The MALDI-TOF MS Bruker Biotyper MBT subtyping IVD module enables the early detection of cfiA-positive Bacteroides fragilis (cfiA+ BF) during bacterial identification. However, the relationship between genetic positivity, phenotypic resistance, and clinical outcomes has not been fully elucidated. This retrospective study analyzed B. fragilis isolates from three Hong Kong hospitals between 2021 and 2025 to examine their prevalence and the clinical utility of MALDI-TOF MS in rapid cfiA detection. Antibiotic susceptibility testing, cfiA gene detection using MALDI-TOF MS, and Oxford Nanopore sequencing were performed. Medical records were reviewed, and univariate analyses and multivariate logistic regression were used to identify factors associated with cfiA positivity and 30-day all-cause mortality. Overall, B. fragilis exhibited a high rate of antibiotic resistance. Concomitant resistance to carbapenems and metronidazole was identified in three isolates. Among the 166 isolates, 40 (24.1%) were cfiA-positive. cfiA detection by MALDI-TOF MS showed 100% concordance with the gene sequencing results and correlated strongly with phenotypic carbapenem resistance (Φ = 0.82, p < 0.001 for meropenem; Φ = 0.70, p < 0.001 for ertapenem; Φ = 0.63, p < 0.001 for imipenem). Phylogenetic analysis revealed two distinct clusters corresponding to cfiA status, each exhibiting genetic diversity based on multi-locus sequence typing (MLST). The cfiA+ BF isolates demonstrated high-level phenotypic carbapenem resistance in the presence of upstream insertion sequences. The predominant sequence type (ST) among cfiA+ BF isolates was ST157, and 70% of ST157 isolates harbored IS1187 in the upstream region of cfiA. Gene sequencing also identified other emerging beta-lactamase genes bla_OXA-347 and bla_MUN. The 30-day all-cause mortality following B. fragilis infection was 13.3%, with independent predictors including a high Charlson Comorbidity Index (OR = 1.30; p = 0.02) and the absence of early source control (OR = 4.84; p = 0.03). This study highlights the widespread occurrence of cfiA+ BF in Hong Kong and the clinical significance of rapid cfiA detection. Continuous surveillance is essential to monitor the ongoing threat of antibiotic resistance in B. fragilis.

The emergence of carbapenem-resistant non-typhoidal Salmonella species (CR-NTS) has been observed in recent years, causing increasing challenges in the clinical management and control of Salmonella infections. However, CR-NTS had not been comprehensively studied in Hong Kong previously. We retrieved archived non-typhoidal Salmonella isolates demonstrating carbapenem resistance from five public hospitals in Hong Kong during January 2020–June 2025. The isolates were characterised by NG-TEST CARBA-5 and subjected to whole-genome sequencing (WGS) and phylogenetic analysis. Clinical information of CR-NTS cases was also reviewed. Fourteen CR-NTS isolates (0.3%, 14/4404) were identified during the study period. All 13 CR-NTS isolates (one isolate could not be recovered) were NDM (New Delhi metallo-β-lactamase)-positive, with the first case identified in March 2023. WGS revealed six Group B Salmonella monophasic variants of Salmonella enterica serovar Typhimurium ST34 harbouring the bla_NDM-5 gene. The most common plasmid replicon co-present among bla_NDM-5-positive isolates was IncHI2–IncHI2A (63.6%, 7/11). Among cases of CR-NTS in our study, self-limiting gastroenteritis was the most common presentation (84.6%, 11/13); none presented with invasive infections; travel history was present in 7.7% (1/13). Phylogenetic analysis showed the genotypic relatedness of the ST34 isolates identified in Hong Kong to those on the Chinese mainland, with the possibility of local CR-NTS acquisition via imported food sources. Our findings highlighted the importance of a One Health approach to the control of CR-NTS and the need for continuous antimicrobial resistance surveillance of Salmonella spp. in Hong Kong.