{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:22:44Z","timestamp":1785435764044,"version":"3.56.0"},"reference-count":76,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T00:00:00Z","timestamp":1780790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007700","name":"Carol Davila University of Medicine and Pharmacy","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007700","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04fm87419","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Cantacuzino National Military Medical Institute for Research and Development"},{"id":[{"id":"https:\/\/ror.org\/00691gs61","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Given the ongoing threat of antimicrobial resistance, the identification and characterization of multidrug-resistant isolates are essential. An increase in antimicrobial-resistant bacteria has been reported in Romania, but national data are still scarce. This study aimed to evaluate beta-lactamase-producing Gram-negative bacteria (GNB) isolated over two years at a Romanian nephrology hospital, while comparing carbapenemase detection phenotypic methods. Methods: Gram-negative bacterial isolates collected between January 2022 and May 2024 that met antimicrobial resistance screening criteria were evaluated. After identification, extensive disk diffusion antibiograms were performed, read, and interpreted, complemented by testing on cloxacillin\/oxacillin-supplemented Mueller\u2013Hinton agar. The colistin minimum inhibitory concentration (MIC) was not assessed, and aztreonam\u2013avibactam was not tested for Enterobacterales. For non-fermenter GNB, the colistin MIC was determined. Phenotypic carbapenemase production tests were performed for all strains (BlueCarba Test, CIM, mCIM, zCIM, and rCIM). Carbapenemase detection immunochromatographic tests were performed for a set of strains. Results: Among the 397 evaluated strains, 335 (84.38%) were Enterobacterales and 62 (15.62%) non-fermenter GNB, showing high antimicrobial resistance levels. Of these, 188 (47.35%) were Klebsiella pneumoniae; 139\/188 (73.93%) showed carbapenem resistance and carbapenemase production; 49\/188 (26.06%) produced two carbapenemases; and 45\/188 (23.93%) presented resistance to all tested antimicrobials. MALDI-TOF identified 28 KPC-producing K. pneumoniae strains. Lateral flow assays revealed NDM, VIM, KPC, and OXA-48-like enzymes in 48 of 56 tested Enterobacterales; 12\/48 strains produced two carbapenemases. Of the 62 non-fermenter GNB, 33 were Pseudomonas spp. and 20 Acinetobacter baumannii; one Pseudomonas spp. was susceptible only to colistin and seven only to cefiderocol; four A. baumannii were susceptible only to colistin and three only to cefiderocol. Lateral flow assays detected VIM or IMP enzymes in 13\/33 Pseudomonas spp. and OXA-23 and\/or OXA-40\/-58 enzymes in all 20 A. baumannii. Conclusions: Among the evaluated strains, many showed resistance to multiple antimicrobial classes. Furthermore, strains co-producing two carbapenemases were identified.<\/jats:p>","DOI":"10.3390\/antibiotics15060580","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:43:46Z","timestamp":1780897426000},"page":"580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Beta-Lactamase-Producing Strains Isolated in a Tertiary Nephrology Hospital in Romania"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9564-1585","authenticated-orcid":false,"given":"Edgar-Costin","family":"Chelaru","sequence":"first","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4124-2909","authenticated-orcid":false,"given":"Andrei-Alexandru","family":"Muntean","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-3037","authenticated-orcid":false,"given":"Ioana","family":"Manea","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Dr. Carol Davila Clinical Nephrology Hospital, 010731 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-7953","authenticated-orcid":false,"given":"Mihai-Octav","family":"Hogea","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crina-Mihaela","family":"Dinu\u021b\u0103","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mioara","family":"Maz\u0103re","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103d\u0103lina-Maria","family":"Muntean","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103lin-Constantin","family":"Ghi\u021bulescu","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6697-6706","authenticated-orcid":false,"given":"Bogdan-Florin","family":"Ciomaga","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3867-9122","authenticated-orcid":false,"given":"Costin-\u0218tefan","family":"Caracoti","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana-Maria","family":"Preoteasa","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-9329","authenticated-orcid":false,"given":"Mircea