{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:03:46Z","timestamp":1784891026491,"version":"3.55.0"},"reference-count":75,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Pleven under Intramural Research Project","award":["7\/2024"],"award-info":[{"award-number":["7\/2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Acinetobacter baumannii is a formidable nosocomial pathogen responsible for severe hospital-acquired infections. This study aimed to investigate the relationship between genotypic and phenotypic resistance profiles in 36 non-duplicate invasive A. baumannii isolates collected at a tertiary care hospital in Bulgaria over a six-year period (2019\u20132024). Identification was performed by MALDI-TOF MS and PCR-based detection of blaOXA-51-like and gyrB. Antimicrobial susceptibility testing to ten agents was performed by gradient diffusion and broth microdilution, and selected resistance genes were detected by conventional PCR. Whole-genome sequencing of 17 representative isolates was conducted to confirm the resistance genotype\u2013phenotype associations and perform MLST. Carbapenem resistance was detected in 34\/36 isolates (94.4%), mediated by blaOXA-23-like (29\/34) or blaOXA-72 (5\/34). The armA gene associated with high-level resistance to all three aminoglycosides was identified exclusively in blaOXA-23-like-positive isolates (18\/29). In armA-negative isolates, gentamicin and tobramycin MICs decreased markedly, whereas amikacin MICs remained elevated. In addition, minocycline MICs \u2265 8 mg\/L were observed in the presence of armA. Seven distinct genotypic\u2013phenotypic profiles were defined based on these gene\u2013MIC associations. Resistome and phylogenetic analyses confirmed these relationships, with MLST assigning the isolates to established clonal lineages ST2 and ST636 (International Clone II). These findings support the use of targeted genes, such as armA, combined with phenotypic testing to guide empirical therapy and strengthen local surveillance of high-risk A. baumannii clones in hospital settings.<\/jats:p>","DOI":"10.3390\/microorganisms14081618","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:38:41Z","timestamp":1784889521000},"page":"1618","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genotypic and Phenotypic Resistance Profiles of Invasive Acinetobacter baumannii Isolates at Bulgarian University Hospital"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0951-1961","authenticated-orcid":false,"given":"Teodora","family":"Marinova-Bulgaranova","sequence":"first","affiliation":[{"name":"Department of Microbiology and Virology, Medical University of Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preslava","family":"Hristova","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Virology, Medical University of Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polya","family":"Marinovska","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Virology, Medical University of Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay","family":"Balgaranov","sequence":"additional","affiliation":[{"name":"Department of Pediatric Diseases, Medical University of Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6766-5897","authenticated-orcid":false,"given":"Vladislav","family":"Nankov","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Histology, Cytology and Biology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slavil","family":"Peykov","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria"},{"name":"Department of Genetics, Faculty of Biology, University of Sofia \u2018St. Kliment Ohridski\u2019, 8 Dragan Tzankov Blvd., 1164 Sofia, Bulgaria"},{"name":"BioInfoTech Laboratory, Sofia Tech Park, 111 Tsarigradsko Shose Blvd., 1784 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristina","family":"Hitkova","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Virology, Medical University of Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1128\/CMR.00058-07","article-title":"Acinetobacter baumannii: Emergence of a Successful Pathogen","volume":"21","author":"Peleg","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","first-page":"e02260","article-title":"A Global View on Carbapenem-Resistant Acinetobacter baumannii","volume":"14","author":"Reuter","year":"2023","journal-title":"mBio"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1038\/s41579-024-01054-w","article-title":"ESKAPE Pathogens: Antimicrobial Resistance, Epidemiology, Clinical Impact and Therapeutics","volume":"22","author":"Miller","year":"2024","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_4","unstructured":"(2026, July 14). Surveillance Atlas of Infectious Diseases. Available online: https:\/\/atlas.ecdc.europa.eu\/public\/index.aspx."