The clinical impact and dissemination of carbapenemase-producing Enterobacter : a genome-based study in China

Abstract

Carbapenemase-producing Enterobacter (CPEn) causes difficult-to-treat infections and has emerged globally as a significant antimicrobial resistance threat. Here, we generated genome sequences of 128 CPEn clinical isolates with accompanying clinical data. We found that CPEn causes a variety of infections, typically healthcare associated, and also asymptomatically colonizes patients. Among infections due to CPEn, bacteremia, pneumonia, and urinary tract infection are the most common. CPEn infections lead to a high predicted in-hospital all-cause mortality rate (32.9%). We examined all publicly-available Enterobacter genomes, identified an additional 562 CPEn strains from China, and unveiled the complex population structure of CPEn. We identified multiple intra- and inter-ward transmissions in the hospital and uncovered several inter-hospital and cross-region dissemination of CPEn. Infection control is key to counter CPEn and may need to include enhanced environmental hygiene and measures to reduce transmission related to patient transfer.