Search Results (252)

Background: Streptococcus pneumoniae may asymptomatically colonize the human nasopharynx and remains a leading cause of invasive and noninvasive disease in children, accounting for an estimated 294,000 global deaths in those aged under five years. Nationally representative serotype data from Indonesia remain limited despite national PCV13 rollout in 2022. This study aims to evaluate the distribution of Streptococcus pneumoniae serotypes and estimate the coverage of pneumococcal conjugate vaccines (PCVs) among children aged 0–18 years in Indonesia. Methods: Systematic search of PubMed, Scopus, ScienceDirect, Google Scholar, and Paediatrica Indonesiana (to December 2025) for observational studies (PROSPERO CRD420251239935). The extracted data included the study period, setting, population, specimen type, serotypes, sample size, and nasopharyngeal carriage. Pooled serotype prevalence is calculated; vaccine coverage estimated for pneumococcal conjugate vaccines containing 10 (PCV10), 13 (PCV13), 15 (PCV15), and 20 (PCV20) serotypes assuming vaccine-type priority in multicolonization. Risk of bias assessed using the Joanna Briggs Institute’s checklist for prevalence studies. Results: Nineteen studies across 13 regions of Indonesia involving children aged 0–18 years included. Nasopharyngeal carriage ranged from 21.0% to 87.6% in healthy children and 9.2% to 73% in children with illnesses. The most common serotypes were 19F, 23F, 6B, 14, 19A, and 34. Non-typeable isolates accounted for more than 20% of all isolates in several studies. The pooled coverage for PCV10, PCV13, PCV15, and PCV20 was 40.3%, 50.2%, 50.8%, and 57.0% respectively. Low-moderate RoB (63% low). Conclusions: The dominant serotypes largely included in PCV13. Active surveillance is required to monitor serotype shifts and ensure the long-term effectiveness of the national vaccination program. Full article

Background: Streptococcus pneumoniae, also referred to as pneumococcus, is of immense public health significance. In particular, it causes severe invasive diseases among children. This has led to the recommendation of anti-pneumococcal prophylaxis, including the administration of penicillin and pneumococcal conjugate vaccines (PCVs), which have become available in about 90% of the countries in sub-Saharan Africa. Nonetheless, breakthrough disease still occurs. Also, PCVs can cause a shift in the distribution of pneumococcal serotypes, usually towards non-vaccine types. However, in many sub-Saharan African countries where PCVs have been introduced, there are hardly any comprehensive post-vaccination surveillance data on pneumococcus. Aim: To describe the post-vaccination epidemiology of invasive pneumococcal disease (IPD) in Ghana, including the prevalence, serotype distribution and antibiotic resistance. Methods: The study was cross-sectional and involved 14,597 patients recruited at the Korle Bu Teaching Hospital, Greater Accra Regional Hospital, Princess Marie Louise Children’s Hospital, Ho Regional Hospital, Eastern Regional Hospital, and Zonal Public Health and Reference Laboratory, Tamale. Specimens of cerebrospinal fluid (obtained by lumbar puncture) and blood were collected routinely from meningitis patients, while blood specimens were taken from pneumonia patients. These were cultured for S. pneumoniae following standard microbiological methods and subjected to antimicrobial susceptibility testing. The isolates were serotyped by the pneumotest latex agglutination kit, and the results confirmed by Quellung reaction, using serotype-specific antisera. Results: The overall prevalence of IPD was 0.66% (n = 97), varying across syndromes: bloodstream infections (0.53%, n = 38), meningitis (2.45%, n = 43), and pneumonia (0.28%, n = 16). The majority of the cases (56.70%, n = 55) occurred in the 11–20-year-old group. Ten pneumococcal serotypes were identified, with Serotype 1 being predominant (58.76%), followed by Serotypes 23B (11.34%), 33F (9.28%), and 12F (8.24%). Vaccine serotypes accounted for 81.44% of the isolates, while 18.56% were non-vaccine serotypes (23A, 23B, and 38). Antimicrobial resistance was highest against sulphamethoxazole-trimethoprim (52%), ampicillin (51%), and penicillin (46%). No resistance was observed against ciprofloxacin, levofloxacin, and vancomycin. The multidrug resistance proportion was 42.3% (n = 41). Conclusions: Even in the post-vaccination era, vaccine-type IPD remains a significant public health issue in Ghana. The observed serotype distribution and antimicrobial resistance patterns warrant sustained surveillance, more adaptive vaccination policies, and rigorous antibiotic stewardship to effectively mitigate IPD burden. Full article

