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The war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.


To investigate the genomic epidemiology of New Delhi metallo-β-lactamase (NDM)-producing from Ukrainian patients among European countries.


Whole-genome sequencing of 66 isolates sampled in 2022–2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five -carrying- isolates underwent antimicrobial susceptibility testing (AST). Transferability to of a -carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing were gathered by questionnaire.


wgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised -carrying- and the third -carrying- The clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring , , and , which was transferrable and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam–avibactam. Patients with data on age (n = 41) were 19–74 years old; of 49 with information on sex, 38 were male.


XDR were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.


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