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Between 2014 and 2022, 211 non-duplicate\n                      <jats:italic toggle=\"yes\">E. cloacae<\/jats:italic>\n                      complex isolates (ECC) with reduced carbapenem susceptibility based on automated susceptibility testing were collected from 58 hospitals in 14 prefectures across Japan. PCR detected the\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>IMP-1<\/jats:sub>\n                      group in 92.9% of isolates. Among these, 80 representative CPEC isolates underwent whole-genome sequencing. Two dominant high-risk clonal groups, ST78 and ST133 (including single-locus variants), accounted for 62.5% of sequenced isolates. Notably, ST133\u2014rarely reported in Japan\u2014was the second most common type and detected widely, suggesting gradual and inconspicuous dissemination. ST78 exhibited substantial genomic diversity, frequent co-carriage of extended-spectrum beta-lactamase genes, and multiple plasmid replicons, while ST133 formed a more uniform lineage with limited resistance determinants. Most isolates remained highly susceptible to amikacin and cefiderocol. Core-genome multi-locus sequence typing suggested possible intra-facility persistence and inter-facility transmission of closely related strains (\u226410 allele differences) in some hospitals over time. Among the 46 facilities with\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>IMP-1<\/jats:sub>\n                      group-positive isolates, 73.9% (34\/46) were small hospitals (&lt;200 beds). The proportion among screened ECC isolates was similarly high in small and large hospitals (90.5% vs 94.8%), with no significant difference, suggesting the need to extend molecular surveillance even in resource-limited settings. These findings highlight the utility of molecular confirmation and targeted genomic analysis, particularly in regions or settings where high-risk CPEC clones may circulate undetected, to support timely detection and containment efforts.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.00953-25","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T16:53:55Z","timestamp":1760720035000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["High-risk clonal expansion of IMP-producing\n                    <i>Enterobacter cloacae<\/i>\n                    complex in regional Japanese healthcare settings"],"prefix":"10.1128","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3234-062X","authenticated-orcid":true,"given":"Kentarou","family":"Takei","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01dq60k83","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3026-5272","authenticated-orcid":true,"given":"Hajime","family":"Kanamori","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hwp6a56","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases and Laboratory Medicine, Kanazawa University","place":["Kanazawa, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuji","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Bacteriology, BML Inc.","place":["Kawagoe, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Bacteriology, BML Inc.","place":["Kawagoe, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5487-6698","authenticated-orcid":true,"given":"Hiroaki","family":"Baba","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01dq60k83","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Takei","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01dq60k83","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asami","family":"Nakayama","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01dq60k83","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6821-9701","authenticated-orcid":true,"given":"Tetsuji","family":"Aoyagi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01dq60k83","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00002-19"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-018-0452-8"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiw282"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00044"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1710.110655"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11020236"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02729-16"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2017.07.015"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2022.04.004"},{"key":"e_1_3_5_11_2","unstructured":"National Institute of Infectious Diseases. 2019. 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