Background/Objectives: Respiratory failure in late pregnancy represents a complex and high-risk clinical scenario due to physiological adaptations during pregnancy that reduce maternal respiratory reserve, with tightly coupled maternal and foetal outcomes. This review aims to synthesise current evidence on epidemiology, maternal–foetal physiology, and management strategies for respiratory failure in late gestation. Methods: This narrative review integrates contemporary literature, national surveillance data, physiological principles, and expert consensus to summarise the causes, clinical implications, and management of respiratory failure in pregnancy. Results: Respiratory failure in pregnancy arises from diverse obstetric and non-obstetric conditions, including pneumonia, asthma, pulmonary embolism, cardiogenic pulmonary oedema, and ARDS. Maternal hypoxaemia is strongly associated with foetal compromise. Management requires pregnancy-specific ventilatory targets, avoidance of permissive hypercapnia, cautious use of non-invasive and invasive ventilation, and safe implementation of prone or semi-prone positioning. ECMO use has expanded, with maternal survival improving to approximately 75%, although optimal anticoagulation and timing of delivery remain uncertain. Conclusions: Effective management of respiratory failure in late pregnancy requires early recognition, multidisciplinary coordination, and adaptation of respiratory support to maternal–foetal physiology. Despite improvements in critical care and ECMO outcomes, key evidence gaps persist, underscoring the need for integrated maternal critical care pathways and further research to optimise outcomes for both mother and baby. Full article

Idiopathic pulmonary fibrosis (IPF) and autoimmune usual interstitial pneumonia (aUIP) share overlapping clinico-radiological features, complicating differential diagnosis. Electronic nose (eNose) technology characterizes exhaled breath profiles (“breathprints”) and may offer a non-invasive diagnostic approach in fibrotic interstitial lung diseases. To evaluate whether eNose breathprint analysis can discriminate between IPF and aUIP. In this cross-sectional study of 60 patients (34 IPF, 26 aUIP), breathprints were analyzed using principal component analysis (PCA, retaining eigenvalues > 1). Group differences were assessed via independent t-tests. Linear discriminant analysis (LDA) with leave-one-out cross-validation evaluated the discriminatory performance of PC combinations. PCA identified four principal components, with PC1 explaining 96% of the total variance. PC1 scores were significantly higher in aUIP compared to IPF (mean difference −0.53; 95% CI −1.04 to −0.02; p = 0.04); PC2-PC4 showed no significant differences (p > 0.3). LDA utilizing PC1 and PC3 achieved a cross-validated classification accuracy of 73.3% (95% CI 60.7–84.4, p < 0.05). eNose-derived breathprints showed preliminary discriminatory potential between IPF and autoimmune UIP, supporting further validation of this non-invasive adjunctive approach. Breathomics represents a promising non-invasive adjunctive tool for phenotyping fibrotic interstitial lung diseases, though larger validation studies integrating clinical and biological data are warranted. Full article

