Abstract Background Klebsiella pneumoniae is a major cause of healthcare-associated infections in Romania, where carbapenem resistance rates exceed 63%. The dissemination of clones co-producing multiple carbapenemases poses a critical challenge to infection control and antimicrobial management. Objectives To describe the molecular characteristics of carbapenem-resistant K. pneumoniae (CRKp) isolates and to assess their epidemiological relevance in a Romanian tertiary-care hospital. Methods Non-duplicate CRKp isolates collected between July 2023 and May 2025 were included. Identification and antimicrobial susceptibility testing were performed according to EUCAST 2025 criteria. Isolates with reduced carbapenem susceptibility underwent WGS using Oxford Nanopore technology. MLST, resistome, virulome and plasmid profiling were analysed. Results A total of 101 CRKp isolates were included. In 55.4% (n = 56) of strains the resistance genotype displayed both blaNDM-5 and blaOXA-48-like genes. WGS identified ST383 as the dominant sequence type (n = 31; 30.7%), with 93.5% (29/31) of ST383 clones co-harbouring blaNDM-5 and blaOXA-48 along with blaCTX-M-15 genes, primarily located on mosaic resistance–virulence plasmids, with evidence of chromosomal integration. Cefiderocol susceptibility was 90.3% by broth microdilution. All tested ST383 isolates remained susceptible to aztreonam–avibactam. Conclusions ST383 emerged as the dominant carbapenemase-producing K. pneumoniae lineage and represents the first documented identification in Romania of strains co-harbouring blaNDM-5 and blaOXA-48, highlighting the emergence of a high-risk clone with substantial dissemination potential.
Gheorghita et al. (Thu,) studied this question.
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