{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:04:37Z","timestamp":1791443077911,"version":"4.3.3"},"reference-count":52,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"MOST | NSFC | National Outstanding Youth Science Fund Project of National Natural Science Foundation of China","award":["No.32100136"],"award-info":[{"award-number":["No.32100136"]}]},{"DOI":"10.13039\/501100001809","name":"MOST | National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["No.82073610"],"award-info":[{"award-number":["No.82073610"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"MOST | National Key Research and Development Program of China","award":["2023YFC2307100"],"award-info":[{"award-number":["2023YFC2307100"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,12,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              The aim of this study was to explore the mechanisms and molecular epidemiology of carbapenem resistance in the carbapenem-resistant\n              <jats:italic>Enterobacter cloacae<\/jats:italic>\n              complex (CRECC) over a decade in a tertiary hospital in Zhejiang, China. From January 2011 to December 2021, we collected a total of 931\n              <jats:italic>Enterobacter cloacae<\/jats:italic>\n              complex (ECC) isolates from a tertiary hospital in Zhejiang, China. Antimicrobial susceptibility tests were performed. Whole-genome sequencing was used to analyze the molecular characteristics of the CRECC isolates. For carbapenem-resistant strains, efflux inhibitor assay and quantitative real-time PCR (qRT-PCR) were performed to evaluate the function of efflux pumps. A total of 82 CRECC isolates were detected, and the rate of resistance for carbapenems was 8.8%, increasing from 5.5% in 2011 to 18.3% in 2019, with an overall increasing trend, with\n              <jats:italic>Enterobacter hormaechei<\/jats:italic>\n              subsp\n              <jats:italic>. hoffmannii<\/jats:italic>\n              being the predominant species. Among the CRECC, 24 (24\/931) isolates were found to produce carbapenemases, including NDM-1, NDM-5, IMP-4, and KPC-2. Among all carbapenemases, NDM-1 was the most prevalent, accounting for 62.5% (15\/24) of carbapenemases, followed by NDM-5 (5\/24). Genes encoding extended-spectrum beta-lactamases (47\/82) and AmpC (76\/82) were also identified, with\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>SHV-12<\/jats:sub>\n              and\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>ACT<\/jats:sub>\n              being the predominant ones, respectively. Multilocus sequence typing revealed 28 different sequence types, among which ST78 was the predominant, followed by ST93 and ST177. IncFIB was the most common type of plasmid replicon. Efflux inhibitor assay and qRT-PCR indicated that the overexpression of efflux pumps was involved in carbapenem resistance mechanisms. Additionally, disrupted outer membrane proteins also contribute to carbapenem resistance. The detection rate of CRECC was rising in the tertiary hospital.\n              <jats:italic>Bla<\/jats:italic>\n              <jats:sub>NDM-1<\/jats:sub>\n              and\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>NDM-5<\/jats:sub>\n              were the main carbapenem resistance genes. Our study revealed the presence of carbapenem-resistant ECC strains, emphasizing the need for effective infection prevention approaches to reduce the prevalence of CRECC.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              The emergence and spread of the carbapenem-resistant\n              <jats:italic>Enterobacter cloacae<\/jats:italic>\n              complex (CRECC) have become a significant public health problem. CRECC strains frequently harbor multiple drug resistance genes and can be epidemic within healthcare facilities. The study explored the characteristics and prevalence of CRECC strains in the same hospital over a decade, which provides a theoretical basis for epidemiologic surveillance and clinical treatment.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.00780-24","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T15:14:02Z","timestamp":1730301242000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":32,"title":["High prevalence of carbapenem-resistant\n            <i>Enterobacter cloacae<\/i>\n            complex in a tertiary hospital over a decade"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3321-6435","authenticated-orcid":false,"given":"Shiqi","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, 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Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]},{"name":"Key laboratory of Microbial Technology and Bioinformatics of Zhejiang Province","place":["Hangzhou, China"]},{"name":"Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]},{"name":"Key laboratory of Microbial 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