Background/Objectives: Streptococcus pneumoniae remains a major cause of morbidity and mortality in Egypt, yet pneumococcal conjugate vaccines (PCVs) are not included in the national immunization program. Recent commitments to domestic vaccine manufacturing and temporary Gavi support create a timely decision context for policymakers to assess whether PCV introduction is cost-effective, affordable, and sustainable within Egypt’s health financing constraints. This study evaluates the cost-effectiveness, budget impact, and return on investment (ROI) of PCV introduction in Egypt. Methods: A deterministic, age-structured dynamic transmission model was developed to estimate the health and economic outcomes of PCV introduction over a 20-year horizon from a healthcare payer perspective. The analysis was conducted in line with the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) guidelines. The model captures direct and indirect effects across all age groups and includes pneumonia, meningitis, non-pneumonia non-meningitis invasive disease, and acute otitis media. Scenarios assessed immediate versus delayed introduction, alternative PCV10-to-PCV13 pathways, and domestic manufacturing price assumptions. Outcomes included deaths averted, incremental cost-effectiveness ratios (ICERs) relative to GDP per capita, budget impact, and ROI using the value of statistical life. Results: Immediate PCV13 introduction was projected to avert 139,451 deaths across all age groups over 20 years, with an ICER of 523.31 USD per DALY averted equal to 0.16 × GDP per capita. The total budget impact was USD 124.9 million per year without Gavi support and USD 120.9 million with support, yielding an ROI of 23.1. Delaying the introduction substantially reduced health gains and economic returns. Pathways involving initial PCV10 introduction followed by transition to PCV13 achieved similar health outcomes with a lower budget impact and higher ROI. Conclusions: PCV introduction in Egypt represents a high-value investment. Immediate introduction maximizes health and economic benefits, while delayed introduction entails substantial opportunity costs. Alternative PCV10-to-PCV13 pathways offer a more affordable route with a similar long-term impact. Full article

Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging. Full article

Haemophilus influenzae (H. influenzae) is an important respiratory pathogen that can cause various invasive and non-invasive bacterial infections requiring rapid and sensitive detection. In recent years, electrochemical biosensors have emerged as a practical alternative for pathogen detection due to their high sensitivity, portability and short analysis time. Molecularly imprinted polymers (MIPs) are a class of synthetic receptors designed to mimic biological recognition through template-directed polymerization. In this study, an electrochemical biosensor based on MIPs was developed for the selective detection of H. influenzae. The polymeric film composed of methacrylamide (MAM), acrylamide (AAM), and vinylpyrrolidone (VP) monomers was fabricated on a gold screen-printed electrode (gold-SPE). The results of cyclic voltammetry (CV) revealed a strong redox current shift corresponding to bacteria concentrations within an analytical range of 1–10,000 CFU/mL with LOD 1.03 CFU/mL, with relative standard deviation (RSD) values below 9% across the tested concentration range. The optimized composition yielded and exhibited excellent selectivity when tested against non-target bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Full article

Background: Neonatal hyperglycemia is a common metabolic complication in extremely preterm (EP) infants; however, early risk factors and associated outcomes remain incompletely defined. Objective: To evaluate the association between neonatal hyperglycemia in the first postnatal week and key neonatal morbidities including early neurodevelopmental risk in EP infants. Methods: We conducted a retrospective cohort study of EP infants born in 2018–2019 at the Women’s Wellness and Research Center. Neonatal hyperglycemia was defined as a blood glucose level > 8.3 mmol/L. Maternal factors, delivery room interventions, early physiological markers, neonatal morbidities, and follow-up outcomes were compared. Propensity score matching was applied to balance the baseline demographic and perinatal differences. Results: Among 225 EP infants, 131 (58.2%) developed neonatal hyperglycemia in the first week (mild, 21.4%; moderate, 42%; severe, 36.6%). Before matching, infants with neonatal hyperglycemia had lower gestational age and birth weight and required more delivery-room surfactant, and their mothers had lower rates of premature rupture of membranes. After matching, neonatal hyperglycemia was associated with higher rates of ventilator-associated pneumonia (1.45 vs. 0.37; IRR 6.2, 95% CI 1.4–27.6), longer duration of invasive ventilation (19.8 ± 25.3 vs. 8.9 ± 24.8 days; mean difference −10.9 days; p = 0.042), higher postnatal steroid exposure (18.2% vs. 5.5%; OR 4.6, 95% CI 1.6–14.4; p = 0.040), and severe retinopathy of prematurity (ROP) (21.6% vs. 6.4%; OR 4.0, 95% CI 1.0–15.5; p = 0.032). A trend toward moderate-to-severe bronchopulmonary dysplasia was observed (33.3% vs. 15.9%; p = 0.054). Mortality did not differ significantly between groups; however, among non-survivors, age at death was higher in the neonatal hyperglycemia group. Conclusions: In EP infants, early neonatal hyperglycemia is associated with higher respiratory morbidity and severe ROP even after propensity score matching. These findings support neonatal hyperglycemia as a clinically relevant early risk marker and justify further prospective and interventional studies. Full article

