{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:56:34Z","timestamp":1787028994838,"version":"build-2736575974"},"reference-count":78,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CIBER\u2014Consorcio Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBERINFEC), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaci\u00f3n, and Uni\u00f3n Europea-NextGenerationEU","award":["PMP22\/00092"],"award-info":[{"award-number":["PMP22\/00092"]}]},{"name":"CIBER\u2014Consorcio Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBERINFEC), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaci\u00f3n, and Uni\u00f3n Europea-NextGenerationEU","award":["PI21CIII\/00039"],"award-info":[{"award-number":["PI21CIII\/00039"]}]},{"name":"CIBER\u2014Consorcio Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBERINFEC), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaci\u00f3n, and Uni\u00f3n Europea-NextGenerationEU","award":["PI24CIII\/00044"],"award-info":[{"award-number":["PI24CIII\/00044"]}]},{"name":"Antibiotic Resistance Surveillance Programs of the National Center for Microbiology, Instituto de Salud Carlos III","award":["PMP22\/00092"],"award-info":[{"award-number":["PMP22\/00092"]}]},{"name":"Antibiotic Resistance Surveillance Programs of the National Center for Microbiology, Instituto de Salud Carlos III","award":["PI21CIII\/00039"],"award-info":[{"award-number":["PI21CIII\/00039"]}]},{"name":"Antibiotic Resistance Surveillance Programs of the National Center for Microbiology, Instituto de Salud Carlos III","award":["PI24CIII\/00044"],"award-info":[{"award-number":["PI24CIII\/00044"]}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PMP22\/00092"],"award-info":[{"award-number":["PMP22\/00092"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21CIII\/00039"],"award-info":[{"award-number":["PI21CIII\/00039"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI24CIII\/00044"],"award-info":[{"award-number":["PI24CIII\/00044"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The global emergence of carbapenem-resistant Acinetobacter baumanii (CRAB) represents a significant public health threat. In the summer of 2022, a polyclonal CRAB outbreak occurred in our hospital, marking the first detection of an NDM-1 plus OXA-23 co-producing A. baumannii strain in Spain. The aim of this study was to phenotypically and genotypically characterize the clonal spread of NDM-1 and OXA-23 co-producing A. baumannii isolates and to describe the infection control measures implemented to contain the outbreak. Patients with multidrug-resistant A. baumannii isolates (July 2022\u2013May 2023) were included in the study. Isolates were identified via MALDI-TOF, and antimicrobial susceptibility was tested using a broth microdilution method (DKMGN SensititreTM panels). Whole-genome sequencing was performed on 24 representative isolates. Phylogenetic analysis was performed using Ridom SeqSphere+ (cgMLST), while sequence typing was performed using ARIBA (Pasteur and Oxford schemes). A. baumannii isolates from the affected patients belonged to five different sequence types. The two main STs were ST1Pas\/ST231Oxf (NDM-1- and OXA-23-co-producing), which accounted for 58%, and ST136Pas\/ST406Oxf (OXA-23-producing), which accounted for 21%. All isolates were resistant to fluoroquinolones, trimethoprim\/sulfamethoxazole, aminoglycosides, and carbapenems. In addition, 8% were resistant to colistin and 17% to cefiderocol. Finally, the affected patients were cohorted, and a thorough cleaning of the affected units was carried out. This study documents the clonal spread of an NDM-1- and OXA-23-co-producing A. baumannii strain in Spain, linked to a Libyan patient, highlighting the risk of cross-border spread. Although infection control measures successfully contained the outbreak, surveillance is essential as the incidence of CRAB infections is expected to increase.