Ioan","family":"Popa","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology II, Department 2, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (2026, April 24). Antimicrobial Resistance: Causes and How It Spreads, Available online: https:\/\/www.cdc.gov\/antimicrobial-resistance\/causes\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/drugresistance\/where-resistance-spreads.html."},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (2026, April 24). Controlling the Emergence and Spread of Antimicrobial Resistance, Available online: https:\/\/www.cdc.gov\/antimicrobial-resistance\/prevention\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/drugresistance\/actions-to-fight.html."},{"key":"ref_4","unstructured":"European Centre for Disease Prevention and Control (2026, April 24). ECDC Country Visit to Romania to Discuss Antimicrobial Issues. Available online: https:\/\/data.europa.eu\/doi\/10.2900\/052263."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Perestrelo, S., Amaro, A., Brouwer, M.S.M., Clemente, L., Ribeiro Duarte, A.S., Kaesbohrer, A., Karp\u00ed\u0161kov\u00e1, R., Lopez-Chavarrias, V., Morris, D., and Prendergast, D. (2023). Building an International One Health Strain Level Database to Characterise the Epidemiology of AMR Threats: ESBL\u2014AmpC Producing E. coli as An Example\u2014Challenges and Perspectives. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030552"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e00047-19","DOI":"10.1128\/CMR.00047-19","article-title":"Epidemiology of \u0392-Lactamase-Producing Pathogens","volume":"33","author":"Bush","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jean, S.-S., Harnod, D., and Hsueh, P.-R. (2022). Global Threat of Carbapenem-Resistant Gram-Negative Bacteria. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.823684"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1473-3099(16)30257-2","article-title":"Occurrence of Carbapenemase-Producing Klebsiella Pneumoniae and Escherichia coli in the European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE): A Prospective, Multinational Study","volume":"17","author":"Grundmann","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Choi, J.-H., Ali, M.S., Moon, B.-Y., Kang, H.-Y., Kim, S.-J., Song, H.-J., Mechesso, A.F., Moon, D.-C., and Lim, S.-K. (2023). Prevalence and Characterization of Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli Isolated from Dogs and Cats in South Korea. Antibiotics, 12.","DOI":"10.3390\/antibiotics12040745"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Colosi, I.A., Baciu, A.M., Opri\u0219, R.V., Peca, L., Gudat, T., Simon, L.M., Colosi, H.A., and Costache, C. (2020). Prevalence of ESBL, AmpC and Carbapenemase-Producing Enterobacterales Isolated from Raw Vegetables Retailed in Romania. Foods, 9.","DOI":"10.3390\/foods9121726"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1089\/mdr.2016.0036","article-title":"Veterinary Hospital Dissemination of CTX-M-15 Extended-Spectrum Beta-Lactamase\u2013Producing Escherichia coli ST410 in the United Kingdom","volume":"22","author":"Timofte","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lixandru, B.E., Cotar, A.I., Straut, M., Usein, C.R., Cristea, D., Ciontea, S., Tatu-Chitoiu, D., Codita, I., Rafila, A., and Nica, M. (2015). Carbapenemase-Producing Klebsiella pneumoniae in Romania: A Six-Month Survey. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143214"},{"key":"ref_13","unstructured":"Popescu, G.A., Codi\u021b\u0103, I., Szekely, E., \u0218erban, R., Ruja, G., and T\u0103l\u0103pan, D. (2026, April 24). Ghid privind Enterobacteriaceae Produc\u0103toare de Carbapenemaze: Diagnosticul, Prevenirea Transmiterii Interumane \u0219i Tratamentul Infec\u021biilor Produse, Available online: https:\/\/insp.gov.ro\/wpfb-file\/ghid-privind-enterobacteriaceae-producatoare-de-carbapenemaze-diagnosticul-prevenirea-transmiterii-interumane-si-tratamentul-infectiilor-produse-pdf\/."