Sequence Type 131 Research Articles

Molecular and Epidemiological Analysis of Carbapenem-Resistant Klebsiella pneumoniae in a Greek Tertiary Hospital: A Retrospective Study

Carbapenemase-producing Klebsiella pneumoniae is responsible for multiple serious infections with high mortality rates. K. pneumoniae carbapenemases (KPCs) are the most commonly isolated carbapenemases worldwide. To study the epidemiological and molecular characteristics of KPC-producing K. pneumoniae (KPC-KP), we conducted a retrospective study at the University General Hospital of Ioannina, Greece. A total of 177 K. pneumoniae clinical strains from the period 2014–2015 were confirmed as KPC producers by polymerase chain reaction (PCR) and were further examined for the presence of blaVIM, blaNDM, blaTEM, blaSHV, and blaCTX-M genes. Using the amplification refractory mutation system (ARMS) method, we identified the presence of the KPC-2 allele in 130 strains and the KPC-9 allele in 47. Strains from both allele groups belonged to the sequence type 258 (ST258). KPC-9 was responsible for a distinct outbreak, considered part of the broader KPC-2 outbreak. Molecular characterization of selected KPC-KP isolates from the period 2021–2022 revealed their continued presence in our hospital. Comparison of the antimicrobial susceptibility profiles of the two alleles showed a statistically significant increase in minimum inhibitory concentration (MIC) for ceftazidime (p = 0.03) and higher resistance to amikacin (p = 0.012) and colistin (p < 0.001) for KPC-9 compared to the KPC-2 allele. The two KPC alleles had similar mortality rates. This study demonstrates the heterogeneity of resistance genes in carbapenem-resistant K. pneumoniae (CR-KP) within a single-hospital setting and underscores the need for immediate containment measures.

Potential of a phage cocktail in the treatment of multidrug-resistant Klebsiella pneumoniae pulmonary infection in mice

The emergence of multidrug-resistant Klebsiella pneumoniae, including carbapenem-resistant K. pneumoniae (CRKP), as one of the most common and notable superbugs, has long been a major threat to public health. As natural predators of bacteria, bacteriophages (or phages) can induce the lysis of bacterial cells. Herein, we report the isolation and characterization of two phages and their efficacy in the control of CRKP. Using the sequence type 11 (ST11) CRKP strain THR60 and its related strain THR60r as the host bacteria, phages GZ7 and GZ9 were isolated from hospital sewage, respectively. GZ7 is a myovirus with a head of 64 nm in diameter and a tail of 97 nm in length, and GZ9 is a siphovirus with a head of 67 nm in diameter and a tail of 175 nm in length. The host spectrum of a phage cocktail consisting of phages GZ7 and GZ9 was 82.4% (42/51 strains). An in vitro antibacterial activity assay demonstrated that the phage cocktail consisting of GZ7 and GZ9 effectively inhibited bacterial growth and suppressed the production of phage-resistant bacteria. In vivo experiment revealed that phage-treated mice exhibited lower K. pneumoniae burdens in the lungs compared to untreated control mice. Additionally, phage-treated mice experienced less body weight loss and had reduced levels of inflammatory cytokines in their lungs. Lung lesion conditions were significantly improved by phage therapy. Notably, the therapeutic effects of the GZ7 + GZ9 cocktail and GZ7 alone on mouse pulmonary infections were nearly equivalent. Therefore, phages GZ7 and GZ9 showed potential as alternatives to antibiotics for treating pneumonia caused by multidrug-resistant K. pneumoniae.

Genomic and phylogenetic analysis of hypervirulent Klebsiella pneumoniae ST23 in Ireland.

Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a pathogen of global concern associated with invasive community-acquired infections. The combination of hypervirulence and carbapenem resistance can result in severe and difficult-to-treat infections. This retrospective study aimed to investigate the spread of hvKp sequence type 23 (ST23) in Ireland and the convergence of hypervirulent (hv) and antimicrobial resistance genotypes. Short-read sequences (PE300) for 90 K. pneumoniae ST23 isolates were generated by the Galway Reference Laboratory Services (GRLS). Isolates were from screening swabs (n=59), invasive infections (n=18), non-invasive sites (n=12) and the hospital environment (n=1). The virulence and resistance content were assessed genomically using Kleborate (v2.2.0), ABRicate (v1.0.1) and Platon (v1.6). The in vivo virulence of the isolates was assessed using a murine model. All isolates were genotypically hv with 88/90 isolates having a maximal Kleborate virulence score of 5 including carriage of key genes. Eighty-two per cent of isolates (74/90) carried a carbapenemase gene (bla OXA-48/bla OXA-181/bla NDM-1), and 42% carried resistance genes to 3 or more antimicrobial classes. Core genomic delineation revealed the isolates to be clonal with similar resistance and virulence profiles. Two distinct clusters of Irish isolates were detected consisting of 82/90 of the isolates. Isolates associated with carriage and infection demonstrated similar in vivo virulence. An established clone of hvKp ST23 is circulating within Ireland and causing both colonization and infection of patients. The lack of reliable screening methods for hvKp makes its detection and control in the healthcare setting challenging.