<\/jats:p>","DOI":"10.3390\/microorganisms13051149","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T03:51:03Z","timestamp":1747626663000},"page":"1149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Emergence of NDM-1- and OXA-23-Co-Producing Acinetobacter baumannii ST1 Isolates from a Burn Unit in Spain"],"prefix":"10.3390","volume":"13","author":[{"given":"Elena","family":"Hidalgo","sequence":"first","affiliation":[{"name":"Servicio de Microbiolog\u00eda, Hospital Universitario de Getafe, 28905 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Sotelo","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-8914","authenticated-orcid":false,"given":"Mar\u00eda","family":"P\u00e9rez-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngela","family":"Iniesta","sequence":"additional","affiliation":[{"name":"Servicio de Microbiolog\u00eda, Hospital Universitario de Getafe, 28905 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Ca\u00f1ada-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Valiente","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Aracil","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-395X","authenticated-orcid":false,"given":"David","family":"Arana","sequence":"additional","affiliation":[{"name":"Servicio de Microbiolog\u00eda, Hospital Universitario de Getafe, 28905 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3327-8263","authenticated-orcid":false,"given":"Jes\u00fas","family":"Oteo-Iglesias","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, 28222 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e196","DOI":"10.1017\/ash.2024.455","article-title":"Can Risk Factors and Risk Scores Help Predict Colonization and Infection in Multidrug-Resistant Gram-Negative Bacteria?","volume":"4","author":"Pallares","year":"2024","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Morris, S., and Cerceo, E. (2020). Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting. Antibiotics, 9.","DOI":"10.3390\/antibiotics9040196"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lee, C.-R., Lee, J.H., Park, M., Park, K.S., Bae, I.K., Kim, Y.B., Cha, C.-J., Jeong, B.C., and Lee, S.H. (2017). Biology of Acinetobacter Baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front. Cell Infect. Microbiol., 7.","DOI":"10.3389\/fcimb.2017.00055"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1574-6976.2012.00344.x","article-title":"Acinetobacter Baumannii: Human Infections, Factors Contributing to Pathogenesis and Animal Models","volume":"37","author":"McConnell","year":"2013","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_5","first-page":"357","article-title":"Acinetobacter Baumannii: An Overview of Emerging Multidrug-Resistant Pathogen","volume":"77","author":"Gautam","year":"2022","journal-title":"Med. J. Malays."},{"key":"ref_6","unstructured":"National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (2019). Antibiotic Resistance Threats in the United States 2019, U.S. Department of Health and Human Services, CDC."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/BCR.0000000000000256","article-title":"Multidrug-Resistant Bacterial Outbreaks in Burn Units: A Synthesis of the Literature According to the ORION Statement","volume":"37","author":"Vanhems","year":"2016","journal-title":"J. Burn Care Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, Research, and Development of New Antibiotics: The WHO Priority List of Antibiotic-Resistant Bacteria and Tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report for 2021."},{"key":"ref_10","unstructured":"WHO (2019). GLASS, 2019 WHO. Global Antimicrobial Resistance Surveillance System."},{"key":"ref_11","unstructured":"WHO (2019). CAESAR, 2019. Central Asian and European Surveillance of Antimicrobial Resistance."},{"key":"ref_12","unstructured":"WHO (2017). CHINET, 2017. China Antimicrobial Surveillance Network."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3855\/jidc.2268","article-title":"Bla(IMP) and Bla(VIM) Mediated Carbapenem Resistance in Pseudomonas and Acinetobacter Species in India","volume":"6","author":"Amudhan","year":"2012","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Khan, A.U., Maryam, L., and Zarrilli, R. (2017). Structure, Genetics and Worldwide Spread of New Delhi Metallo-\u03b2-Lactamase (NDM): A Threat to Public Health. BMC Microbiol., 17.","DOI":"10.1186\/s12866-017-1012-8"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3617","DOI":"10.1038\/s41467-019-11615-w","article-title":"Protein Determinants of Dissemination and Host Specificity of Metallo-\u03b2-Lactamases","volume":"10","author":"Ayala","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.ijantimicag.2016.03.007","article-title":"Early Detection of Metallo-\u03b2-Lactamase NDM-1- and OXA-23 Carbapenemase-Producing Acinetobacter Baumannii in Libyan Hospitals","volume":"48","author":"Mathlouthi","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.ijantimicag.2018.04.008","article-title":"NDM-1- and OXA-23-Producing Acinetobacter Baumannii Isolated from Intensive Care Unit Patients in