{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:04:34Z","timestamp":1791443074823,"version":"4.3.3"},"reference-count":47,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 113-2321-B-006-007-"],"award-info":[{"award-number":["NSTC 113-2321-B-006-007-"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-11109029"],"award-info":[{"award-number":["NCKUH-11109029"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Enterobacter cloacae<\/jats:italic>\n                      complex (ECC) has become a clinically important pathogen with increased incidence worldwide in recent years. In Taiwan, IMP-8 accounted for most carbapenemase produced by ECC in earlier studies. Clinical ECC isolates resistant to ertapenem, imipenem, and meropenem at the study hospital between 2014 and 2022 were collected at a medical center in southern Taiwan. The isolates were subjected to multilocus sequence typing, species identification by\n                      <jats:italic toggle=\"yes\">hsp60<\/jats:italic>\n                      sequencing, polymerase chain reaction detection of beta-lactamase genes, antimicrobial susceptibility tests, and whole genome sequencing analysis. Fifty-four ECC isolates causing infections were included. Bloodstream (20 episodes, 37.0%) and lower respiratory tract infections (14, 25.9%) were the common infection types. The crude in-hospital mortality was 51.8%. Carbapenemase genes were detected among 90.7% of the isolates, and\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>IMP-8<\/jats:sub>\n                      remained to be the most common gene. The amikacin and colistin resistance rates were lower than 20%, while other agents were less active\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      . Infections caused by ECC with extensive carbapenem resistance herald a poor prognosis and have limited treatment options. Clonal spread of\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      harboring\n                      <jats:italic toggle=\"yes\">E. hormaechei<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">xiangfangensis<\/jats:italic>\n                      ST171 and\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>VIM-1<\/jats:sub>\n                      harboring\n                      <jats:italic toggle=\"yes\">E. hormaechei<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">hoffmannii<\/jats:italic>\n                      ST78, which have not been reported in Taiwan, was responsible for the increased incidence of ECC with complete resistance to tested carbapenems since 2019.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This study reported the increase of carbapenemase-producing\n                        <jats:italic toggle=\"yes\">Enterobacter cloacae<\/jats:italic>\n                        complex (ECC) isolates at a medical center in southern Taiwan during 2014 and 2022. The emergence of NDM-1-producing\n                        <jats:italic toggle=\"yes\">E. hormaechei<\/jats:italic>\n                        subsp.\n                        <jats:italic toggle=\"yes\">xiangfangensis<\/jats:italic>\n                        ST171 and VIM-1-producing\n                        <jats:italic toggle=\"yes\">E. hormaechei<\/jats:italic>\n                        subsp.\n                        <jats:italic toggle=\"yes\">hoffmannii<\/jats:italic>\n                        ST78, contrary to widely reported IMP-8-producing carbapenem-resistant\n                        <jats:italic toggle=\"yes\">E. cloacae<\/jats:italic>\n                        complex, accounts for the increased incidence of health care-associated infections with few remaining treatment options and poor clinical outcomes. Our findings highlighted the changing antimicrobial resistance of carbapenem resistance among Enterobacterales, leading to clinical difficulties in Taiwan.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00234-25","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T09:02:53Z","timestamp":1749546173000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["Infections caused by clonal spread of metallo-beta-lactamase-producing\n                    <i>Enterobacter cloacae<\/i>\n                    complex isolates at a southern Taiwan 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