Antimicrobial susceptibility and epidemiological types of Legionella pneumophila human isolates from Italy (1987-2020).

Antimicrobial susceptibility and epidemiological types of Legionella pneumophila human isolates from Italy (1987-2020).

ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone Harboring Capsular Type KL25 became the primarily prevalent capsular serotypes in a Tertiary Teaching Hospital in China.

ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone Harboring Capsular Type KL25 became the primarily prevalent capsular serotypes in a Tertiary Teaching Hospital in China.

Identification of NDM-1 producing and colistin resistant Klebsiella pneumoniae ST11: A highly drug-resistant strain detected in intensive care unit of a Greek tertiary care hospital.

The spread of NDM-1-harboring Klebsiella pneumoniae is a worldwide concern. In this study the whole-genome sequence (WGS) of a carbapenem- and colistin-resistant K. pneumoniae 838Gr strain is presented. This strain was isolated from a urine sample of a patient in the Intensive Care Unit (ICU) at Volos Hospital, Greece. The initial assembly produced 224 contigs with a combined genome size of 5,561,803 bp and a GC content of 57.21%. The K. pneumoniae strain carried IncR, IncFIA, IncC, and repB (R1701) replicons. Multilocus sequence typing (MLST) analysis revealed that the isolate belonged to the sequence type 11 (ST11) and serogroup KL24 and O2a. The WGS analysis identified several beta-lactamase genes (blaTEM-1B, blaCTX-M-15, blaNDM-1, blaOXA-1, blaVEB-1, blaOXA-10, and blaSHV-11) alongside resistance genes for other antibiotic classes, including floR2, cmlA1, cmlA5, catB3, arr-3, aph(6)-Id, aadA2. Colistin resistance was attributed to specific point mutations in pmrB (R256G, T140P). This is the first report of a carbapenem- and colistin-resistant K. pneumoniae ST11 strain in Greece. The findings of this study highlight the urgent need for increased surveillance and stringent infection control.

Genotyping and phylogenetic analysis of Mannheimia haemolytica isolates from cattle and buffaloes of West Azerbaijan, Iran.

This study was conducted in West Azerbaijan province, Iran (37°27'18.022" N, 45°0'0" E) to investigate the genotyping and phylogenetic characterization of Mannheimia haemolytica in cattle and buffaloes from November 2022 to January 2024. Mannheimia haemolytica is a bacterium known to cause pasteurellosis pneumonia, a respiratory disease in ruminants, such as cattle and sheep. This is one of the main causes of economic losses in the feedlot industry. In addition to the deaths, treatment costs are also significant. The lung and nasal swab samples were collected from 378 cattle and buffaloes. The M. haemolytica was detected in 32 (8.46%) of the samples, with a notably higher isolation rate from lung tissue (56.25%; n = 18) compared to the nasal swabs (43.75%; n = 14). Interestingly, the study also revealed a seasonal pattern, with the highest isolation rates observed during January, February, and March. Multi-locus sequence typing demonstrated that all isolates belonged to sequence type 1 (ST1) within clonal complex 28. This finding is consistent with the global prevalence of ST1 in bovine isolates, indicating widespread distribution. Phylogenetic analysis revealed a strong correlation between ST1 and STs 30 and 54, highlighting the prevalence of ST1 in M. haemolytica among ruminants in West Azerbaijan, Iran. Further research is needed to investigate its potential for causing disease and its transmission pattern.

