{
  "abstract": "Background/objectives\n\nThe dissemination of multidrug-resistant Enterobacterales poses a critical public health challenge, particularly in resource-limited regions with high antimicrobial use and limited surveillance. We analysed the phenotypic and genotypic resistance profiles of carbapenemase-producing Enterobacterales collected in 2023 from three tertiary care hospitals in Peshawar, Pakistan.Methods\n\nWe performed antimicrobial susceptibility testing on 32 Enterobacterales isolates suspected of carbapenemase production using disk diffusion, gradient diffusion, and broth microdilution according to EUCAST guidelines. We conducted whole-genome sequencing to identify resistance genes, sequence types, and mutations associated with reduced susceptibility to novel β-lactams.Results\n\nThe collection comprised 16 Escherichia coli, 13 Klebsiella pneumoniae, and 3 Proteus mirabilis isolates. The predominant carbapenemase gene was bla NDM-5 (90.6%), frequently combined with bla OXA-48-like variants (46.9%). ESBL genes, mainly bla CTX-M-15, were common (78.1%), while CMY-type AmpC β-lactamases were detected in 28.1% of isolates. Insertions in the PBP3-encoding gene ftsI and CMY co-production were associated with elevated aztreonam-avibactam MICs in E.coli. Reduced cefiderocol susceptibility was observed mainly among NDM-producing E. coli ST2 isolates carrying cirA disruption and ftsI insertions. All isolates remained susceptible to colistin, most of them to gentamicin (84.4%), and exhibited wild-type MIC-distributions for tigecycline, and eravacycline. Genomic analysis identified clustering of high-risk clones, suggesting ongoing local transmission. Notably, 11/13 K. pneumoniae ST147 isolates carried multiple virulence-associated genes consistent with hypervirulence.Conclusions\n\nHigh-risk NDM-producing Enterobacterales with increasingly complex resistance and virulence mechanisms are circulating in Pakistan, including determinants compromising last-line β-lactams. Strengthened genomic surveillance is essential to guide therapy and limit further spread.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Medical Microbiology, University Zurich, Gloriastrasse 28/30, Zurich 8006, Switzerland.",
    "Department of Microbiology, The University of Haripur, Haripur, Pakistan.",
    "SIB Swiss Institute of Bioinformatics, Zurich, Switzerland."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Stefano Mancini"
    },
    {
      "affs": [
        1
      ],
      "name": "Irfan Ullah"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Helena M B Seth-Smith"
    },
    {
      "affs": [
        0
      ],
      "name": "Natalia Kolesnik-Goldmann"
    },
    {
      "affs": [
        0
      ],
      "name": "Vladimira Hinic"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Tim Roloff"
    },
    {
      "affs": [
        0
      ],
      "name": "Adrian Egli",
      "orcid": "0000-0002-3564-8603"
    },
    {
      "affs": [
        1
      ],
      "name": "Muhammad Ali Syed"
    },
    {
      "affs": [
        0
      ],
      "name": "Oliver Nolte"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/af0s459xze0w0.bib",
  "cited_by": 0,
  "doi": "10.1093/jacamr/dlag233",
  "fulltext_url": "https://europepmc.org/articles/PMC13691608",
  "id": "af0s459xze0w0",
  "issns": [
    "2632-1823"
  ],
  "landing_url": "https://europepmc.org/article/MED/42921071",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7223414675",
  "pdf_url": "https://europepmc.org/articles/PMC13691608?pdf=render",
  "pmcid": "PMC13691608",
  "pmid": "42921071",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/af0s459xze0w0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42921071",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42921071"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:1313|Antibiotic Resistance in Bacteria",
      "subfield": "general"
    }
  ],
  "title": "Molecular characterization of carbapenemase-producing Enterobacterales from Peshawar City, Khyber Pakhtunkhwa, Pakistan.",
  "title_text": "Molecular characterization of carbapenemase-producing Enterobacterales from Peshawar City, Khyber Pakhtunkhwa, Pakistan.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/af0s459xze0w0",
  "venue": "JAC-antimicrobial resistance",
  "versions": []
}