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Genomic surveillance of carbapenem-resistant Acinetobacter baumannii from bloodstream infections in Thailand reveals widespread dissemination of blaNDM-harboring mobile genetic elements.

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Title: Genomic surveillance of carbapenem-resistant Acinetobacter baumannii from bloodstream infections in Thailand reveals widespread dissemination of blaNDM-harboring mobile genetic elements.
Authors: Unahalekhaka A; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Krobanan K; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Kamjumphol W; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Leethongdee P; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Sukheephak Y; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Boonjan P; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Thapaan K; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Klayut W; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Sripichai O; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Thadtapong N; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Kurehong C; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Moolwang K; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Muanplueng D; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Wongboot W; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Okada PA; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand., Premsuriya J; Princess Srisavangavadhana Faculty of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.; Research Center on Clinical and System Microbiology (RCSyM), Chulabhorn Royal Academy, Bangkok, Thailand.
Source: PloS one [PLoS One] 2026 Jul 13; Vol. 21 (7), pp. e0353488. Date of Electronic Publication: 2026 Jul 13 (Print Publication: 2026).
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
Imprint Name(s): Original Publication: San Francisco, CA : Public Library of Science
MeSH Terms: Carbapenems*/pharmacology , Acinetobacter baumannii*/genetics , Acinetobacter baumannii*/drug effects , Acinetobacter baumannii*/isolation & purification , beta-Lactamases*/genetics , Acinetobacter Infections*/microbiology , Acinetobacter Infections*/epidemiology , Acinetobacter Infections*/drug therapy , Interspersed Repetitive Sequences*/genetics, Thailand/epidemiology ; Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Humans ; Phylogeny ; Microbial Sensitivity Tests ; Whole Genome Sequencing
Abstract: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major cause of hospital-acquired bloodstream infections in Thailand, with limited treatment options and a strong association with high morbidity and mortality. We performed nationwide genomic surveillance of 41 CRAB isolates from bloodstream infections collected across Thailand between 2020 and 2024 to characterize the population structure, antimicrobial resistance determinants, and the genomic context of blaNDM-harboring mobile genetic elements (MGEs). Whole-genome sequencing and core genome SNP-based phylogenetic analysis of the Thai samples revealed the dominance of international clone II (Pasteur ST2), which was widely distributed across geographic regions. Carbapenem resistance was primarily mediated by blaOXA-23, together with intrinsic blaOXA-66 and resistance-associated mutations in a penicillin-binding protein gene. In addition to OXA-type carbapenemase genes, blaNDM-5 and blaNDM-1 were detected in a subset of isolates. In particular, blaNDM-5 was located within a highly conserved MGE associated with a class 1 integron, IS91 family transposase and ISAba125 and was detected across multiple ST2 sublineages. This MGE was distributed across multiple geographic regions and phylogenetic lineages in Thailand, with evidence suggesting widespread horizontal dissemination followed by local clonal expansion. By contrast, blaNDM-1 was detected less frequently but was consistently associated with a canonical Tn125 transposon in both ST2 and ST16 isolates, highlighting its continued epidemiological relevance. Collectively, our findings demonstrate that CRAB bloodstream infections in Thailand are driven by a combination of endemic high-risk lineages and the sustained circulation of blaNDM-harboring MGEs. Overall, our results confirm the importance of continued genomic surveillance for monitoring the emergence and dissemination of blaNDM-producing CRAB and for strengthening infection prevention and antimicrobial resistance control efforts in hospital settings.
(Copyright: © 2026 Unahalekhaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Competing Interests: The authors have declared that no competing interests exist.
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Substance Nomenclature: 0 (Carbapenems)
EC 3.5.2.6 (beta-Lactamases)
0 (Anti-Bacterial Agents)
EC 3.5.2.6 (beta-lactamase NDM-1)
0 (Bacterial Proteins)
Entry Date(s): Date Created: 20260713 Date Completed: 20260713 Latest Revision: 20260813
Update Code: 20260814
PubMed Central ID: PMC13362128
DOI: 10.1371/journal.pone.0353488
PMID: 42441555
Database: MEDLINE
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  Data: Genomic surveillance of carbapenem-resistant Acinetobacter baumannii from bloodstream infections in Thailand reveals widespread dissemination of blaNDM-harboring mobile genetic elements.
– Name: Author
  Label: Authors
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  Data: <searchLink fieldCode="AU" term="%22Unahalekhaka+A%22">Unahalekhaka A</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Krobanan+K%22">Krobanan K</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Kamjumphol+W%22">Kamjumphol W</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Leethongdee+P%22">Leethongdee P</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Sukheephak+Y%22">Sukheephak Y</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Boonjan+P%22">Boonjan P</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Thapaan+K%22">Thapaan K</searchLink>; National Antimicrobial Resistance Surveillance Center, Thailand (NARST), National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Klayut+W%22">Klayut W</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Sripichai+O%22">Sripichai O</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Thadtapong+N%22">Thadtapong N</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Kurehong+C%22">Kurehong C</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Moolwang+K%22">Moolwang K</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Muanplueng+D%22">Muanplueng D</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Wongboot+W%22">Wongboot W</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Okada+PA%22">Okada PA</searchLink>; National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.<br /><searchLink fieldCode="AU" term="%22Premsuriya+J%22">Premsuriya J</searchLink>; Princess Srisavangavadhana Faculty of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.; Research Center on Clinical and System Microbiology (RCSyM), Chulabhorn Royal Academy, Bangkok, Thailand.
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  Data: <searchLink fieldCode="JN" term="%22101285081%22">PloS one</searchLink> [PLoS One] 2026 Jul 13; Vol. 21 (7), pp. e0353488. <i>Date of Electronic Publication: </i>2026 Jul 13 (<i>Print Publication: </i>2026).
