Detection of cefiderocol and aztreonam/avibactam resistance in epidemic Escherichia coli ST-361 carrying bla NDM-5 and bla KPC-3 from foreign fighters evacuated from Ukraine.

Genomic surveillance detected clonal Escherichia coli sequence type-361 isolates carrying bla NDM-5 , bla KPC-3 , bla CTX-M-15 , and rmtB1 from a patient in Ukraine and four wounded foreign soldiers evacuated to Germany. Isolates were non-susceptible to carbapenems, aminoglycosides, and cefiderocol and aztreonam/avibactam due to a PBP3 YRIN insertion and the bla CMY-145 AmpC β-lactamase. Coordinated surveillance efforts across civilian, military, and veteran healthcare systems are essential to prevent further spread as international volunteers return home after medical evacuation from Ukraine.