},{"key":"ref_14","first-page":"341","article-title":"Carbapenemase Producing Enterobacterales in Romania: Investigating the Origins","volume":"28","author":"Vas","year":"2020","journal-title":"Rev. Rom\u00e2n\u0103 Med. Lab."},{"key":"ref_15","first-page":"2049936120933187","article-title":"Antimicrobial Stewardship Programs; a Two-Part Narrative Review of Step-Wise Design and Issues of Controversy Part I: Step-Wise Design of an Antimicrobial Stewardship Program","volume":"7","author":"Resman","year":"2020","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1007\/s11096-015-0096-1","article-title":"Evaluation of Restricted Antibiotic Use in a Hospital in Romania","volume":"37","author":"Bizo","year":"2015","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10096-017-3118-1","article-title":"Extensive Colonization with Carbapenemase-Producing Microorganisms in Romanian Burn Patients: Infectious Consequences from the Colectiv Fire Disaster","volume":"37","author":"Pirii","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_18","unstructured":"Institutul Na\u021bional de Boli Infec\u021bioase \u201cProf. Dr. Matei Bal\u0219\u201d din Bucure\u0219ti (2026, April 24). Ghid pentru Prevenirea \u0219i Limitarea Fenomenului de Rezisten\u021b\u0103 la Antimicrobiene (AMR) \u0219i a Infec\u021biilor Asociate Asisten\u021bei Medicale (IAAM). Available online: https:\/\/www.mateibals.ro\/index.php\/cercetare-si-proiecte\/pdp-8-proiect-amr."},{"key":"ref_19","unstructured":"The European Committee on Antimicrobial Susceptibility Testing (2026, March 13). EUCAST Guidelines for Detection of Resistance Mechanisms and Specific Resistances of Clinical and\/or Epidemiological Importance. Version 2.0. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Resistance_mechanisms\/EUCAST_detection_of_resistance_mechanisms_170711.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sepp, E., Andreson, R., Balode, A., Bilozor, A., Brauer, A., Egorova, S., Huik, K., Ivanova, M., Kaftyreva, L., and K\u00f5ljalg, S. (2019). Phenotypic and Molecular Epidemiology of ESBL-, AmpC-, and Carbapenemase-Producing Escherichia coli in Northern and Eastern Europe. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.02465"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hammoudi Halat, D., and Ayoub Moubareck, C. (2020). The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria. Antibiotics, 9.","DOI":"10.3390\/antibiotics9040186"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1128\/CMR.00036-08","article-title":"AmpC \u03b2-Lactamases","volume":"22","author":"Jacoby","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1093\/cid\/ciz173","article-title":"A Primer on AMPC \u0392-Lactamases: Necessary Knowledge for an Increasingly Multidrug-Resistant World","volume":"69","author":"Tamma","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1128\/JCM.00219-10","article-title":"Extended-Spectrum-\u0392-Lactamase, AMPC, and Carbapenemase Issues","volume":"48","author":"Thomson","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"25043","DOI":"10.1073\/pnas.2003407117","article-title":"Integrated Chromosomal and Plasmid Sequence Analyses Reveal Diverse Modes of Carbapenemase Gene Spread among Klebsiella pneumoniae","volume":"117","author":"David","year":"2020","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Beshah, D., Desta, A.F., Woldemichael, G.B., Belachew, E.B., Derese, S.G., Zelelie, T.Z., Desalegn, Z., Tessema, T.S., Gebreselasie, S., and Abebe, T. (2023). High Burden of ESBL and Carbapenemase-Producing Gram-Negative Bacteria in Bloodstream Infection Patients at a Tertiary Care Hospital in Addis Ababa, Ethiopia. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0287453"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1128\/CMR.00037-09","article-title":"Three Decades of \u0392-Lactamase Inhibitors","volume":"23","author":"Drawz","year":"2010","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1038\/s41564-021-00879-y","article-title":"Pervasive Transmission of a Carbapenem Resistance Plasmid in the Gut Microbiota of Hospitalized Patients","volume":"6","author":"DelaFuente","year":"2021","journal-title":"Nat. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jhin.2016.03.007","article-title":"Carbapenemase-Producing Enterobacteriaceae in Hospital Wastewater: A Reservoir That May Be Unrelated to Clinical Isolates","volume":"93","author":"White","year":"2016","journal-title":"J. Hosp. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S521","DOI":"10.1093\/cid\/ciz824","article-title":"Epidemiology and Diagnostics of Carbapenem Resistance in Gram-Negative Bacteria","volume":"69","author":"Nordmann","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0213-005X(14)70167-3","article-title":"Carbapenemase-Producing Enterobacteriaceae: The End of the Antibiotic Era?","volume":"32","author":"Pascual","year":"2014","journal-title":"Enfermedades Infecc. Microbiol. Cl\u00ednica"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bonnin, R.A., Jousset, A.B., Emeraud, C., Oueslati, S., Dortet, L., and Naas, T. (2021). Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales. Front. Med., 7.","DOI":"10.3389\/fmed.2020.616490"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4943","DOI":"10.1128\/AAC.00296-11","article-title":"Carbapenems: Past, Present, and Future","volume":"55","author":"Endimiani","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4751","DOI":"10.2147\/IDR.S280977","article-title":"Distribution of NDM1 Carbapenemase-Producing Proteeae Strains on High-Risk Hospital Wards","volume":"13","author":"Rus","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jhin.2019.04.015","article-title":"Dissemination of NDM-1 Carbapenemase-Producer Providencia stuartii Strains in Romanian Hospitals: A Multicentre Study","volume":"103","author":"Flonta","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s40121-022-00591-2","article-title":"Therapeutic Strategies for Emerging Multidrug-Resistant Pseudomonas aeruginosa","volume":"11","author":"Coyne","year":"2022","journal-title":"Infect. Dis. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ijid.2015.01.011","article-title":"Therapeutic Strategy for Pandrug-Resistant Klebsiella pneumoniae Severe Infections: Short-Course Treatment with Colistin Increases the in Vivo and in Vitro Activity of Double Carbapenem Regimen","volume":"33","author":"Oliva","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance","volume":"18","author":"Magiorakos","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e00353-19","DOI":"10.1128\/JCM.00353-19","article-title":"CIM City: The Game Continues for a Better Carbapenemase Test","volume":"57","author":"Humphries","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"699","DOI":"10.25259\/IJMR_1976_2024","article-title":"Evaluation of the Rapid Lateral Flow Assay (LFA) for Detection of Five Major Carbapenemase Enzyme Families in Genotypically Characterised Bacterial Isolates","volume":"161","author":"Rahmani","year":"2025","journal-title":"Indian J. Med. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e0079323","DOI":"10.1128\/spectrum.00793-23","article-title":"Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae","volume":"11","author":"Tarlton","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1007\/s42770-022-00798-y","article-title":"MALDI-TOF Mass Spectrometry for Direct KPC Detection among Enterobacterales","volume":"53","author":"Moreira","year":"2022","journal-title":"Braz. J. Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e0314020","DOI":"10.1128\/JCM.03140-20","article-title":"Systematic Comparison of Three Commercially Available Combination Disc Tests and the Zinc-Supplemented Carbapenem Inactivation Method (ZCIM) for Carbapenemase Detection in Enterobacterales Isolates","volume":"59","author":"Sattler","year":"2021","journal-title":"J. Clin. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1093\/jac\/dkx519","article-title":"Evaluation of the Rapid Carbapenem Inactivation Method (rCIM): A Phenotypic Screening Test for Carbapenemase-Producing Enterobacteriaceae","volume":"73","author":"Muntean","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1093\/jac\/dkab170","article-title":"Optimization of the Rapid Carbapenem Inactivation Method for Use with AmpC Hyperproducers","volume":"76","author":"Muntean","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_46","first-page":"50","article-title":"Use of the Rapid Carbapenem Inactivation Method (rCIM) with Carbapenemase Inhibitors: A Proof of Concept Experiment","volume":"77","author":"Muntean","year":"2018","journal-title":"Roum. Arch. Microbiol. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e0000823","DOI":"10.1128\/cmr.00008-23","article-title":"Klebsiella pneumoniae Carbapenemase Variants: The New Threat to Global Public Health","volume":"36","author":"Ding","year":"2023","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1038\/s41579-019-0315-1","article-title":"Population Genomics of Klebsiella pneumoniae","volume":"18","author":"Wyres","year":"2020","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.ijantimicag.2008.01.011","article-title":"Colistin Susceptibility Testing by Etest and Disk Diffusion Methods","volume":"31","author":"Galani","year":"2008","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"101123","DOI":"10.1016\/j.drup.2024.101123","article-title":"Emergence of Silent NDM-1 Carbapenemase Gene in Carbapenem-Susceptible Klebsiella Pneumoniae: Clinical Implications and Epidemiological Insights","volume":"76","author":"Qin","year":"2024","journal-title":"Drug Resist. Updates"},{"key":"ref_51","first-page":"181","article-title":"Expressed and Silent Carbapenemase Genes Detected by Multiplex PCR in Both Carbapenem-Resistant and Phenotypically-Susceptible Gram Negative Bacilli","volume":"56","author":"Emira","year":"2020","journal-title":"Alex. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00284-025-04424-6","article-title":"Genomic Characterization Reveals Infections and Silent Dissemination of Carbapenemase-Producing Klebsiella Oxytoca Complex Associated with ST2 Lineage in a Hospital Setting","volume":"82","author":"Knecht","year":"2025","journal-title":"Curr. Microbiol."},{"key":"ref_53","unstructured":"Soci\u00e9t\u00e9 Fran\u00e7aise de Microbiologie, and Comit\u00e9 de l\u2019Antibiogramme de la Soci\u00e9t\u00e9 Fran\u00e7aise de Microbiologie (2026, April 24). Recommandations 2025 V.1.1 Juillet. Available online: https:\/\/www.sfm-microbiologie.org\/wp-content\/uploads\/2025\/07\/CASFM2025_V1.1-JUILLET-2025.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1136\/jcp.56.7.528","article-title":"Evaluation of a New Chromogenic Medium, Uriselect 4, for the Isolation and Identification of Urinary Tract Pathogens","volume":"56","author":"Perry","year":"2003","journal-title":"J. Clin. Pathol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"258","DOI":"10.54044\/RAMI.2023.04.04","article-title":"Antibiogram Picture Guide for the Medical Microbiology Practitioner\u2014Part 2: Common Carbapenemases in Enterobacterales","volume":"82","author":"Muntean","year":"2023","journal-title":"Roum. Arch. Microbiol. Immunol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"312","DOI":"10.54044\/RAMI.2021.04.02","article-title":"Antibiogram Picture Guide for the Medical Microbiology Practitioner\u2014Part 1: Extended-Spectrum Beta-Lactamases (ESBLs) and Cephalosporinases (AmpCs) in Enterobacterales","volume":"80","author":"Muntean","year":"2021","journal-title":"Roum. Arch. Microbiol. Immunol."},{"key":"ref_57","unstructured":"(2026, April 24). The European Committee on Antimicrobial Susceptibility Testing. Clinical Breakpoints and Dosing of Antibiotics. Available online: https:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"ref_58","unstructured":"(2026, May 05). The European Committee on Antimicrobial Susceptibility Testing. Disk Diffusion and Quality Control. Available online: https:\/\/www.eucast.org\/bacteria\/methodology-and-instructions\/disk-diffusion-and-quality-control\/."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Chelaru, E.-C., Muntean, A.-A., Muntean, M.-M., Hogea, M.-O., Caracoti, C.-\u0218., Ciomaga, B.-F., Naas, T., and Popa, M.I. (2025). Oxacillin-Supplemented Mueller-Hinton Agar for In Vitro Inhibition of Ambler Class C \u03b2-Lactamases in Enterobacterales. Antibiotics, 14.","DOI":"10.3390\/antibiotics14060616"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3846","DOI":"10.1128\/JCM.01299-13","article-title":"A Convenient Method To Screen for Carbapenemase-Producing Pseudomonas aeruginosa","volume":"51","author":"Fournier","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_61","unstructured":"CNR R\u00e9sistance aux Antibiotiques (2026, March 13). Detection des Beta-Lactamases a Spectre Etendu de Classe a et d par la Realisation de Tests de Synergie Chez Pseudomonas aeruginosa, Fiche d\u2019Informations. Available online: https:\/\/www.cnr-resistance-antibiotiques.fr\/ressources\/pages\/Tests_synergie_BLSE_V1.pdf."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1128\/JCM.02313-12","article-title":"Clonal Dissemination of Pseudomonas aeruginosa Isolates Producing Extended-Spectrum \u03b2-Lactamase SHV-2a","volume":"51","author":"Jeannot","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_63","unstructured":"Fournier, D., Grisot, E., Potron, A., Liapis, E., Jeannot, K., and Pl\u00e9siat, P. (2026, March 13). Nouvelle Strat\u00e9gie de D\u00e9pistage des P. aeruginosa BLSE ou Carbap\u00e9n\u00e8mase Positifs. Available online: https:\/\/www.cnr-resistance-antibiotiques.fr\/ressources\/pages\/Poster_RICAI_CT_algorithmev2.pdf."