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
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Institution: Guangxi Maternal and Child Health Hospital
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7220981933