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ajic.2006.05.226","article-title":"Resistance in Nonfermenting Gram-Negative Bacteria: Multidrug Resistance to the Maximum","volume":"34","author":"McGowan","year":"2006","journal-title":"Am. J. Infect. Control"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Breijyeh, Z., Jubeh, B., and Karaman, R. (2020). Resistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It. Molecules, 25.","DOI":"10.3390\/molecules25061340"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kyriakidis, I., Vasileiou, E., Pana, Z.D., and Tragiannidis, A. (2021). Acinetobacter baumannii Antibiotic Resistance Mechanisms. Pathogens, 10.","DOI":"10.3390\/pathogens10030373"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1093\/jac\/dkac010","article-title":"Large-Scale WGS of Carbapenem-Resistant Acinetobacter baumannii Isolates Reveals Patterns of Dissemination of ST Clades Associated with Antibiotic Resistance","volume":"77","author":"Frenk","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Fournier, P.-E., Vallenet, D., Barbe, V., Audic, S., Ogata, H., Poirel, L., Richet, H., Robert, C., Mangenot, S., and Abergel, C. (2006). Comparative Genomics of Multidrug Resistance in Acinetobacter baumannii. PLoS Genet., 2.","DOI":"10.1371\/journal.pgen.0020007"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4506","DOI":"10.1128\/AAC.01134-10","article-title":"Genomic Analysis of the Multidrug-Resistant Acinetobacter baumannii Strain MDR-ZJ06 Widely Spread in China","volume":"55","author":"Zhou","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhu, L., Yan, Z., Zhang, Z., Zhou, Q., Zhou, J., Wakeland, E.K., Fang, X., Xuan, Z., Shen, D., and Li, Q.-Z. (2013). Complete Genome Analysis of Three Acinetobacter baumannii Clinical Isolates in China for Insight into the Diversification of Drug Resistance Elements. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0066584"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8643","DOI":"10.1038\/srep08643","article-title":"Complete Genome Sequence of Hypervirulent and Outbreak-Associated Acinetobacter baumannii Strain LAC-4: Epidemiology, Resistance Genetic Determinants and Potential Virulence Factors","volume":"5","author":"Ou","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1128\/AAC.02143-15","article-title":"Novel Aminoglycoside Resistance Transposons and Transposon-Derived Circular Forms Detected in Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates","volume":"60","author":"Karah","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_14","first-page":"e000052","article-title":"Five Decades of Genome Evolution in the Globally Distributed, Extensively Antibiotic-Resistant Acinetobacter baumannii Global Clone 1","volume":"2","author":"Holt","year":"2016","journal-title":"Microb. Genom."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1128\/JCM.01021-06","article-title":"Identification of Acinetobacter baumannii by Detection of the blaOXA-51-like Carbapenemase Gene Intrinsic to This Species","volume":"44","author":"Turton","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4592","DOI":"10.1128\/JCM.01765-10","article-title":"gyrB Multiplex PCR to Differentiate between Acinetobacter calcoaceticus and Acinetobacter Genomic Species 3","volume":"48","author":"Higgins","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_17","unstructured":"(2025). Performance Standards for Antimicrobial Susceptibility Testing (Standard No. M100)."},{"key":"ref_18","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":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ijantimicag.2006.01.004","article-title":"Multiplex PCR for Genes Encoding Prevalent OXA Carbapenemases in Acinetobacter Spp","volume":"27","author":"Woodford","year":"2006","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Goudarzi, H., Mirsamadi, E.S., Ghalavand, Z., Hakemi Vala, M., Mirjalali, H., and Hashemi, A. (2019). Rapid Detection and Molecular Survey of blaVIM, blaIMP and blaNDM Genes among Clinical Isolates of Acinetobacter baumannii Using New Multiplex Real-Time PCR and Melting Curve Analysis. BMC Microbiol., 19.","DOI":"10.1186\/s12866-019-1510-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.diagmicrobio.2010.12.002","article-title":"Multiplex PCR for Detection of Acquired Carbapenemase Genes","volume":"70","author":"Poirel","year":"2011","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1128\/JCM.01550-08","article-title":"Development and Evaluation of a Real-Time PCR Assay for Detection of Klebsiella Pneumoniae Carbapenemase Genes","volume":"47","author":"Cole","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"642","DOI":"10.3201\/eid1304.060501","article-title":"16S rRNA Methylase\u2013Producing, Gram-Negative Pathogens, Japan","volume":"13","author":"Yamane","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1128\/AAC.48.2.666-669.2004","article-title":"Class 1 Integrons Increase Trimethoprim-Sulfamethoxazole MICs against Epidemiologically Unrelated Stenotrophomonas Maltophilia Isolates","volume":"48","author":"Barbolla","year":"2004","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1093\/bioinformatics\/btu170","article-title":"Trimmomatic: A Flexible Trimmer for Illumina Sequence Data","volume":"30","author":"Bolger","year":"2014","journal-title":"Bioinformatics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1089\/cmb.2012.0021","article-title":"SPAdes: A New Genome Assembly Algorithm and Its Applications to Single-Cell Sequencing","volume":"19","author":"Bankevich","year":"2012","journal-title":"J. Comput. