Emergence and global spread of a dominant multidrug-resistant clade within Acinetobacter baumannii

Shengkai Li, Guilai Jiang, Shengke Wang, Min Wang, Yilei Wu, Jinzhi Zhang, Xiao Liu, Ling Zhong, Min Zhou, Shichang Xie, Yi Ren, Ping He, Yongliang Lou (), Heng Li (), Jimei Du () and Zhemin Zhou ()
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Shengkai Li: Soochow University
Guilai Jiang: Soochow University
Shengke Wang: Wenzhou Medical University
Min Wang: The Second Affiliated Hospital of Soochow University
Yilei Wu: Soochow University
Jinzhi Zhang: Zhejiang Provincial People’s Hospital
Xiao Liu: Soochow University
Ling Zhong: Soochow University
Min Zhou: Shanghai Jiao Tong University School of Medicine
Shichang Xie: Soochow University
Yi Ren: Iotabiome Biotechnology Inc.
Ping He: Shanghai Jiao Tong University School of Medicine
Yongliang Lou: Wenzhou Medical University
Heng Li: Soochow University
Jimei Du: Wenzhou Medical University
Zhemin Zhou: Soochow University

Nature Communications, 2025, vol. 16, issue 1, 1-14

Abstract: Abstract The proliferation of multi-drug resistant (MDR) bacteria is driven by the global spread of epidemic lineages that accumulate antimicrobial resistance genes (ARGs). Acinetobacter baumannii, a leading cause of nosocomial infections, displays resistance to most frontline antimicrobials and represents a significant challenge to public health. In this study, we conduct a comprehensive genomic analysis of over 15,000 A. baumannii genomes to identify a predominant epidemic super-lineage (ESL) accounting for approximately 70% of global isolates. Through hierarchical classification of the ESL into distinct lineages, clusters, and clades, we identified a stepwise evolutionary trajectory responsible for the worldwide expansion and transmission of A. baumannii over the last eight decades. We observed the rise and global spread of a previously unrecognized Clade 2.5.6, which emerged in East Asia in 2006. The epidemic of the clade is linked to the ongoing acquisition of ARGs and virulence factors facilitated by genetic recombination. Our results highlight the necessity for One Health-oriented research and interventions to address the spread of this MDR pathogen.

Date: 2025
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DOI: 10.1038/s41467-025-58106-9

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