Whole Genome Sequencing Insights on Extensive Drug Resistant Klebsiella pneumoniae and Pseudomonas aeruginosa Traumatic Infection.

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<b>Background and Objective:</b> It is well documented that Whole Genome Sequencing (WGS) has recently used to explore new resistance patterns and track the dissemination of extensive and pan drug-resistant microbes in healthcare settings. This article explores the link between traumatic infections caused by road traffic accidents (RTAs) leading to coma and the development of chest infections caused by extensively drug-resistant (XDR) <i>Klebsiella pneumoniae</i> and <i>Pseudomonas aeruginosa</i>. <b>Materials and Methods:</b> The study was carried out from March to December 2022 which included a 45-year-old male patient admitted to the ICU of Al Ramadi Teaching Hospitals following a severe RTA that resulted in a TBI and subsequent coma. Two study isolates were diagnosed bacteriologically using the VITEK<sup>®</sup>-2 technique including resistant mechanisms like extended-spectrum beta-lactamases and carbapenemases. Whole genome sequencing was performed using a DNA nanoball sequencing platform from BGI-Tech. Genome assembly and annotation were done using the bacterial bioinformatics resource center. The report on Comprehensive Genome Analysis includes a phylogenetic analysis using the reference and representative genomes provided by PATRIC. <b>Results:</b> <i>Klebsiella pneumoniae</i> and <i>P. aeruginosa</i> isolates were XDR, producing ESBLs and carbapenemases. The WGS detection NDM-5 gene in the <i>K. pneumoniae</i> strain is not very common compared to the NDM-1 and blaOXA-181 g. At the same time, a file in <i>P. aeruginosa</i> isolate found genes GES-type ESBL (not reported in Iraq before), blaPAO and blaOXA-396 with NDM-1 all these genes are carbapenemases. In phylogenetic analysis, the <i>K. pneumoniae</i> isolate has an evolutionary relationship with strains originating from China while <i>P. aeruginosa</i> was globally unique. <b>Conclusion:</b> The XDR <i>K. pneumoniae</i> and <i>P. aeruginosa</i> pose a public health threat. The WGS revealed unique virulence and antibiotic-resistance genes associated with nosocomial outbreaks. The XDR isolates carrying NDM-5, blaOXA-181 and GES-type ESBL genes were detected.