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1093\/bioinformatics\/btt086","article-title":"QUAST: Quality Assessment Tool for Genome Assemblies","volume":"29","author":"Gurevich","year":"2013","journal-title":"Bioinformatics"},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"3691","DOI":"10.1093\/bioinformatics\/btv421","article-title":"Roary: Rapid Large-Scale Prokaryote Pan Genome Analysis","volume":"31","author":"Page","year":"2015","journal-title":"Bioinformatics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4453","DOI":"10.1093\/bioinformatics\/btz305","article-title":"RAxML-NG: A Fast, Scalable and User-Friendly Tool for Maximum Likelihood Phylogenetic Inference","volume":"35","author":"Kozlov","year":"2019","journal-title":"Bioinformatics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"W78","DOI":"10.1093\/nar\/gkae268","article-title":"Interactive Tree of Life (iTOL) v6: Recent Updates to the Phylogenetic Tree Display and Annotation Tool","volume":"52","author":"Letunic","year":"2024","journal-title":"Nucleic Acids Res."},{"key":"ref_32","unstructured":"(2026, July 19). Jamovi\u2014Open Statistical Software. Available online: https:\/\/www.jamovi.org\/index.html."},{"key":"ref_33","unstructured":"(2026, July 19). The Comprehensive R Archive Network. Available online: https:\/\/cran.r-project.org\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.phrp.2011.11.040","article-title":"Alterations of gyrA, gyrB, and parC and Activity of Efflux Pump in Fluoroquinolone-Resistant Acinetobacter baumannii","volume":"2","author":"Park","year":"2011","journal-title":"Osong Public. Health Res. Perspect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e0089222","DOI":"10.1128\/aac.00892-22","article-title":"Genomic Analysis of a Strain Collection Containing Multidrug-, Extensively Drug-, Pandrug-, and Carbapenem-Resistant Modern Clinical Isolates of Acinetobacter baumannii","volume":"66","author":"Valcek","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Shelenkov, A., Akimkin, V., and Mikhaylova, Y. (2023). International Clones of High Risk of Acinetobacter baumannii-Definitions, History, Properties and Perspectives. Microorganisms, 11.","DOI":"10.3390\/microorganisms11082115"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hummel, D., Juhasz, J., Kamotsay, K., Kristof, K., Xavier, B.B., Koster, S.D., Szabo, D., and Kocsis, B. (2024). Genomic Investigation and Comparative Analysis of European High-Risk Clone of Acinetobacter baumannii ST2. Microorganisms, 12.","DOI":"10.3390\/microorganisms12122474"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1111\/j.1469-0691.2008.02018.x","article-title":"Clonal Spread of Carbapenem-Resistant OXA-23-Positive Acinetobacter baumannii in a Bulgarian University Hospital","volume":"14","author":"Stoeva","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","unstructured":"Stoeva, T.J. (2009). Microbiological and Molecular-Genetic Investigations on the Epidemiology and Antimicrobial Resistance of Clinical A. baumannii Isolates. [Doctoral Thesis, Medical University of Varna]. (In Bulgerian)."},{"key":"ref_40","unstructured":"Strateva, T.V. (2023). Antibiotic Resistance, Virulence and Epidemiology of Therapeutically Problematic Isolates from the Group of \u201cNon-Glucose-Fermenting Gram-Negative Bacteria\u201d (2004\u20132023). [Habilitation Thesis, Medical University of Sofia]. (In Bulgarian)."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e33372","DOI":"10.1016\/j.heliyon.2024.e33372","article-title":"Decoding the Resistome, Virulome and Mobilome of Clinical versus Aquatic Acinetobacter baumannii in Southern Romania","volume":"10","author":"Surleac","year":"2024","journal-title":"Heliyon"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s13353-021-00612-9","article-title":"Endemicity of OXA-23 and OXA-72 in Clinical Isolates of Acinetobacter baumannii from Three Neighbouring Countries in Southeast Europe","volume":"62","author":"Kovacic","year":"2021","journal-title":"J. Appl. Genet."