{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:04:43Z","timestamp":1791443083422,"version":"4.3.3"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000288","name":"Royal Society","doi-asserted-by":"crossref","award":["100087\/14\/Z"],"award-info":[{"award-number":["100087\/14\/Z"]}],"id":[{"id":"10.13039\/501100000288","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100001275","name":"Oak Foundation","doi-asserted-by":"crossref","award":["AK OCAY-15-547"],"award-info":[{"award-number":["AK OCAY-15-547"]}],"id":[{"id":"10.13039\/100001275","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Community-onset bloodstream infections (BSIs) caused by carbapenemase-producing Enterobacter cloacae complex (ECC) species are increasing internationally. This observation suggests that ECC are emerging pathogens, requiring for detailed understanding on their genomic epidemiology including transmission dynamics and antimicrobial resistance profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We performed WGS on 79 Enterobacter spp. isolated from the patients with clinically significant BSIs and admitted to emergency department of a major tertiary hospital in Nepal between April 2016 and October 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 5 species and 13 STs of ECC. Enterobacter xiangfangensis ST171, one of the globally emerging carbapenem resistant ECC clones with epidemic potential, was the most prevalent (42%). Phylogenetic analysis showed a large (&amp;gt;19\u200a400 SNPs) core genome SNP distance across major STs, which was minimal (&amp;lt;30 SNPs) among the isolates of each prevalent ST, suggesting the relatively recent importation of major STs followed by local clonal expansions. Genomic evidence for resistance to all major antimicrobial classes except for colistin and macrolides was detected. A limited number of isolates also carried blaNDM-1 (n\u200a=\u200a2) and blaOXA-48 (n\u200a=\u200a1) carbapenemase genes. Virulence factors encoding siderophores (24%), T6SSD (25%) and fimbriae (54%) were detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study highlighted that MDR ECC clones are important pathogens of BSIs in community. Though of low prevalence, carbapenem resistance observed in our ECC isolates raised concern about further community dissemination, underscoring the need for community surveillance to identify MDR ECC clones with epidemic potential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlac050","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T08:23:41Z","timestamp":1650961421000},"source":"Crossref","is-referenced-by-count":22,"title":["Genomic epidemiology, antimicrobial resistance and virulence factors of\n                    <i>Enterobacter cloacae<\/i>\n                    complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal"],"prefix":"10.1093","volume":"4","author":[{"given":"Sulochana","family":"Manandhar","sequence":"first","affiliation":[{"name":"Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal"},{"name":"Centre for Tropical Medicine and Global Health, Medical sciences division, Nuffield Department of Medicine, University of Oxford , Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Hospital for tropical diseases , Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"To","family":"Nguyen Thi Nguyen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Hospital for tropical diseases , Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duy Thanh","family":"Pham","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Medical sciences division, Nuffield Department of Medicine, University of Oxford , Oxford, UK"},{"name":"Oxford University Clinical Research Unit, Hospital for tropical diseases , Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maia A.","family":"Rabaa","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Medical sciences division, Nuffield Department of Medicine, University of Oxford , Oxford, UK"},{"name":"Oxford University Clinical Research Unit, Hospital for tropical diseases , Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Dongol","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buddha","family":"Basnyat","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal"},{"name":"Centre for Tropical Medicine and Global Health, Medical sciences division, Nuffield Department of Medicine, University of Oxford , Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer M.","family":"Dixit","sequence":"additional","affiliation":[{"name":"Center for Molecular Dynamics Nepal , Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1308-5755","authenticated-orcid":false,"given":"Stephen","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus , Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5179-650X","authenticated-orcid":false,"given":"Abhilasha","family":"Karkey","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal"},{"name":"Centre for Tropical Medicine and Global Health, Medical sciences division, Nuffield Department of Medicine, University of Oxford , Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"2022060805295676600_dlac050-B1","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1086\/533452","article-title":"Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE","volume":"197","author":"Rice","year":"2008","journal-title":"J Infect Dis"},{"key":"2022060805295676600_dlac050-B2","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1128\/CMR.00036-08","article-title":"AmpC \u03b2-lactamases","volume":"22","author":"Jacoby","year":"2009","journal-title":"Clin Microbiol Rev"},{"key":"2022060805295676600_dlac050-B3","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3389\/fmicb.2015.00392","article-title":"Enterobacter aerogenes and Enterobacter cloacae; 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