Tunisia","volume":"52","author":"Maamar","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1255","DOI":"10.1016\/j.ijid.2013.07.016","article-title":"First Report of NDM-1-Producing Acinetobacter Baumannii in East Africa","volume":"17","author":"Revathi","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13756-017-0262-4","article-title":"Clonal Diversity and Detection of Carbapenem Resistance Encoding Genes among Multidrug-Resistant Acinetobacter Baumannii Isolates Recovered from Patients and Environment in Two Intensive Care Units in a Moroccan Hospital","volume":"6","author":"Uwingabiye","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ragueh, A.A., Aboubaker, M.H., Mohamed, S.I., Rolain, J.-M., and Diene, S.M. (2023). Emergence of Carbapenem-Resistant Gram-Negative Isolates in Hospital Settings in Djibouti. Antibiotics, 12.","DOI":"10.3390\/antibiotics12071132"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/s13756-019-0611-6","article-title":"Phenotypic and Genotypic Characterization of Carbapenem-Resistant Acinetobacter Baumannii Isolates from Egypt","volume":"8","author":"Abouelfetouh","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jgar.2020.11.016","article-title":"Detection of OXA-23, GES-11 and NDM-1 among Carbapenem-Resistant Acinetobacter Baumannii in Dubai: A Preliminary Study","volume":"24","author":"Nabi","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1093\/jac\/dkq273","article-title":"Coexistence of blaOXA-23 with blaNDM-1 and armA in Clinical Isolates of Acinetobacter Baumannii from India","volume":"65","author":"Karthikeyan","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13756-017-0180-5","article-title":"Co-Existence of blaOXA-23 and blaNDM-1 Genes of Acinetobacter Baumannii Isolated from Nepal: Antimicrobial Resistance and Clinical Significance","volume":"6","author":"Joshi","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1089\/mdr.2016.0248","article-title":"Dissemination of blaOXA-23, blaOXA-24, blaOXA-58, and blaNDM-1 Genes of Acinetobacter Baumannii Isolates from Four Tertiary Hospitals in Thailand","volume":"24","author":"Leungtongkam","year":"2018","journal-title":"Microb. Drug Resist."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1093\/jac\/dks064","article-title":"Characterization of a Multidrug-Resistant Acinetobacter Baumannii Strain Carrying the blaNDM-1 and blaOXA-23 Carbapenemase Genes from the Czech Republic","volume":"67","author":"Krizova","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13756-020-00769-8","article-title":"The First Nationwide Multicenter Study of Acinetobacter Baumannii Recovered in Serbia: Emergence of OXA-72, OXA-23 and NDM-1-Producing Isolates","volume":"9","author":"Lukovic","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/0196-6553(88)90053-3","article-title":"CDC Definitions for Nosocomial Infections, 1988","volume":"16","author":"Garner","year":"1988","journal-title":"Am. J. Infect. Control"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1089\/mdr.2020.0132","article-title":"Evaluation of the Novodiag CarbaR+, a Novel Integrated Sample to Result Platform for the Multiplex Qualitative Detection of Carbapenem and Colistin Resistance Markers","volume":"27","author":"Girlich","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Holma, T., Antikainen, J., and Haiko, J. (2021). Evaluation of Three Molecular Carbapenemase Tests: Eazyplex SuperBug Complete B, Novodiag CarbaR+, and Amplidiag CarbaR+MCR. J. Microbiol. Methods, 180.","DOI":"10.1016\/j.mimet.2020.106105"},{"key":"ref_31","unstructured":"(2019). Susceptibility Testing of Infectious Agents and Evaluation of Performance of Antimicrobial Susceptibility Test Devices. Part 1: Broth Micro-Dilution Reference Method for Testing the In Vitro Activity of Antimicrobial Agents Against Rapidly Growing Aerobic Bacteria Involved in Infectious Diseases (Standard No. ISO 20776-1:2019)."},{"key":"ref_32","unstructured":"EUCAST (2022). Breakpoint Tables for Interpretation of MICs and Zone Diameters, version 12.0, EUCAST."},{"key":"ref_33","unstructured":"(2023). Performance Standards for Antimicrobial Susceptibility Testing, 33rd Edition (Standard No. M100)."