Fatal Clonal Outbreak of KPC-2–Producing Enterobacter roggenkampii in Paediatric Patients: Cefiderocol Resistance and a Novel IncU Plasmid

Clonal dissemination of KPC-2-E.roggenkampii ST516 in a paediatric ICU. Automated systems misidentified the isolates, masking a fatal nosocomial outbreak. The blaKPC-2 gene was located on a novel, streamlined IncU plasmid backbone. XDR isolates showed cefiderocol resistance despite no prior drug exposure.Graphical abstract of the fatal E. roggenkampii ST516 outbreak.The study highlights: (i) 50% mortality and severe clinical complications; (ii) diagnostic misidentification by automated systems; (iii) a novel ~30 kb IncU plasmid carrying blaKPC-2; and (iv) an XDR phenotype with cefiderocol resistance despite no prior drug exposure.Created in PowerPoint and Canva using royalty-free icons.