ICEmST contributes to colonization of Salmonella in the intestine of piglets

Salmonella enterica serovar 4,[5],12:i:- sequence type 34 (ST34) has recently become a global concern for public and animal health. The acquisition of mobile genetic element ICEmST, which contains two copper tolerance gene clusters, cus and pco, influences the epidemic success of this clone. Copper is used as a feed additive in swine at levels that potentially lead to selection pressure for Enterobacteriaceae; however, it remains unclear whether the copper tolerance system of ICEmST functions in vivo. We performed competition assays with Salmonella 4,[5],12:i:- ST34 wildtype (WT) and deletion mutants of ICEmST (ΔICEmST, Δcus, and Δpco) in groups of mice fed 0, 150, and 500 ppm CuSO4. In the competition of WT against ΔICEmST and Δcus, the competitive index of the 500 ppm-fed group was significantly lower than that of the 0 ppm-fed group. In the swine experiment, all individuals were fed 150 ppm CuSO4. The number of ICEmST-positive strain in the feces was significantly greater than that of ICEmST-negative strain. The serum inflammatory markers were significantly increased in swine infected with the ICEmST-positive strain. These data suggest that ICEmST, especially cus, provides Salmonella with the ability to colonize in the intestine, even at high copper concentrations, leading to swine salmonellosis.

Whole genome analysis revealed the role of bla OXA-23 and bla OXA-66 genes in carbapenem resistance of Acinetobacter baumannii strains

ABSTRACT Acinetobacter baumannii is a multidrug-resistant bacterium that has emerged as a significant nosocomial pathogen globally and renowned for its ability to acquire antimicrobial resistance (AMR) genes. However, understanding of its resistance mechanisms to certain drug classes remains limited. This study focused on four bacterial strains (AB863, AB889, AB930, and AB960) exhibiting carbapenem resistance. They demonstrated high minimum inhibitory concentration (MIC) (128 mg/L) to meropenem and were categorized as extensively drug-resistant strains. Subsequently, they were identified as A. baumannii through 16S rRNA gene sequence analysis and species-specific PCR targeting the bla OXA51-like gene. Three strains were sequenced for their genomes to study the genetic determinants and functional relevance of carbapenem resistance. The draft genome length of the strains ranged from 3.8 to 4.0 Mbp. A total of 16 antibiotic resistance genes including the genes bla OXA-23 and bla OXA-66 which mediate carbapenem resistance were identified in the genomes. A comprehensive multilocus sequence typing analysis involving 95 A. baumannii strains from different Asian countries assigned the four strains to sequence type 2 (ST2), the most predominant ST circulating in Asia. Comparative genome analysis also revealed bla OXA-66 as the most dominant variant of bla OXA-51-like gene and also a widespread distribution of bla OXA-23 gene. In addition, various mobile genetic elements associated with AMR genes and three efflux pumps families were detected in the genomes of the strains. Transformation of bla OXA-23 and bla OXA-66 genes resulted in meropenem resistance in the transformant which exhibited a MIC of 2 mg/L, thus confirming direct involvement of both genes in carbapenem resistance.

Characterization of a carbapenemase-producing Klebsiella pneumoniae isolate of a patient in an intensive care unit in Greece: A study of resistome, virulome, and mobilome.

Klebsiella pneumoniae is a major pathogen associated with hospital-acquired infections, particularly those involving multidrug-resistant strains. Carbapenem resistance, often driven by carbapenemases such as KPC, VIM, OXA-48, and NDM, poses a significant challenge in clinical settings. This study reports on K. pneumoniae strain A165, isolated from a blood culture of a 51-year-old female patient hospitalized for respiratory distress post-SARS-CoV-2 infection. This K. pneumoniae strain exhibited resistance to several antibiotics, including carbapenems, cephalosporins, aminoglycosides, and fluoroquinolones, but remained susceptible to gentamicin, colistin, and trimethoprim-sulfamethoxazole. Next-generation sequencing was performed on Ion torrent platform, that revealed a genome size of 5,676,404 bp, including a chromosome and six plasmids. The strain was classified as sequence type 11 (ST11), a high-risk lineage associated with carbapenem resistance. The resistome of A165 included multiple β-lactamase genes, such as blaNDM-1 and blaOXA-48, as well as genes conferring resistance to other antibiotic classes. The virulome analysis identified genes involved in iron acquisition (yersiniabactin operon genes: ybtE, ybtT, irp1, irp2; aerobactin receptor: iutA), adhesion (mrkA-J, fimA-K), capsule and biofilm formation (rcsA, rcsB, ompA) and resistance to complement (traT) contributing to its pathogenic potential. The mobilome analysis revealed nine insertion sequences, including ISKpn1, ISKpn18, ISKpn43, ISKpn28, ISKpn14, ISEcp1, and IS6100. The strain also harbored six replicons: Col440II, ColRNAI, IncFIA(HI1), IncFIB(K), IncFII(K), and IncR, which are associated with the horizontal transfer of resistance and virulence genes. Comparative analysis with global isolates demonstrated the widespread dissemination of carbapenemase-producing K. pneumoniae, with notable occurrences in Europe, Asia, and the Americas. This study highlights the growing concern of multidrug-resistant K. pneumoniae in hospital settings and emphasizes the need for robust surveillance and infection control measures.