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"i884","DOI":"10.1093\/bioinformatics\/bty560","article-title":"Fastp: An Ultra-Fast All-in-One FASTQ Preprocessor","volume":"34","author":"Chen","year":"2018","journal-title":"Bioinformatics"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Wick, R.R., Judd, L.M., Gorrie, C.L., and Holt, K.E. (2017). Unicycler: Resolving Bacterial Genome Assemblies from Short and Long Sequencing Reads. PLoS Comput. Biol., 13.","DOI":"10.1371\/journal.pcbi.1005595"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1093\/bioinformatics\/btu153","article-title":"Prokka: Rapid Prokaryotic Genome Annotation","volume":"30","author":"Seemann","year":"2014","journal-title":"Bioinformatics"},{"key":"ref_37","first-page":"e000131","article-title":"ARIBA: Rapid Antimicrobial Resistance Genotyping Directly from Sequencing Reads","volume":"3","author":"Hunt","year":"2017","journal-title":"Microb. Genom."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Diancourt, L., Passet, V., Nemec, A., Dijkshoorn, L., and Brisse, S. (2010). The Population Structure of Acinetobacter Baumannii: Expanding Multiresistant Clones from an Ancestral Susceptible Genetic Pool. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0010034"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4382","DOI":"10.1128\/JCM.43.9.4382-4390.2005","article-title":"Development of a Multilocus Sequence Typing Scheme for Characterization of Clinical Isolates of Acinetobacter Baumannii","volume":"43","author":"Bartual","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2289769","DOI":"10.1080\/21505594.2023.2289769","article-title":"Pathogenicity and Virulence of Acinetobacter Baumannii: Factors Contributing to the Fitness in Healthcare Settings and the Infected Host","volume":"15","author":"Lucidi","year":"2024","journal-title":"Virulence"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e02529-18","DOI":"10.1128\/AAC.02529-18","article-title":"Characterization of Carbapenemase-Producing Klebsiella Oxytoca in Spain, 2016\u20132017","volume":"63","author":"Bautista","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_42","first-page":"e000339","article-title":"Identification of Acinetobacter Baumannii Loci for Capsular Polysaccharide (KL) and Lipooligosaccharide Outer Core (OCL) Synthesis in Genome Assemblies Using Curated Reference Databases Compatible with Kaptive","volume":"6","author":"Wyres","year":"2020","journal-title":"Microb. Genom."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hawkey, J., Hamidian, M., Wick, R.R., Edwards, D.J., Billman-Jacobe, H., Hall, R.M., and Holt, K.E. (2015). ISMapper: Identifying Transposase Insertion Sites in Bacterial Genomes from Short Read Sequence Data. BMC Genom., 16.","DOI":"10.1186\/s12864-015-1860-2"},{"key":"ref_44","first-page":"e000062","article-title":"Quantitative Assessment of Insertion Sequence Impact on Bacterial Genome Architecture","volume":"2","author":"Adams","year":"2016","journal-title":"Microb. Genom."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e00032-15","DOI":"10.1128\/genomeA.00032-15","article-title":"Genome Sequence of Acinetobacter Baumannii Strain A1, an Early Example of Antibiotic-Resistant Global Clone 1","volume":"3","author":"Holt","year":"2015","journal-title":"Genome Announc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/AAC.01672-09","article-title":"A Novel Insertion Sequence, ISAba10, Inserted into ISAba1 Adjacent to the Bla(OXA-23) Gene and Disrupting the Outer Membrane Protein Gene carO in Acinetobacter Baumannii","volume":"55","author":"Lee","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1128\/AAC.02101-13","article-title":"Role of OmpA in the Multidrug Resistance Phenotype of Acinetobacter Baumannii","volume":"58","author":"Smani","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sun, X., Ni, Z., Tang, J., Ding, Y., Wang, X., and Li, F. (2021). The abaI\/abaR Quorum Sensing System Effects on Pathogenicity in Acinetobacter Baumannii. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.679241"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5953","DOI":"10.1128\/JB.00647-09","article-title":"The pgaABCD Locus of Acinetobacter Baumannii Encodes the Production of Poly-Beta-1-6-N-Acetylglucosamine, Which Is Critical for Biofilm Formation","volume":"191","author":"Choi","year":"2009","journal-title":"J. Bacteriol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"11735","DOI":"10.1021\/bi801625b","article-title":"Aryl Acid Adenylating Enzymes Involved in Siderophore Biosynthesis: Fluorescence Polarization Assay, Ligand Specificity, and Discovery of Non-Nucleoside Inhibitors via High-Throughput Screening","volume":"47","author":"Neres","year":"2008","journal-title":"Biochemistry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3473","DOI":"10.1099\/mic.0.26541-0","article-title":"Attachment