Streptococcus pneumoniae (S. pneumoniae) is a leading cause of pneumonia, meningitis, and sepsis worldwide, posing a major threat to young children and older adults. In China, it is a key pathogen responsible for life-threatening invasive pneumococcal disease (IPD)—including pneumonia, bacteremia, and meningitis—and contributes substantially to hospitalizations and deaths each year. The high disease burden, together with rising antibiotic resistance, underscores the urgent need for more effective strategies for prevention and control. Currently, the most established pneumococcal vaccines include polysaccharide vaccines (e.g., PPV23) and polysaccharide conjugate vaccines (e.g., PCV13), both of which provide effective protection against pneumococcal infections. However, challenges remain, such as the T-cell-independent nature of polysaccharide antigens and inadequate coverage against prevalent strains, which hinder to improve their overall effectiveness. In this review, we trace the progression from pneumococcal pathogenesis to vaccine development. We first outline the mechanisms of colonization, invasion, and key virulence factors, and then critically summarize historical and current vaccine strategies. A systematic literature search was conducted in PubMed and Web of Science (2010–present) using relevant keyword and MeSH combinations. A total of 10,273 articles were identified from PubMed; after removal of duplicates and non-full-text records, 260 research articles were included in the final analysis. Based on this body of evidence, we evaluate emerging approaches toward broadly protective, serotype-independent vaccines and discuss how advances in antigen design, delivery systems, and adjuvants may further optimize next-generation pneumococcal vaccines. Full article

Antibiotic use in critically ill children requiring respiratory support remains controversial, particularly in the absence of standardized guidelines for patients managed with non-invasive ventilation (NIV). Evidence in this area remains limited, and real-world data are therefore valuable. Objective: This retrospective single-center study aimed to describe antibiotic prescribing patterns and infectious outcomes in pediatric patients admitted to the intensive care unit (PICU) with respiratory failure, according to the type of respiratory support. Methods: Children aged 0–17 years admitted between January 2021 and February 2025 who required oxygen supplementation, NIV, or invasive mechanical ventilation (IMV) were included. Demographic characteristics, underlying conditions, infectious complications, antibiotic exposure, length of PICU stay, and outcomes were analyzed using descriptive statistics and univariate comparisons. Results: Eighty-nine patients were included. Ventilator-associated pneumonia (VAP) occurred exclusively in patients receiving IMV, and infection complications were observed more in this group compared to those receiving NIV (p = 0.005). Pseudomonas aeruginosa was the most frequently isolated pathogen. Antibiotics were administered in 82% of patients, with no significant association between the respiratory support and initiation of antibiotic therapy (p = 0.195). A higher number of antibiotics was administered in patients receiving IMV compared with those receiving oxygen therapy alone. Conclusions: Antibiotic use in children requiring respiratory support in the PICU was common and appears to be driven primarily by underlying disease and illness severity rather than by the ventilation modality alone. Infections specific to invasive ventilation, such as VAP, were more frequent in patients receiving IMV, while infection-related outcomes in non-invasive groups should be interpreted cautiously due to differences in diagnostic definitions. These findings are descriptive and hypothesis-generating and highlight the need for prospective multicenter studies to create evidence-based antibiotic stewardship strategies in pediatric critical care. Full article