Molecular characterization and antimicrobial susceptibility for 62 isolates of Bordetella pertussis from children.

Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis (BP). Despite global control of pertussis cases through the Expanded Programme on Immunization (EPI), there has been a significant increase in the incidence of pertussis in recent years, characterized by a "resurgence" in developed countries with high immunization rates as well as a comparable reemergence in certain areas of China. We aim to explore the genotypes and antimicrobial susceptibility of circulating BP from children in Hebei. Children diagnosed with BP infection from 2019 to 2020 in Hebei, China were enrolled. We performed antimicrobial susceptibility testing (AST), whole-genome sequencing (WGS) analysis, single nucleotide polymorphism (SNP) detection, mltilocus sequence typing (MLST), multilocus antigen sequence typing (MAST), multilevel genome typing (MGT). A total of 313 international BP genomes were selected for comparison to examine the genomic diversity and evolutionary traits of Chinese strains within a global framework. Sixty-two individuals were identified with BP infection via culture, yielding a positive rate of 15.62% (62/397) for BP. Two phylogenetic groups were identified, each carrying a dominating genotype. The two vaccine strains, CS and Tohama I, exhibited a distant relationship to these two groups. This study identified 56 erythromycin-resistant isolates, 55 azithromycin-resistant isolates, 58 sulfamethoxazole-sensitive isolates, and 53 cefotaxime-sensitive isolates. All BP isolates were sensitive to levofloxacin, amoxicillin, ceftriaxone, and meropenem. Meanwhile, all erythromycin-resistant strains, which belonged to lineage I and MGT2 sequence type 7 (ST7), shared the ptxP1 gene and contained the 23S rRNA A2047G mutation. The major MAST was prn1/ptxP1/ptxA1/fim3-1/fim2-1 (75.81%). All 62 BP strains were divided into 1, 2, 3, 14, and 52 types at the MGT1, MGT2, MGT3, MGT4, and MGT5 levels, respectively. This work showed that there may be a link between antimicrobial resistance and alterations in specific molecular types, and the isolates showed a clear change when compared with the vaccine strain and that selection pressure from both antibiotics and immunization may be responsible for driving Chinese BP evolution, and necessitate a reevaluation of the immunization strategy and the development of novel vaccines in China to halt the resurgence and medication resistance of pertussis.

The draft genome sequence of a carbapenem-resistant Klebsiella pneumoniae strain belonging to sequence type 11 and capsular type 62.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) of sequence type 11 (ST11) and capsular type KL47 or KL64 are dominant in China. We report the draft genome sequence of an ST11 blaKPC-2-carrying CRKP strain belonging to uncommon capsular type KL62. This strain carries virulence factors encoding multiple iron acquisition systems and mucoid regulators.

Clinical impact of major pathogenic genotypes of Pseudomonas aeruginosa associated with refractory chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is characterized by persistent inflammation of the mucous membrane of the middle ear and mastoid. One of the primary causative agents of CSOM is P. aeruginosa, known for its production of virulent toxins and enzymes. Some cases of CSOM, improvement may not occur despite treatment lasting three weeks, leading to what is termed refractory CSOM. This research aims to characterize the P. aeruginosa strains isolated from patients with refractory CSOM in Gyeongsangnam-do, South Korea, providing insights into their pathogenic profiles. We conducted a retrospective analysis of P. aeruginosa isolates from the otorrhea of patients diagnosed with CSOM at a tertiary hospital in Gyeongsangnam-do, over a period from January 2005 to August 2022. The strains were examined using multilocus sequence typing (MLST) and toxin gene assay to assess genetic diversity and virulence. 39 samples were obtained from 13 cases of refractory CSOM and 15 cases of non-refractory CSOM. The findings unveiled that the P. aeruginosa cultured from patients with refractory CSOM belonged to the P. aeruginosa sequence type 235 (ST235) strain, which harbors the exoU gene as a major virulence factor. The detection of ST235 in refractory CSOM signifies a challenging clinical scenario. Given the genotype's strong virulence and antibiotic resistance, identifying ST235 through MLST can guide effective management approaches, including potential surgical intervention. This study underscores the necessity of broader epidemiological investigations to understand ST235 behavior and advocates for patient education to mitigate the impacts of this formidable pathogen in CSOM.

