{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:11:47Z","timestamp":1792523507240,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: The epidemiology of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) in Europe is evolving towards an increasing contribution of metallo-\u03b2-lactamases (MBLs). In particular, co-production of New Delhi metallo-\u03b2-lactamase (NDM) and OXA-48-like carbapenemases represents a major concern due to limited therapeutic options and epidemic potential. We aimed to describe temporal trends and genomic characteristics of NDM and OXA-48-like co-producing K. pneumoniae within a regional surveillance programme targeting ceftazidime-avibactam (CZA)-resistant carbapenem-resistant Enterobacterales (CRE) in the Latium Region, Italy. Methods: Between January 2019 and December 2025, CZA-resistant CRE isolates were collected through a regional surveillance network. Antimicrobial susceptibility testing and carbapenemase detection were performed, and NDM-producing K. pneumoniae (NDM-Kpn) was analysed by whole-genome sequencing (WGS). Genomic analyses included multi-locus sequence typing, assessment of clonal relatedness, and resistome\/virulome profiling. Results: A total of 2752 non-repetitive CZA-resistant CRE were collected. The analysis of CZA-resistant K. pneumoniae isolates submitted to the regional surveillance network showed that the proportion of NDM producers increased markedly from 2023 onwards. In particular, NDM in association with OXA-48-like reached 26.0% in 2024 and 43.6% in 2025, becoming the predominant carbapenemase profile within this selected surveillance population. WGS of 437 NDM-Kpn revealed a structured population dominated by Sequence Type (ST)147 (63.2%), widely disseminated across 24 hospitals and characterised by a predominant NDM-1 variant and OXA-48-like co-producing profile associated with KL10\/wzi420 capsular type. A subset of isolates, mainly within the ST147-KL64 subgroup, showed higher virulence scores, indicating a possible convergence of resistance and virulence. Conclusions: Our findings indicate a rapid shift towards NDM-mediated resistance among CZA-resistant K. pneumoniae submitted to the regional surveillance network, with the emergence of NDM and OXA-48-like co-producing isolates associated with a dominant ST147 clone detected across multiple hospitals. These results highlight the urgent need for coordinated genomic surveillance and infection prevention strategies.<\/jats:p>","DOI":"10.3390\/antibiotics15080766","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:23:50Z","timestamp":1786357430000},"page":"766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Emergence and Dissemination of NDM+OXA-48-like Co-Producing Klebsiella pneumoniae in a Regional Healthcare Network: Seven-Year Surveillance from Latium, Italy"],"prefix":"10.3390","volume":"15","author":[{"given":"Carolina","family":"Venditti","sequence":"first","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4214-2812","authenticated-orcid":false,"given":"Claudia","family":"Rotondo","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Maestripieri","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Caparrelli","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornella","family":"Butera","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"},{"name":"UOS Technical Health Professions, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1768-6017","authenticated-orcid":false,"given":"Michele","family":"Properzi","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-0437","authenticated-orcid":false,"given":"Carla","family":"Nisii","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-6194","authenticated-orcid":false,"given":"Silvia","family":"D\u2019Arezzo","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9131-7502","authenticated-orcid":false,"given":"Marina","family":"Selleri","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cervoni","sequence":"additional","affiliation":[{"name":"Regional Service for Surveillance and Control of Infectious Diseases (SERESMI)\u2014Lazio Region, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilda","family":"Tonziello","sequence":"additional","affiliation":[{"name":"Regional Service for Surveillance and Control of Infectious Diseases (SERESMI)\u2014Lazio Region, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-6457","authenticated-orcid":false,"given":"Paola","family":"Scognamiglio","sequence":"additional","affiliation":[{"name":"Regional Service for Surveillance and Control of Infectious Diseases (SERESMI)\u2014Lazio Region, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"},{"name":"Directorate for Health and Social Policy, Lazio Region, 00145 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Siddu","sequence":"additional","affiliation":[{"name":"Directorate for Health and Social Policy, Lazio Region, 00145 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2198-1947","authenticated-orcid":false,"given":"Carla","family":"Fontana","sequence":"additional","affiliation":[{"name":"Microbiology and Biobank Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d, IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100089","DOI":"10.1016\/j.infpip.2020.100089","article-title":"Carbapenemase-producing Enterobacterales: A challenge for healthcare now and for the next decade","volume":"2","author":"Patel","year":"2020","journal-title":"Infect. 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