Abstract Background Since March 2022, there has been an emergence of MDR microorganisms (MDRO) in Europe because of an increasing number of Ukrainian patients with MDRO. The goal was to collect large-scale phenotypic susceptibility data to assess implications for clinical practice. Methods For 122 MDRO (carbapenemase-producing Enterobacterales (CPE, n=96), Pseudomonas aeruginosa CPPA (n=20), carbapenem-resistant Acinetobacter baumannii-calcoaceticus (CRAB, n=6), collected from March to December 2022, broth microdilution (BMD), fosfomycin agar dilution, gradient strip ampicillin/sulbactam, sulbactam/durlobactam, ceftazidime-avibactam-aztreonam and disc diffusion (DD) cefiderocol was performed. Epidemiological data was obtained as part of mandatory reporting by Municipal Health Services (CPE), and surveillance questionnaires (CPPA/CRAB). Results Admission at a Ukrainian hospital in the last year was a risk factor for acquiring MDRO. Of all isolates, 65% (79/122) were blaNDM-positive. For meropenem, aminoglycosides, ceftazidime-avibactam, ceftolozane-tazobactam and imipenem-relebactam susceptibility rates were low (0-30%). For cefiderocol, results depended on reading with or without microcolonies, applying EUCAST or CLSI breakpoints, and whether DD or BMD was used: e.g. for Klebsiella pneumoniae, 30%–97% were susceptible, depending on these variables. For colistin, 103/111 (93%) non-intrinsically resistant CPE/CPPA/CRAB isolates were susceptible. For the majority of CPE, a low MIC of <0.5 mg/L was measured for tigecycline and ceftazidime-avibactam-aztreonam. For CPPA, cefiderocol tested susceptible in 65%–100% of isolates. For CRAB, ampicillin/sulbactam MICs were ≥128 mg/L, for sulbactam/durlobactam 1–2 mg/L. Conclusions There is extensive phenotypic resistance to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients. For cefiderocol, interpretation of susceptibility results depends on a number of variables. In case of infection, treatment options are colistin, cefiderocol (CPE/CPPA/CRAB), tigecycline (CPE/CRAB), ceftazidime-avibactam-aztreonam (CPE), sulbactam/durlobactam (CRAB).
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