Invasive meningococcal disease (IMD) is classically associated with meningitis and septic shock, but an increasing proportion of cases present with atypical, extra-meningeal manifestations. Following the COVID-19 pandemic, major epidemiological shifts have occurred in France, including a rebound in IMD incidence and changes in circulating serogroups and clonal complexes. We conducted a nationwide retrospective study including all laboratory-confirmed IMD cases analysed by the French National Reference Centre between July 2014 and June 2025. Clinical presentations were coded as non-exclusive entities. Associations with age, serogroup, clonal complex, antimicrobial susceptibility and early mortality (≤72 h) were assessed using descriptive analyses and multivariable logistic regression models. Among 4328 IMD cases, sepsis/shock (61.1%) and meningeal involvement (54.9%) predominated, while atypical forms were frequent, including bacteraemic pneumonia (7.7%), abdominal presentations (8.0%) and arthritis (6.0%). Bacteraemic pneumonia was strongly associated with older age and serogroups W and Y, whereas abdominal forms predominated in adolescents and young adults and were independently associated with serogroups W and Y and clonal complex (cc) cc11. Abdominal presentations were independently associated with early mortality (adjusted odds ratio [aOR] 2.40) but not meningococcal pneumonia. Abdominal presentations were associated with serogroup W (aOR 2.27; 95% CI 1.35–3.83) and serogroup Y (aOR 2.92; 95% CI 1.79–4.75) and with cc11 (aOR 1.77; 95% CI 1.07–2.94). In contrast, cc23 was associated with lower odds of abdominal involvement (aOR 0.42; 95% CI 0.25–0.70). Overall, atypical presentations now represent a substantial proportion of IMD in France and are strongly shaped by age and meningococcal lineage. These findings highlight diagnostic challenges, prognostic heterogeneity and the need for continued integrated clinical, microbiological and genomic surveillance in the context of evolving vaccination strategies. Full article

Invasive pulmonary fungal infections remain a major cause of morbidity and mortality among immunocompromised and critically ill patients. Rapid and accurate diagnosis is crucial for improving outcomes, yet conventional methods such as culture and histopathology suffer from limited sensitivity and slow turnaround times. Recently, significant progress has been made in the development and standardization of serological and molecular biomarkers that enhance the early detection of the key pulmonary fungal diseases, particularly invasive pulmonary aspergillosis and pneumocystosis. Diagnostic tools for mucormycosis, however, remain scarce. PCR tools have strong potential to significantly improve early detection, but they are not yet widely implemented, and standardized commercial assays remain limited. Accessible antigen-based tests with robust performance are highly anticipated and expected to become available soon. This review summarizes the current evidence regarding the optimal use of galactomannan, β-D-glucan and PCR-based assays, emphasizing how their performance varies according to the pathogen, the type of specimen and the host population. Specific challenges, such as differentiating colonization from infection in non-HIV Pneumocystis pneumonia or interpreting galactomannan and PCR in patients receiving mold-active prophylaxis, are highlighted. We also discuss how combining biomarkers can enhance diagnostic accuracy and support timely therapeutic decisions. A clear understanding of the strengths, limitations and appropriate interpretation of these diagnostic tools is crucial in an era of increasing host complexity, shifting fungal epidemiology, and expanding antifungal options. Full article

Background: Airway bacterial infection and inflammation are often present in children with bronchiectasis. Systemic inflammation has also been reported. Currently, there are no data on the association between systemic inflammatory markers with airway pathogens or neutrophilia in children with bronchiectasis. We aimed to define the bronchoalveolar lavage (BAL) pathogens (bacteria and viruses), and cytology in children with bronchiectasis and to explore any association between peripheral inflammatory markers and airway neutrophilia. Methods: Participants numbering 402, aged <18 years, with peripheral blood and BAL results within 3 months of diagnosis of bronchiectasis were included. Blood and BAL results were reviewed and analysed for possible associations. Results: Of 355 children (88.31%), cultured bacteria from BAL and Haemophilus influenzae (n = 185) were the most frequent. A virus was identified in 131 (32.59%). Adenovirus (n = 69) was most common. Children numbering 279 (69.40%) had airway neutrophilia (neutrophils > 15%) which was associated with the presence of H. influenzae (OR 2.03 95% CI 1.31–3.15, p = 0.002), S. pneumonia 2.41 (95% CI 1.36–4.29, p = 0.003), and Adenovirus (OR 2.06 95% CI 1.06–4.04, p = 0.033). Airway neutrophilia was associated with raised CRP (OR 2.26 95% CI 1.14–4.49, p = 0.019), but there were no other systemic inflammatory markers including monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and platelet/mean platelet volume ratio. Conclusions: In children, there is an association between airway neutrophilia and raised CRP in bronchiectasis, but not with other peripheral inflammatory markers. There is a need to identify non-invasive inflammatory markers in children with bronchiectasis. Full article

