while carbapenem hydrolysis was investigated using mCIM and eCIM tests. The screening for \u03b2-lactamase and fluoroquinolone cluster resistance genes was carried out by PCR. Plasmids were characterized by PCR-based replicon typing (PBRT). An inter-array genotyping CarbaResist test and whole genome sequencing (WGS) were applied on selected isolates. Results: All of the 31 isolates studied exhibited high-level resistance to amoxicillin\u2013clavulanate, piperacillin\u2013tazobactam, cefuroxime, expanded-spectrum cephalosporins (ESC), cefepime, ceftolozan\u2013tazobactam and ciprofloxacin and the majority to gentamicin, and amikacin. Colistin and ceftazidime\u2013avibactam preserved activity against 71% and 87% of the isolates, respectively. The combined disk method with clavulanic acid was positive in all but one isolate, indicating the production of an ESBL. Twenty-eight isolates carried one single carbapenemase-encoding gene, whereas three harbored double blaCARB genes. Among the studied isolates, 61% carried blaOXA-48, 29% blaKPC and 12.9% blaNDM genes. The inter-array genotyping CarbaResist test and WGS identified additional aminoglycoside-, sulphonamide- and trimethoprim-resistance genes. Conclusion: To our knowledge, this is the first study on FDC resistance in Croatia. The diffusion of FDC-resistant isolates was detected in both hospital and outpatient settings, emphasizing the need for a \u201cOne Health\u201d approach.<\/jats:p>","DOI":"10.3390\/antibiotics14020154","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T10:57:53Z","timestamp":1738666673000},"page":"154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Characterization of Klebsiella pneumoniae Isolates Resistant to Cefiderocol from Hospitals and Outpatient Settings in Croatia"],"prefix":"10.3390","volume":"14","author":[{"given":"Branka","family":"Bedeni\u0107","sequence":"first","affiliation":[{"name":"Biomedical Research Center-BIMIS, University of Zagreb School of Medicine, 10000 Zagreb, Croatia"},{"name":"Clinical Department for Clinical Microbiology and Infection Control and Prevention, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6579-5089","authenticated-orcid":false,"given":"Josefa","family":"Luxner","sequence":"additional","affiliation":[{"name":"Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1592-4559","authenticated-orcid":false,"given":"Gernot","family":"Zarfel","sequence":"additional","affiliation":[{"name":"Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ben\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Sardeli\u0107","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Parasitology, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Anu\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Dr. Andrija \u0160tampar Teaching Institute of Public Health Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3282-0973","authenticated-orcid":false,"given":"Jasmina","family":"Vrane\u0161","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Dr. Andrija \u0160tampar Teaching Institute of Public Health Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Medical Microbiology and Parasitology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2365-8975","authenticated-orcid":false,"given":"Verena","family":"Dobretzberger","sequence":"additional","affiliation":[{"name":"Department of Molecular Diagnostics, Austrian Institute for Technology, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1301-6197","authenticated-orcid":false,"given":"Ivan","family":"Bari\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Department of Molecular Diagnostics, Austrian Institute for Technology, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6937-521X","authenticated-orcid":false,"given":"Andrea","family":"Grisold","sequence":"additional","affiliation":[{"name":"Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.giec.2020.06.004","article-title":"Antimicrobial Resistance","volume":"30","author":"Morrison","year":"2020","journal-title":"Gastrointest. 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