},{"key":"ref_64","unstructured":"CNR R\u00e9sistance aux Antibiotiques (2026, March 13). Etude des M\u00e9canismes de R\u00e9sistance Chez A. baumannii: Logigramme. Version 5. Available online: https:\/\/www.cnr-resistance-antibiotiques.fr\/ressources\/pages\/v5_logigramme_prise_en_charge_Acinetobacter.pdf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3542","DOI":"10.1128\/JCM.41.8.3542-3547.2003","article-title":"Outbreak of Extended-Spectrum \u03b2-Lactamase VEB-1-Producing Isolates of Acinetobacter baumannii in a French Hospital","volume":"41","author":"Poirel","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/17460913.2025.2468112","article-title":"Cefepime-Enmetazobactam: First Approved Cefepime-\u03b2-Lactamase Inhibitor Combination for Multi-Drug Resistant Enterobacterales","volume":"20","author":"Bhowmick","year":"2025","journal-title":"Future Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1158.e1","DOI":"10.1016\/j.cmi.2019.05.007","article-title":"Effect of AmpC Derepression on Cefepime MIC in Enterobacterales with Chromosomally Encoded Inducible AmpC \u03b2-Lactamase","volume":"25","author":"Kohlmann","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1093\/cid\/cit395","article-title":"The Use of Cefepime for Treating AMPC \u0392-Lactamase\u2013Producing Enterobacteriaceae","volume":"57","author":"Tamma","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Laborda, P., Colque, C.A., La Rosa, R., Molin, S., and Johansen, H.K. (Nat. Commun., 2025). Carbapenem-Resistance oprD Mutations Reshape Pseudomonas Aeruginosa Host-Pathogen Interactions during Infection, Nat. Commun., Online ahead of print.","DOI":"10.1038\/s41467-026-71782-5"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"4281","DOI":"10.1128\/JCM.01634-13","article-title":"Blue-Carba, an Easy Biochemical Test for Detection of Diverse Carbapenemase Producers Directly from Bacterial Cultures","volume":"51","author":"Pires","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_71","first-page":"464","article-title":"Detection of Carbapenemase Production in a Collection of Enterobacteriaceae with Characterized Resistance Mechanisms from Clinical and Environmental Origins by Use of Both Carba NP and Blue-Carba Tests","volume":"54","author":"Morosini","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Van Der Zwaluw, K., De Haan, A., Pluister, G.N., Bootsma, H.J., De Neeling, A.J., and Schouls, L.M. (2015). The Carbapenem Inactivation Method (CIM), a Simple and Low-Cost Alternative for the CARBA NP Test to Assess Phenotypic Carbapenemase Activity in Gram-Negative Rods. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123690"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1128\/JCM.00193-17","article-title":"Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production among Enterobacteriaceae","volume":"55","author":"Pierce","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e01369-17","DOI":"10.1128\/JCM.01369-17","article-title":"Multicenter Evaluation of the Modified Carbapenem Inactivation Method and the Carba NP for Detection of Carbapenemase-Producing Pseudomonas aeruginosa and Acinetobacter baumannii","volume":"56","author":"Simner","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jgar.2020.03.021","article-title":"Comparison of the Performance of Three Variations of the Carbapenem Inactivation Method (CIM, Modified CIM [mCIM] and in-House Method (iCIM)) for the Detection of Carbapenemase-Producing Enterobacterales and Non-Fermenters","volume":"21","author":"Howard","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e0150924","DOI":"10.1128\/jcm.01509-24","article-title":"Variability of Reagents Matters\u2014Enhancements to the CLSI Modified Carbapenem Inactivation Method Outside the United States to Improve Accuracy","volume":"63","author":"Singh","year":"2025","journal-title":"J. Clin. Microbiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:19:27Z","timestamp":1781324367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,7]]},"references-count":76,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["antibiotics15060580"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15060580","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,7]]}}}