to and Biofilm Formation on Abiotic Surfaces by Acinetobacter Baumannii: Involvement of a Novel Chaperone-Usher Pili Assembly System","volume":"149","author":"Tomaras","year":"2003","journal-title":"Microbiology"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Singh, M., De Silva, P.M., Al-Saadi, Y., Switala, J., Loewen, P.C., Hausner, G., Chen, W., Hernandez, I., Castillo-Ramirez, S., and Kumar, A. (2020). Characterization of Extremely Drug-Resistant and Hypervirulent Acinetobacter Baumannii AB030. Antibiotics, 9.","DOI":"10.3390\/antibiotics9060328"},{"key":"ref_53","first-page":"2001735","article-title":"Epidemiological Situation, Laboratory Capacity and Preparedness for Carbapenem-Resistant Acinetobacter Baumannii in Europe, 2019","volume":"25","author":"Albiger","year":"2020","journal-title":"Euro Surveill."},{"key":"ref_54","first-page":"100780","article-title":"Endemicity and Diversification of Carbapenem-Resistant Acinetobacter Baumannii in an Intensive Care Unit","volume":"37","author":"Doughty","year":"2023","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Medioli, F., Bacca, E., Faltoni, M., Burastero, G.J., Volpi, S., Menozzi, M., Orlando, G., Bedini, A., Franceschini, E., and Mussini, C. (2022). Is It Possible to Eradicate Carbapenem-Resistant Acinetobacter baumannii (CRAB) from Endemic Hospitals?. Antibiotics, 11.","DOI":"10.3390\/antibiotics11081015"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Bedeni\u0107, B., Brati\u0107, V., Mihaljevi\u0107, S., Luki\u0107, A., Vidovi\u0107, K., Reiner, K., Sch\u00f6enthaler, S., Bari\u0161i\u0107, I., Zarfel, G., and Grisold, A. (2023). Multidrug-Resistant Bacteria in a COVID-19 Hospital in Zagreb. Pathogens, 12.","DOI":"10.3390\/pathogens12010117"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/jebm.12515","article-title":"Effect of Daily Chlorhexidine Bathing on Reducing Infections Caused by Multidrug-Resistant Organisms in Intensive Care Unit Patients: A Semiexperimental Study with Parallel Controls","volume":"16","author":"Huang","year":"2023","journal-title":"J. Evid. Based Med."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Mangioni, D., Fox, V., Chatenoud, L., Bolis, M., Bottino, N., Cariani, L., Gentiloni Silverj, F., Matinato, C., Monti, G., and Muscatello, A. (2023). Genomic Characterization of Carbapenem-Resistant Acinetobacter Baumannii (CRAB) in Mechanically Ventilated COVID-19 Patients and Impact of Infection Control Measures on Reducing CRAB Circulation during the Second Wave of the SARS-CoV-2 Pandemic in Milan, Italy. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.00209-23"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Xiong, L., Deng, C., Yang, G., Shen, M., Chen, B., Tian, R., Zha, H., and Wu, K. (2023). Molecular Epidemiology and Antimicrobial Resistance Patterns of Carbapenem-Resistant Acinetobacter Baumannii Isolates from Patients Admitted at ICUs of a Teaching Hospital in Zunyi, China. Front. Cell Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1280372"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"M\u00fcller, C., Reuter, S., Wille, J., Xanthopoulou, K., Stefanik, D., Grundmann, H., Higgins, P.G., and Seifert, H. (2023). A Global View on Carbapenem-Resistant Acinetobacter Baumannii. mBio, 14.","DOI":"10.1128\/mbio.02260-23"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.2147\/IDR.S310478","article-title":"Molecular Epidemiology of Extensively-Drug Resistant Acinetobacter Baumannii Sequence Type 2 Co-Harboring Bla NDM and Bla OXA From Clinical Origin","volume":"14","author":"Ejaz","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S1473-3099(21)00194-8","article-title":"Widespread Cefiderocol Heteroresistance in Carbapenem-Resistant Gram-Negative Pathogens","volume":"21","author":"Choby","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"201652","DOI":"10.1098\/rsos.201652","article-title":"Screening of Anti-Acinetobacter Baumannii Phytochemicals, Based on the Potential Inhibitory Effect on OmpA and OmpW Functions","volume":"8","author":"Shahryari","year":"2021","journal-title":"R. Soc. Open Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1261\/rna.042572.113","article-title":"Aminoglycoside Resistance 16S rRNA Methyltransferases Block Endogenous Methylation, Affect Translation Efficiency and Fitness of the Host","volume":"20","author":"Lioy","year":"2014","journal-title":"RNA"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1128\/mr.57.1.138-163.1993","article-title":"Molecular Genetics of Aminoglycoside Resistance Genes and Familial Relationships of the Aminoglycoside-Modifying Enzymes","volume":"57","author":"Shaw","year":"1993","journal-title":"Microbiol. