| Summary: | The gastrointestinal tract is an important reservoir of extended spectrum beta-lactamase (ESBL)/carbapenemase-producing Enterobacterales isolates. This study included patients from two Bulgarian hospitals. Overall, 98 ESBL producers (including 68 <i>Escherichia coli</i> and 20 <i>Klebsiella pneumoniae</i> isolates) were detected among 99 hospitalized patients, 212 patients at admission, and 92 hospital staff in 42.4%, 24.5%, and 4%, respectively. We observed <i>bla</i><sub>CTX-M-15</sub> in 47% of isolates, <i>bla</i><sub>CTX-M-3</sub> in 39% and <i>bla</i><sub>CTX-M-14</sub> in 11%. Three <i>bla</i><sub>CTX-M-15</sub> positive isolates were also <i>bla</i><sub>KPC-2</sub> positive. High transferability was detected for <i>bla</i><sub>CTX-M-3</sub> carrying plasmids (55%) with L/M and I1 replicon plasmids, followed by CTX-M-14 (36.4%) and CTX-M-15 (27.9%) with IncF plasmids. BlaKPC-2 was carried by FIIAs plasmids. Epidemiology typing revealed 8 <i>K. pneumoniae</i> ST types—ST15(8/20), ST17(4/20), ST37(2/20) and 9 <i>E. coli</i> ST types—ST131 (30.9%, 21/68), ST38 (8/68), ST95(7/68) and ST316(7/68). All ST131 isolates but one was from the highly virulent epidemic clone O25bST131. This is the first report in Bulgaria about ESBL/carbapenemase faecal carriage. We observed high ESBL/carbapenemases prevalence. A predominant number of isolates were members of highly epidemic and virulent PanEuropean clones ST15 <i>K. pneumoniae</i> and O25bST131 <i>E. coli</i>. High antibiotics usage during the COVID pandemic will worsen the situation. Routine screenings and strict infection control measures should be widely implemented.
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