AUTHOR=Jia Xiaojiong , Dai Wei , Ma Weijia , Yan Jinrong , He Jianchun , Li Shuang , Li Congya , Yang Shuangshuang , Xu Xiuyu , Sun Shan , Shi Jing , Zhang Liping 

TITLE=Carbapenem-Resistant E. cloacae in Southwest China: Molecular Analysis of Resistance and Risk Factors for Infections Caused by NDM-1-Producers

JOURNAL=Frontiers in Microbiology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2018.00658

DOI=10.3389/fmicb.2018.00658

ISSN=1664-302X

ABSTRACT=<p>Carbapenem-resistant <italic>Enterobacteriaceae</italic> (CRE) has been considered a serious global threat, but carbapenem resistance remains relatively uncommon in <italic>E. cloacae</italic>, especially in China. The aim of this study was to characterize carbapenem-resistant <italic>E. cloacae</italic> (CR-ECL) isolates from 2012 to 2016 in Southwest China. Our study revealed that 20 (15.2%) of the 132 CR-ECL isolates obtained from patients were identified as NDM-1, with most isolates carrying the IncFIIA plasmids. Notably, we initially observed that the <italic>E. cloacae</italic> strain co-harbored NDM-1 and IMP-8 carbapenemases simultaneously. Analysis of the genetic environment of these two genes has revealed that the highly conserved regions (<italic>bl</italic>a<sub>NDM-1</sub>-<italic>ble</italic><sub>MBL</sub>-<italic>trpF</italic>-<italic>tat</italic>) are associated with the dissemination of NDM-1, while IS26, <italic>intI1</italic>, and <italic>tniC</italic> could be involved in the spread of IMP-8. Molecular epidemiology studies showed the nosocomial outbreak caused by NDM-1-producing <italic>E. cloacae</italic> ST88. Transferring from another hospital and previous carbapenem exposure were identified as independent risk factors for the acquisition of NDM-1-producing <italic>E. cloacae.</italic> These findings emphasize the need for intensive surveillance and precautions to monitor the further spread of NDM-1 in China.</p>