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Pathogens
Volume 15
Issue 4
10.3390/pathogens15040381
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Review

Phenotype–Genotype Discordance in Antimicrobial Resistance of Acinetobacter baumannii: Implications for Diagnostics and Surveillance

by
Nazgul Sutimbekova
1,
Nelya Bissenova
2,
Marat Dusmagambetov
1,
Ulbossyn Saltabayeva
3,*,
Aigul Utegenova
1,*,
Gulmira Smanova
4,
Alfiya Igissenova
5,
Farida Rakhimzhanova
6,
Nurgul Askarova
7,
Gulbanu Duissebekova
1,
Ayaz Yktiyarov
1 and
Evgeni Sokurenko
8
1
Department of Microbiology and Virology, Astana Medical University, Astana 010000, Kazakhstan
2
Microbiological Laboratory, National Scientific Medical Center, Astana 010000, Kazakhstan
3
Department of Nursing, Astana Medical University, Astana 010000, Kazakhstan
4
Department of Medical Genetics and Molecular Biology, Astana Medical University, Astana 010000, Kazakhstan
5
Department of Microbiology and Virology, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
6
Department of Microbiology, Semey Medical University, Semey 071400, Kazakhstan
7
Department of Normal Physiology, Astana Medical University, Astana 010000, Kazakhstan
8
Department of Microbiology, School of Medicine, University of Washington, Seattle, WA 98195, USA
*
Authors to whom correspondence should be addressed.
Pathogens 2026, 15(4), 381; https://doi.org/10.3390/pathogens15040381
Submission received: 4 March 2026 / Revised: 24 March 2026 / Accepted: 27 March 2026 / Published: 2 April 2026
(This article belongs to the Special Issue Acinetobacter baumannii: An Emerging Pathogen)
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Abstract

Acinetobacter baumannii has emerged as one of the most challenging opportunistic pathogens in modern healthcare due to its remarkable ability to acquire and disseminate antimicrobial resistance determinants. Carbapenem-resistant A. baumannii (CRAB) is now recognized by the World Health Organization as a critical priority pathogen, highlighting the urgent need for improved diagnostic, surveillance, and therapeutic strategies. This review synthesizes current evidence on the relationship between phenotypic antimicrobial susceptibility patterns and underlying genetic determinants of resistance in A. baumannii. A structured literature search was conducted across major biomedical databases (PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library), supplemented by citation tracking and relevant institutional sources, focusing on studies published between 2016 and 2026. The analysis integrates findings from studies examining phenotypic antimicrobial susceptibility testing (AST) with molecular and genomic investigations of resistance mechanisms, including carbapenemases, aminoglycoside-modifying enzymes, efflux pumps, and resistance-associated genomic islands. Particular attention is given to the complex and sometimes discordant relationship between genotype and phenotype, where the presence of resistance genes does not always translate directly into phenotypic resistance due to regulatory mechanisms, gene expression variability, and genomic context. The review further discusses methodological differences in AST standards and genomic prediction approaches that may contribute to variability across studies. Collectively, the evidence supports a multidimensional interpretation of antimicrobial resistance in A. baumannii, emphasizing the necessity of integrating phenotypic and genotypic data for accurate diagnostics, surveillance, and clinical decision-making. This integrated perspective may contribute to improved understanding of resistance evolution and support the development of more effective strategies for managing multidrug-resistant A. baumannii infections.
Keywords: Acinetobacter baumannii; antimicrobial resistance; carbapenem resistance; genotype–phenotype correlation; antimicrobial susceptibility testing; carbapenemases; aminoglycoside-modifying enzymes; whole-genome sequencing Acinetobacter baumannii; antimicrobial resistance; carbapenem resistance; genotype–phenotype correlation; antimicrobial susceptibility testing; carbapenemases; aminoglycoside-modifying enzymes; whole-genome sequencing

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MDPI and ACS Style

Sutimbekova, N.; Bissenova, N.; Dusmagambetov, M.; Saltabayeva, U.; Utegenova, A.; Smanova, G.; Igissenova, A.; Rakhimzhanova, F.; Askarova, N.; Duissebekova, G.; et al. Phenotype–Genotype Discordance in Antimicrobial Resistance of Acinetobacter baumannii: Implications for Diagnostics and Surveillance. Pathogens 2026, 15, 381. https://doi.org/10.3390/pathogens15040381

AMA Style

Sutimbekova N, Bissenova N, Dusmagambetov M, Saltabayeva U, Utegenova A, Smanova G, Igissenova A, Rakhimzhanova F, Askarova N, Duissebekova G, et al. Phenotype–Genotype Discordance in Antimicrobial Resistance of Acinetobacter baumannii: Implications for Diagnostics and Surveillance. Pathogens. 2026; 15(4):381. https://doi.org/10.3390/pathogens15040381

Chicago/Turabian Style

Sutimbekova, Nazgul, Nelya Bissenova, Marat Dusmagambetov, Ulbossyn Saltabayeva, Aigul Utegenova, Gulmira Smanova, Alfiya Igissenova, Farida Rakhimzhanova, Nurgul Askarova, Gulbanu Duissebekova, and et al. 2026. "Phenotype–Genotype Discordance in Antimicrobial Resistance of Acinetobacter baumannii: Implications for Diagnostics and Surveillance" Pathogens 15, no. 4: 381. https://doi.org/10.3390/pathogens15040381

APA Style

Sutimbekova, N., Bissenova, N., Dusmagambetov, M., Saltabayeva, U., Utegenova, A., Smanova, G., Igissenova, A., Rakhimzhanova, F., Askarova, N., Duissebekova, G., Yktiyarov, A., & Sokurenko, E. (2026). Phenotype–Genotype Discordance in Antimicrobial Resistance of Acinetobacter baumannii: Implications for Diagnostics and Surveillance. Pathogens, 15(4), 381. https://doi.org/10.3390/pathogens15040381

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