Environmental contamination with carbapenem resistant Acinetobacter baumannii in healthcare settings in Fiji: a potential source of infection.

There are multiple ongoing outbreaks of carbapenem resistant Acinetobacter baumannii (CRAb) infection in Fiji's hospitals. CRAb is able to colonize and persist on various hospital surfaces for extended periods. We conducted a study to understand the extent of hospital environmental contamination and phylogenetic links with clinical isolates. Swabs were collected from high-touch surfaces at Colonial War Memorial Hospital (CWMH) September 2021 and December 2022; Lautoka Hospital (LTKH) August 2022; and Labasa Hospital (LBSH) November 2022. All bacterial isolates were identified, and antimicrobial susceptibility testing (AST) performed; isolates resistant to carbapenems and producing a carbapenemase underwent whole genome sequencing. Comparison was made to clinical isolates obtained from CWMH in 2016-2017 and 2019-2021 and from LTKH and LBSH from 2020-2021. From the 180 environmental samples collected, ten (5.6%) CRAb were isolated; no other carbapenem-resistant gram-negative organisms were isolated. Seven (70%) of the CRAb were isolated from CWMH and three (30%) from LTKH; no CRAb were isolated from LBSH. Of the seven CWMH CRAb, two were sequence type 2 (ST2), three ST25, and two ST499. All LTKH isolates were ST499. The two environmental CRAb ST2 isolates were closely genetically linked to isolates obtained from patients in CWMH, LTKH, and LBSH 2020-2021. Similarly, the three environmental CRAb ST25 isolates were closely genetically linked to isolates obtained from patients admitted to CWMH in 2019-2021 and LBSH in 2020. The environmental CRAb ST499 isolates represented two distinct clones, with clone 1 comprising two genetically identical isolates from CWMH and clone 2 the three isolates from LTKH. Although no genetic linkages were observed when comparing environmental ST499 isolates to those from CWMH patients in 2020-2021, both clone 1 isolates were genetically identical to an isolate obtained from a patient admitted during the sampling period. Our study highlights the contamination of high-touch surfaces within Fiji hospitals with CRAb, suggesting that these may serve as important sources for CRAb. Phylogenetic linkages to CRAb isolated from patients since 2019 underscores the persistence of this resistant pathogen in hospital settings and the ongoing risk for hospital-acquired infections.

Characterization of Streptococcus agalactiae 1a isolated from farmed Nile tilapia (Oreochromis niloticus) in North America, Central America, and Southeast Asia

Characterization of Streptococcus agalactiae 1a isolated from farmed Nile tilapia (Oreochromis niloticus) in North America, Central America, and Southeast Asia

ST105 Lineage of MRSA: An Emerging Implication for Bloodstream Infection in the American and European Continents.

Sequence-type 5 (ST5) of methicillin-resistant Staphylococcus aureus (MRSA), harboring the staphylococcal chromosomal cassette mec type IV (SCCmecIV), was first detected in Portugal. It emerged as a significant cause of healthcare-associated (HA) infection in pediatric units and was hence named the pediatric clone. Another ST5 lineage, which carries SCCmecII, also prevailed in the USA and Japan for multiple years. More recently, another MRSA lineage, ST105-SCCmecII, part of the evolution of clonal complex 5 (CC5) MRSA, has emerged as the cause of hospital-acquired bloodstream infection outbreaks in countries including Portugal, the USA, and Brazil. This article reviews studies on the epidemiology and evolution of these newly emerging pathogens. To this end, a search of PUBMED from inception to 2024 was performed to find articles reporting the occurrence of ST105 MRSA in epidemiologic studies. A second search was performed to find studies on MRSA, CC5, ST5, and SCCmecII. A search of PUBMED from 1999 to 2024 was also performed to identify studies on the genomics and evolution of ST5, CC5, and ST105 MRSA. Further studies were identified by analyzing the references of the previously selected articles from PUBMED. Most articles on ST105 MRSA were included in this review. Only articles written in English were included. Furthermore, only studies that used a reliable genotyping method (e.g., whole genome sequencing, or MLST) to classify the CC5 lineages were selected. The quality and selection of articles were based on the consensus assessment of the three authors in independent evaluations. In conclusion, ST105-SCCmecII is an emerging MRSA in several countries, being the second/third most important CC5 lineage, with a relatively high frequency in bloodstream infections. Of concern is the increased mortality from BSI in patients older than 15 years and the higher prevalence of ST105-SCCmecII in the blood of patients older than 60 years reported in some studies.