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Public+Library+of+Science%22">Public Library of Science </searchLink><i>Country of Publication: </i>United States <i>NLM ID: </i>101285081 <i>Publication Model: </i>eCollection <i>Cited Medium: </i>Internet <i>ISSN: </i>1932-6203 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2219326203%22">19326203 </searchLink><i>NLM ISO Abbreviation: </i>PLoS One <i>Subsets: </i>MEDLINE
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  Data: <i>Original Publication</i>: San Francisco, CA : Public Library of Science
– Name: SubjectMESH
  Label: MeSH Terms
  Group: Su
  Data: <searchLink fieldCode="MM" term="%22Carbapenems%22">Carbapenems*</searchLink>/<searchLink fieldCode="MM" term="%22Carbapenems+pharmacology%22">pharmacology</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+baumannii%22">Acinetobacter baumannii*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+baumannii+genetics%22">genetics</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+baumannii%22">Acinetobacter baumannii*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+baumannii+drug+effects%22">drug effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+baumannii%22">Acinetobacter baumannii*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+baumannii+isolation+%26+purification%22">isolation & purification</searchLink> <br /><searchLink fieldCode="MM" term="%22beta-Lactamases%22">beta-Lactamases*</searchLink>/<searchLink fieldCode="MM" term="%22beta-Lactamases+genetics%22">genetics</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+Infections%22">Acinetobacter Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+Infections+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+Infections%22">Acinetobacter Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+Infections+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Acinetobacter+Infections%22">Acinetobacter Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Acinetobacter+Infections+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Interspersed+Repetitive+Sequences%22">Interspersed Repetitive Sequences*</searchLink>/<searchLink fieldCode="MM" term="%22Interspersed+Repetitive+Sequences+genetics%22">genetics</searchLink><br /><searchLink fieldCode="MH" term="%22Thailand%22">Thailand</searchLink>/<searchLink fieldCode="MH" term="%22Thailand+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Anti-Bacterial+Agents%22">Anti-Bacterial Agents</searchLink>/<searchLink fieldCode="MH" term="%22Anti-Bacterial+Agents+pharmacology%22">pharmacology</searchLink> ; <searchLink fieldCode="MH" term="%22Bacterial+Proteins%22">Bacterial Proteins</searchLink>/<searchLink fieldCode="MH" term="%22Bacterial+Proteins+genetics%22">genetics</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Phylogeny%22">Phylogeny</searchLink> ; <searchLink fieldCode="MH" term="%22Microbial+Sensitivity+Tests%22">Microbial Sensitivity Tests</searchLink> ; <searchLink fieldCode="MH" term="%22Whole+Genome+Sequencing%22">Whole Genome Sequencing</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major cause of hospital-acquired bloodstream infections in Thailand, with limited treatment options and a strong association with high morbidity and mortality. We performed nationwide genomic surveillance of 41 CRAB isolates from bloodstream infections collected across Thailand between 2020 and 2024 to characterize the population structure, antimicrobial resistance determinants, and the genomic context of blaNDM-harboring mobile genetic elements (MGEs). Whole-genome sequencing and core genome SNP-based phylogenetic analysis of the Thai samples revealed the dominance of international clone II (Pasteur ST2), which was widely distributed across geographic regions. Carbapenem resistance was primarily mediated by blaOXA-23, together with intrinsic blaOXA-66 and resistance-associated mutations in a penicillin-binding protein gene. In addition to OXA-type carbapenemase genes, blaNDM-5 and blaNDM-1 were detected in a subset of isolates. In particular, blaNDM-5 was located within a highly conserved MGE associated with a class 1 integron, IS91 family transposase and ISAba125 and was detected across multiple ST2 sublineages. This MGE was distributed across multiple geographic regions and phylogenetic lineages in Thailand, with evidence suggesting widespread horizontal dissemination followed by local clonal expansion. By contrast, blaNDM-1 was detected less frequently but was consistently associated with a canonical Tn125 transposon in both ST2 and ST16 isolates, highlighting its continued epidemiological relevance. Collectively, our findings demonstrate that CRAB bloodstream infections in Thailand are driven by a combination of endemic high-risk lineages and the sustained circulation of blaNDM-harboring MGEs. Overall, our results confirm the importance of continued genomic surveillance for monitoring the emergence and dissemination of blaNDM-producing CRAB and for strengthening infection prevention and antimicrobial resistance control efforts in hospital settings.<br /> (Copyright: © 2026 Unahalekhaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: The authors have declared that no competing interests exist.
– Name: Ref
  Label: References
  Group: RefInfo
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        Value: 10.1371/journal.pone.0353488
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        Text: English
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      – SubjectFull: Thailand epidemiology
        Type: general
      – SubjectFull: Anti-Bacterial Agents pharmacology
        Type: general
      – SubjectFull: Bacterial Proteins genetics
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      – SubjectFull: Carbapenems pharmacology
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      – SubjectFull: Acinetobacter baumannii genetics
        Type: general
      – SubjectFull: Acinetobacter baumannii drug effects
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      – SubjectFull: Acinetobacter baumannii isolation & purification
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      – SubjectFull: beta-Lactamases genetics
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      – SubjectFull: Acinetobacter Infections microbiology
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      – SubjectFull: Acinetobacter Infections drug therapy
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      – SubjectFull: Interspersed Repetitive Sequences genetics
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    Titles:
      – TitleFull: Genomic surveillance of carbapenem-resistant Acinetobacter baumannii from bloodstream infections in Thailand reveals widespread dissemination of blaNDM-harboring mobile genetic elements.
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              Text: 2026 Jul 13
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