Clinical characteristics, molecular features and in vitro susceptibility to sulbactam-durlobactam, cefiderocol, and eravacycline in NDM-1-producing versus OXA-23-producing carbapenem-resistant Acinetobacter baumannii isolates from children in Guangxi, China.

@article{liu2026clinical,
  title = {{Clinical characteristics, molecular features and in vitro susceptibility to sulbactam-durlobactam, cefiderocol, and eravacycline in NDM-1-producing versus OXA-23-producing carbapenem-resistant Acinetobacter baumannii isolates from children in Guangxi, China.}},
  author = {Minxue Liu and Mengjun Li and Chenglan Yan and Liying Huang and Huan Zhang},
  journal = {Frontiers in cellular and infection microbiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fcimb.2026.1965770},
  url = {https://europepmc.org/article/MED/42923101},
  note = {CC BY},
}

TY  - JOUR
TI  - Clinical characteristics, molecular features and in vitro susceptibility to sulbactam-durlobactam, cefiderocol, and eravacycline in NDM-1-producing versus OXA-23-producing carbapenem-resistant Acinetobacter baumannii isolates from children in Guangxi, China.
AU  - Minxue Liu
AU  - Mengjun Li
AU  - Chenglan Yan
AU  - Liying Huang
AU  - Huan Zhang
PY  - 2026
DA  - 2026/10/08
JO  - Frontiers in cellular and infection microbiology
DO  - 10.3389/fcimb.2026.1965770
UR  - https://europepmc.org/article/MED/42923101
AB  - Background  Carbapenem-resistant A. baumannii (CRAB) has been recognized as a critical priority pathogen responsible for a wide range of hospital-acquired infections.Methods  We included pediatric CRAB infection cases at a Maternal and Child Health Hospital in Guangxi, China, from January 2019 to December 2024. The bacterial isolates had previously undergone whole-genome sequencing (WGS). An NDM-1-producing CRAB strain isolated from a bloodstream infection was subjected to Nanopore sequencing to characterize the NDM-1-encoding plasmid. We then retrospectively analyzed the risk factors for NDM-1-producing CRAB infection in children. In addition, the NDM-1-producing and OXA-23-producing CRAB strains were subjected to antimicrobial susceptibility testing (AST) against sulbactam-durlobactam, cefiderocol, and eravacycline using the micro-broth dilution method, and their susceptibility profiles were compared. Associated resistance genes were analyzed.Results  A total of 131 pediatric patients with CRAB infections were included in this study. Based on the WGS data, 33 CRAB strains harboring bla NDM-1 were classified into the NDM-1-producing group, while 98 CRAB strains harboring bla OXA-23 were classified into the OXA-23-producing group. On multivariable analysis, indwelling urethral catheters (OR = 0.293; P = 0.009) and white blood cell (WBC) count (OR = 0.896; P = 0.039) were negatively associated with NDM-1-producing CRAB infection, yet positively associated with OXA-23-producing infections (P < 0.05). WGS analysis revealed that 32 of the 33 (97.0%) NDM-1-producing CRAB isolates co-carried bla PER-1, which has been reported to be associated with cefiderocol resistance in A. baumannii. Plasmid mapping showed that the same plasmid co-harbored bla NDM-1 and bla PER-1, together with a type IV secretion system (T4SS). The resistance rate of NDM-1-producing CRAB isolates to sulbactam-durlobactam was 100%, and to cefiderocol was 66.7%-both rates being significantly higher than those observed in the OXA-23-producing group (1.0% and 0.0%, respectively; P < 0.001). However, all 131 isolates demonstrated susceptibility to eravacycline in vitro.Conclusion  Clinical characteristics and antibiotic susceptibility differed significantly between NDM-1-producing and OXA-23-producing CRAB infections. Carbapenemase surveillance is critical for the management of CRAB infections among pediatric patients in Guangxi, China, and AST is essential to guide treatment.
SN  - 2235-2988
ER  -