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Papadopoulou, M., Deliolanis, I., Polemis, M., Vatopoulos, A., Psichogiou, M., and Giakkoupi, P. (2024). Characteristics of the Genetic Spread of Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Greek Hospital. Genes, 15.","DOI":"10.3390\/genes15040458"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.ijantimicag.2017.01.028","article-title":"Predominance of International Clone 2 OXA-23-Producing-Acinetobacter baumannii Clinical Isolates in Greece, 2015: Results of a Nationwide Study","volume":"49","author":"Pournaras","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3201\/eid1601.090852","article-title":"Worldwide Dissemination of the blaOXA-23 Carbapenemase Gene of Acinetobacter baumannii1","volume":"16","author":"Mugnier","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.meegid.2012.11.003","article-title":"Clonal Diversity and High Prevalence of OXA-58 among Acinetobacter baumannii Isolates from Blood Cultures in a Tertiary Care Centre in Turkey","volume":"14","author":"Metan","year":"2013","journal-title":"Infect. Genet. Evol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s10096-016-2685-x","article-title":"Spread of Carbapenem-Resistant International Clones of Acinetobacter baumannii in Turkey and Azerbaijan: A Collaborative Study","volume":"35","author":"Ahmed","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Karampatakis, T., Tsergouli, K., and Behzadi, P. (2025). Carbapenem-Resistant Acinetobacter baumannii: Virulence Factors, Molecular Epidemiology, and Latest Updates in Treatment Options. Microorganisms, 13.","DOI":"10.3390\/microorganisms13091983"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Strateva, T.V., Sirakov, I., Stoeva, T.J., Stratev, A., and Peykov, S. (2023). Phenotypic and Molecular Characteristics of Carbapenem-Resistant Acinetobacter baumannii Isolates from Bulgarian Intensive Care Unit Patients. Microorganisms, 11.","DOI":"10.3390\/microorganisms11040875"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1099\/jmm.0.055384-0","article-title":"Co-Existence of blaOXA-23 and armA in Multidrug-Resistant Acinetobacter baumannii Isolated from a Hospital in South Korea","volume":"62","author":"Hong","year":"2013","journal-title":"J. Med. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4167\/jbv.2013.43.1.27","article-title":"The Genetic Characteristics of Multidrug-resistant Acinetobacter baumannii Coproducing 16S rRNA MethylasearmAand Carbapenemase OXA-23","volume":"43","author":"Lim","year":"2013","journal-title":"J. Bacteriol. Virol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Palmieri, M., D\u2019Andrea, M.M., Pelegrin, A.C., Perrot, N., Mirande, C., Blanc, B., Legakis, N., Goossens, H., Rossolini, G.M., and van Belkum, A. (2020). Abundance of Colistin-Resistant, OXA-23- and ArmA-Producing Acinetobacter baumannii Belonging to International Clone 2 in Greece. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.00668"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Findlay, J., Nordmann, P., Bouvier, M., Kerbol, A., and Poirel, L. (2023). Dissemination of ArmA- and OXA-23-Co-Producing Acinetobacter baumannii Global Clone 2 in Switzerland, 2020\u20132021. Eur. J. Clin. Microbiol. Infect. Dis., 1\u20135.","DOI":"10.1007\/s10096-023-04643-4"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2916","DOI":"10.1128\/AAC.01212-13","article-title":"Dissemination of 16S rRNA Methylase ArmA-Producing Acinetobacter baumannii and Emergence of OXA-72 Carbapenemase Coproducers in Japan","volume":"58","author":"Tada","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1089\/mdr.2015.0254","article-title":"Frequency of Aminoglycoside-Modifying Enzymes and armA Among Different Sequence Groups of Acinetobacter baumannii in Iran","volume":"22","author":"Hasani","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1093\/ofid\/ofy293","article-title":"Antimicrobial Susceptibility of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex and Stenotrophomonas Maltophilia Clinical Isolates: Results from the SENTRY Antimicrobial Surveillance Program (1997\u20132016)","volume":"6","author":"Gales","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jgar.2024.01.019","article-title":"In Vitro Antimicrobial Susceptibility Data of Global Meropenem-Resistant Acinetobacter baumannii Isolates Causing Pneumonia: Data from the Antimicrobial Testing Leadership and Surveillance Program, 2014\u20132021, and Re-Estimations of Susceptibility Breakpoints and Appropriate Dosages of Important Antibiotics for Pneumonia Treatment","volume":"36","author":"Hsueh","year":"2024","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e02700-25","DOI":"10.1128\/spectrum.02700-25","article-title":"Assessment of the Revision of the 2025 CLSI Breakpoints for the Interpretation of Minocycline Susceptibility for Acinetobacter baumannii Complex","volume":"14","author":"Yu","year":"2026","journal-title":"Microbiol. Spectr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"105444","DOI":"10.1016\/j.meegid.2023.105444","article-title":"Insights into the Genetic Contexts of Sulfonamide Resistance among Early Clinical Isolates of Acinetobacter