{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:27:09Z","timestamp":1785403629457,"version":"3.56.0"},"reference-count":40,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82172309, 82002177"],"award-info":[{"award-number":["82172309, 82002177"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC2308800, 2022YFC2303900"],"award-info":[{"award-number":["2023YFC2308800, 2022YFC2303900"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Carbapenemase-producing\n                      <jats:italic toggle=\"yes\">Enterobacter<\/jats:italic>\n                      (CPEn) has globally emerged to be a severe threat to human health. However, the disease spectrum, impact on affected patients\u2019 outcomes, and transmission of CPEn are largely uncharacterized. We performed genome sequencing on a collection of CPEn clinical isolates spanning a six-year period, collating corresponding disease spectrum data and patient prognosis. Among the 128 sequenced CPEn, 2\/3 were clinical isolates from a range of infections with bloodstream infections the most common. The remaining isolates were obtained from patient screening and considered to be colonizing the patients. Most (77.6%) CPEn infection isolates were healthcare associated. The predicted in-hospital mortality rate of patients with CPEn infections was 32.9%. We extended our analysis to all publicly available\n                      <jats:italic toggle=\"yes\">Enterobacter<\/jats:italic>\n                      genomes in China to uncover the population structure and transmission of CPEn by phylogenomic analysis. There were 562 CPEn isolated in China among the 14,648 publicly available\n                      <jats:italic toggle=\"yes\">Enterobacter<\/jats:italic>\n                      genomes. Consistent with our local isolates, ST171\n                      <jats:italic toggle=\"yes\">E. xiangfangensis<\/jats:italic>\n                      encoding\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      or\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-5<\/jats:sub>\n                      was the most common CPEn type in hospitals across China. Intra-hospital transmission and several inter-hospital and cross-region transmission\/strain-movement events of ST171 CPEn were observed. In conclusion, CPEn typically causes healthcare-associated infection and is a severe clinical problem. Countermeasures may need to focus on patient transfer and environmental cleaning including sinks.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Carbapenemase-producing\n                        <jats:italic toggle=\"yes\">Enterobacter<\/jats:italic>\n                        (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\n                        <jats:italic toggle=\"yes\">Enterobacter<\/jats:italic>\n                        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.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01166-25","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T10:44:07Z","timestamp":1754995447000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["The clinical impact and dissemination of carbapenemase-producing\n                    <i>Enterobacter<\/i>\n                    : a genome-based study in China"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1796-7133","authenticated-orcid":false,"given":"Shikai","family":"Wu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/011ashp19","id-type":"ROR","asserted-by":"publisher"}],"name":"Center of Infectious Diseases, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5654-4256","authenticated-orcid":true,"given":"Yu","family":"Feng","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy","place":["Chengdu, China"]},{"id":[{"id":"https:\/\/ror.org\/011ashp19","id-type":"ROR","asserted-by":"publisher"}],"name":"Laboratory of Pathogen Research, West China Hospital, Sichuan University","place":["Chengdu, 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Health Organization. 2017. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities Geneva Switzerland. World Health Organization. Available from: https:\/\/www.who.int\/publications\/i\/item\/guidelines-for-the-prevention-and-control-of-carbapenem-resistant-enterobacteriaceae-acinetobacter-baumannii-and-pseudomonas-aeruginosa-in-health-care-facilities"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.01166-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.01166-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:03:26Z","timestamp":1756818206000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.01166-25"}},"subtitle":[],"editor":[{"given":"Kai","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"alternative-id":["10.1128\/spectrum.01166-25"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.01166-25","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"2025-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e01166-25"}}