Background: Aspiration pneumonia (AP) remains a major cause of morbidity and mortality, yet non-invasive tools for monitoring lung injury in preclinical models are limited. Lung ultrasound (LUS) is widely used clinically, but existing murine scoring systems lack anatomical resolution and have not been validated for aspiration-related injury. Methods: We developed the Modified Lung Edema Ultrasound Score (MLEUS), a region-structured adaptation of the Mouse Lung Ultrasound Score (MoLUS), designed to accommodate the heterogeneous and gravity-dependent injury patterns characteristic of murine AP. Male C57BL/6 mice were assigned to sham, 6 h, 24 h, or 48 h groups. Regional LUS findings were compared with histological injury scores and wet-to-dry (W/D) ratios. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Results: Global LUS–histology correlation was weak (ρ = 0.33, p = 0.114). In contrast, regional performance varied markedly. The right upper (RU) zone showed the strongest correspondence with histological injury (r = 0.55, p = 0.005), whereas right and left diaphragmatic regions demonstrated minimal association. LUS abnormalities were detectable as early as 6 h, preceding clear histological progression. Inter-rater reliability was good (ICC = 0.87). Conclusions: MLEUS provides a reproducible, region-specific framework for evaluating aspiration-induced lung injury in mice. Although global correlations with histology were limited, region-dependent analysis identified that the RU zone as a reliable acoustic window for concurrent injury assessment. Early ultrasound changes highlight the sensitivity of LUS to dynamic aeration and interstitial alterations rather than cumulative tissue damage. These findings support the use of LUS as a complementary, non-invasive physiological monitoring tool in small-animal respiratory research and clarify its methodological scope relative to existing scoring frameworks. Full article

Background/Objectives: Pseudomonas aeruginosa is an opportunistic pathogen frequently implicated in healthcare-associated infections, particularly ventilator-associated pneumonia and other device-related infections. The global emergence of carbapenem-resistant P. aeruginosa (CRPA) represents a major clinical challenge due to its limited therapeutic options and high mortality rates. Methods: Relevant clinical data were obtained from medical records. Isolates were identified via 16S PCR, and antimicrobial susceptibility testing was performed using the Vitek2 Compact system following CLSI guidelines. Carbapenemase genes (blaGES, blaKPC, blaIMP, blaNDM, blaVIM) were detected via PCR. Clonal relationships were determined via RAPD-PCR, and some sequence types were assigned according to the global P. aeruginosa MLST database. Results: In this study, 40 non-duplicate CRPA isolates were collected from 35 patients in a tertiary-care hospital in Mexico. Most isolates originated from adult patients, predominantly from tracheal aspirates (32.5%) and urine cultures (25.0%). Mechanical ventilation was the most common invasive device associated with infection, and the overall mortality rate reached 14.3%. Antimicrobial susceptibility testing showed that 95% of isolates exhibited a multidrug-resistant phenotype, with high resistance rates to ciprofloxacin (70.0%) and β-lactams. Carbapenemase genes were detected in 55% of isolates, mainly bla_IMP, bla_GES, and bla_VIM, either alone or in combination. Notably, this is the first report of ST309 (bla_IMP), ST411 (bla_GES + bla_IMP), and ST167 (bla_GES + bla_VIM) carrying carbapenemase genes in Mexico. Conclusions: These findings highlight the persistence and genetic diversity of CRPA circulating in hospital settings and emphasize the urgent need for strengthened genomic surveillance and infection control programs to prevent the spread of these high-risk multidrug-resistant clones. Full article