baumannii","volume":"112","author":"Bala","year":"2023","journal-title":"Infect. Genet. Evol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"4031","DOI":"10.1038\/s41467-023-39778-7","article-title":"Molecular Mechanism of Plasmid-Borne Resistance to Sulfonamide Antibiotics","volume":"14","author":"Venkatesan","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1128\/AAC.02413-15","article-title":"The Asp20-to-Asn Substitution in the Response Regulator AdeR Leads to Enhanced Efflux Activity of AdeB in Acinetobacter baumannii","volume":"60","author":"Nowak","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e00712-24","DOI":"10.1128\/aac.00712-24","article-title":"The Novel MFS Efflux Pump SxtP, Regulated by the LysR-Type Transcriptional Activator SxtR, Is Involved in the Susceptibility to Sulfamethoxazole\/Trimethoprim (SXT) and the Pathogenesis of Acinetobacter baumannii","volume":"68","author":"Gaona","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Roy, S., Chatterjee, S., Bhattacharjee, A., Chattopadhyay, P., Saha, B., Dutta, S., and Basu, S. (2021). Overexpression of Efflux Pumps, Mutations in the Pumps\u2019 Regulators, Chromosomal Mutations, and AAC(6\u2019)-Ib-Cr Are Associated With Fluoroquinolone Resistance in Diverse Sequence Types of Neonatal Septicaemic Acinetobacter baumannii: A 7-Year Single Center Study. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.602724"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e00279-24","DOI":"10.1128\/cmr.00279-24","article-title":"Drug-Resistant Acinetobacter baumannii: Mortality, Emerging Treatments, and Future Pharmacological Targets for a WHO Priority Pathogen","volume":"38","author":"Dubey","year":"2025","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Guidelines for the Treatment of Infections Caused by Multidrug-Resistant Gram-Negative Bacilli (Endorsed by European Society of Intensive Care Medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Tamma, P.D., Aitken, S.L., Bonomo, R.A., Mathers, A.J., van Duin, D., and Clancy, C.J. (2023). Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Clin. Infect. Dis., ciad428.","DOI":"10.1093\/cid\/ciad428"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3947\/ic.2024.0110","article-title":"Minocycline Susceptibility of Carbapenem-Resistant Acinetobacter baumannii Blood Isolates from a Single Center in Korea: Role of tetB in Resistance","volume":"57","author":"Kim","year":"2025","journal-title":"Infect. Chemother."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"S179","DOI":"10.1093\/cid\/ciad094","article-title":"Navigating Available Treatment Options for Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus Complex Infections","volume":"76","author":"Shields","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_69","first-page":"e000306","article-title":"Emergence, Molecular Mechanisms and Global Spread of Carbapenem-Resistant Acinetobacter baumannii","volume":"5","author":"Hamidian","year":"2019","journal-title":"Microb. Genom."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"dlaf134","DOI":"10.1093\/jacamr\/dlaf134","article-title":"The Global Epidemiology of Carbapenem-Resistant Acinetobacter baumannii","volume":"7","author":"Boutzoukas","year":"2025","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Cherubini, S., Perilli, M., Segatore, B., Fazii, P., Parruti, G., Frattari, A., Amicosante, G., and Piccirilli, A. (2022). Whole-Genome Sequencing of ST2 A. baumannii Causing Bloodstream Infections in COVID-19 Patients. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070955"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"dlaf140","DOI":"10.1093\/jacamr\/dlaf140","article-title":"Phenotypic and Genotypic Analysis of Acinetobacter baumannii Isolated from Combat Wounds in Ukraine during 2022 and 2023","volume":"7","author":"Kondratiuk","year":"2025","journal-title":"JAC Antimicrob Resist."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"18203","DOI":"10.1038\/s41598-025-03246-7","article-title":"Genomic Landscape of Nosocomial Acinetobacter baumannii: A Comprehensive Analysis of the Resistome, Virulome, and Mobilome","volume":"15","author":"Pearl","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jhin.2021.02.023","article-title":"Clinical and Molecular Characteristics of OXA-72-Producing Acinetobacter baumannii ST636 Outbreak at a Neonatal Intensive Care Unit in Serbia","volume":"112","author":"Gajic","year":"2021","journal-title":"J. Hosp. Infect."},{"key":"ref_75","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"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/8\/1618\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:57:26Z","timestamp":1784890646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/8\/1618"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":75,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["microorganisms14081618"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14081618","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}