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3602","DOI":"10.1128\/AAC.04412-14","article-title":"High Prevalence of Bla(NDM-1) Carbapenemase-Encoding Gene and 16S rRNA armA Methyltransferase Gene among Acinetobacter Baumannii Clinical Isolates in Egypt","volume":"59","author":"Amin","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Urtaza, S., Ocampo-Sosa, A., Molins-Bengoetxea, A., El-Kholy, M.A., Hernandez, M., Abad, D., Shawky, S.M., Alkorta, I., and Gallego, L. (2023). Molecular Characterization of Multidrug Resistant Acinetobacter Baumannii Clinical Isolates from Alexandria, Egypt. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1208046"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1007\/s00284-020-02064-6","article-title":"Polymyxin B Heteroresistance and Adaptive Resistance in Multidrug- and Extremely Drug-Resistant Acinetobacter Baumannii","volume":"77","author":"Genteluci","year":"2020","journal-title":"Curr. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s13756-021-00990-z","article-title":"A Five-Component Infection Control Bundle to Permanently Eliminate a Carbapenem-Resistant Acinetobacter Baumannii Spreading in an Intensive Care Unit","volume":"10","author":"Meschiari","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e379","DOI":"10.1016\/S1473-3099(18)30414-6","article-title":"Epidemiology of Common Resistant Bacterial Pathogens in the Countries of the Arab League","volume":"18","author":"Moghnieh","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/CMR.00042-16","article-title":"Carbapenem-Resistant Acinetobacter Baumannii and Enterobacteriaceae in South and Southeast Asia","volume":"30","author":"Hsu","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Wareth, G., Linde, J., Nguyen, N.H., Nguyen, T.N.M., Sprague, L.D., Pletz, M.W., and Neubauer, H. (2021). WGS-Based Analysis of Carbapenem-Resistant Acinetobacter Baumannii in Vietnam and Molecular Characterization of Antimicrobial Determinants and MLST in Southeast Asia. Antibiotics, 10.","DOI":"10.3390\/antibiotics10050563"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"732","DOI":"10.15537\/smj.2023.44.8.20230194","article-title":"Acinetobacter Baumannii: A Multidrug-Resistant Pathogen, Has Emerged in Saudi Arabia","volume":"44","author":"Aldali","year":"2023","journal-title":"Saudi Med. J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1093\/cid\/ciad100","article-title":"Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)","volume":"76","author":"Falcone","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jgar.2023.02.019","article-title":"Molecular Characterisation of Colistin and Carbapenem-Resistant Clinical Isolates of Acinetobacter Baumannii from Southeast Europe","volume":"33","author":"Music","year":"2023","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"106724","DOI":"10.1016\/j.ijantimicag.2023.106724","article-title":"Multidrug-Resistant Gram-Negative Bacilli Recovered from Respiratory and Blood Specimens from Adults: The ATLAS Surveillance Program in European Hospitals, 2018\u20132020","volume":"61","author":"Humphries","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1080\/14787210.2023.2216455","article-title":"Introduction and Spread of NDM-Producing Enterobacterales and Acinetobacter Baumannii into Middle Eastern Countries: A Molecular-Based Hypothesis","volume":"21","author":"Reich","year":"2023","journal-title":"Expert. Rev. Anti Infect. Ther."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2200926","DOI":"10.2807\/1560-7917.ES.2022.27.50.2200926","article-title":"Increase in NDM-1 and NDM-1\/OXA-48-Producing Klebsiella Pneumoniae in Germany Associated with the War in Ukraine, 2022","volume":"27","author":"Sandfort","year":"2022","journal-title":"Euro Surveill."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/5\/1149\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:34:18Z","timestamp":1760031258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/5\/1149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,16]]},"references-count":78,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["microorganisms13051149"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13051149","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,16]]}}}