Surface Cleaning with a Microfiber Cloth and Water followed by Ultraviolet-C Light Exposure Achieves Non-Inferior Disinfection of a Pathogenic Staphylococcus aureus Strain versus Use of Germicidal Wipes.

We hypothesized that ultraviolet-C (UV-C) irradiation (Surfacide, Waukesha, WI) following use of microfiber cloths (Sanny Shop LLC, Longmont, CO) soaked in waterwould be noninferior to surface disinfection wipes containing a quaternary ammonium compound and alcohol (PDI Healthcare, Woodcliff Lake, NJ)for the pathogenic Staphylococcus aureus (S. aureus) sequence type 5 (ST5). This was a randomized laboratory study of disinfection approaches for S. aureusST5. A total of 270 polycarbonate slides loaded with ST5 were prepared for the standard surface disinfection group (N=18) and water-soaked microfiber cloths and UV-C treatment group (N=144), along with positive and negative microbiological controls. All 18 samples of S. aureus ST5 bacteria treated with standard chemical wipes showed complete disinfection (colony forming units (CFU) = 0). All 144 treatments with water-soaked microfiber wipes followed by UV-C exposure showed complete disinfection (CFU =0) regardless of soiling, height from the floor, or orientation to the emitters. The upper 95% exact one-sided confidence limit for any CFU >0 was 2.1%. These data affirm our hypothesis that surface wiping with a damp cloth followed by triangular UV-C irradiation delivery is noninferior to surface disinfection for S. aureusST5 using germicidal wipes, even when UV-C is compromised by height from the floor and orientation to the emitters and surface disinfection is targeted. Removing bioburden with chemical-free microfiber cloths followed by triangular UV-C delivery is a noninferior strategy to targeted surface disinfection with chemical disinfecting wipes for the pathogenicS. aureusST5 strain in the laboratory setting.

Demographic, clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections in Central Australia

Demographic, clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections in Central Australia

Temporal variations in the serogroup distribution of invasive meningococcal disease in Quebec, Canada, due to emerging unique clade of serogroup Y strain belonging to the Sequence Type-23 clonal complex

Temporal variations in the serogroup distribution of invasive meningococcal disease in Quebec, Canada, due to emerging unique clade of serogroup Y strain belonging to the Sequence Type-23 clonal complex

Carbapenem-resistant Klebsiella pneumoniae in the Balkans: Clonal distribution and associated resistance determinants.

Carbapenems are considered to be among the last line antibiotics against extended-spectrum β-lactamase producing Enterobacterales. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been frequently reported and its spread in Europe is indisputable and poses an enormous threat to hospitalized patients which is of growing concern. This review aims to record prevalence of CRKP in the Balkan region and to review the current knowledge about this life-threatening pathogen. In this review, we summarize data about clinical isolates of carbapenem-resistant K. pneumoniae from Greece, Croatia, Romania, Bulgaria, Serbia, Slovenia, Montenegro, Bosnia-Herzegovina and Albania from published reports between 2000 and 2023. Among Balkan countries, Greece and Romania are the ones with the most reports about CRKP. Since 2007, KPCs are the dominant carbapenemases in both countries. KPC-2 and NDM-1-producing K. pneumoniae strains have been identified as the most frequent CRKP in Croatia, Bulgaria, Serbia, and Slovenia. OXA-48 enzyme has been identified in most Balkan countries. In addition, since 2018, CRKP sequence type 11 (ST11) seems to have replaced ST258 in Balkan Peninsula, while ST15 continues to thrive throughout the years. Not only efficacy of colistin against CRKP has decreased dramatically during the last ten years but colistin resistance mechanism is based on alterations of chromosomal mgrB gene, rather than the already known mcr genes.Moreover, ceftazidime-avibactam-resistant CRKP were detected mostly in Greece. Emergence of CRKP poses a severe threat to the Balkan countries. Due to the narrow therapeutic window, it is essential to prevent the spread of multiresistant K. pneumoniae strains.