{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:36:12Z","timestamp":1792175772903,"version":"4.4.0"},"reference-count":40,"publisher":"American Society for Microbiology","issue":"4","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,4,2]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Blood-borne infections caused by the carbapenem-resistant\n Enterobacter cloacae<\/jats:italic>\n complex (CR-ECC) are major public threats with respect to the challenges encountered during treatment. This study describes the whole genome sequencing-based molecular characteristics of blood isolates (\n n<\/jats:italic>\n = 70) of CR-ECC from patients admitted to the intensive care unit of tertiary care hospitals in Kolkata, India, during 2017\u20132022 with respect to species identification, antimicrobial resistance (AMR) profiling, mechanism of drug resistance, and molecular subtypes. Vitek2 MALDI and species-specific PCR identified\n Enterobacter hormaechei<\/jats:italic>\n subsp.\n xiangfangensis<\/jats:italic>\n (47.14%) as the emerging CR-ECC subspecies in Kolkata. The predominating carbapenemase and extended-spectrum \u03b2-lactamase genes found were\n bla<\/jats:italic>\n NDM-1<\/jats:sub>\n (51.42%) and\n bla<\/jats:italic>\n CTX-M-15<\/jats:sub>\n (27%), respectively. Besides,\n bla<\/jats:italic>\n NDM-4<\/jats:sub>\n ,\n bla<\/jats:italic>\n NDM-5<\/jats:sub>\n , bla<\/jats:italic>\n NDM-7<\/jats:sub>\n , bla<\/jats:italic>\n CMH-3<\/jats:sub>\n ,\n bla<\/jats:italic>\n SFO-1<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-181<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-232<\/jats:sub>\n ,\n bla<\/jats:italic>\n KPC-3<\/jats:sub>\n , and\n bla<\/jats:italic>\n DHA-7<\/jats:sub>\n genes were also detected, which were not previously reported from India. A multitude of Class 1 integrons (including In180, In4874, In4887, and In4888, which were novel) and plasmid replicon types (IncFIB, IncFII, IncX3, IncHI1-HI2, IncC, and IncR) involved in AMR dissemination were identified. Reverse transcription-PCR and western blot revealed that carbapenem resistance in non-carbapenemase-producing CR-ECC isolates was contributed by elevated levels of\n ampC<\/jats:italic>\n , overexpression of\n acrAB,<\/jats:italic>\n and loss of\n ompF<\/jats:italic>\n . A total of 30 distinct sequence types (STs) were ascertained by multi-locus sequence typing; of which, ST2011, ST2018, ST2055, ST2721, and ST2722 were novel STs. Pulsed-field gel electrophoresis analysis showed heterogeneity (69 pulsotypes with a similarity coefficient of 48.40%) among the circulating isolates, suggesting multiple reservoirs of infections in humans. Phylogenetically and genetically diverse CR-ECC with multiple AMR mechanisms mandates close monitoring of nosocomial infections caused by these isolates to forestall the transmission and dissemination of AMR.\n <\/jats:p>\n \n IMPORTANCE<\/jats:title>\n \n The emergence and extensive dissemination of the carbapenem-resistant\n Enterobacter cloacae<\/jats:italic>\n complex (CR-ECC) have positioned it as a critical nosocomial global pathogen. The dearth of a comprehensive molecular study pertaining to CR-ECC necessitated this study, which is the first of its kind from India. Characterization of blood isolates of CR-ECC over the last 6 years revealed\n Enterobacter hormaechei<\/jats:italic>\n subsp.\n xiangfangensis<\/jats:italic>\n as the most prevalent subsp., exhibiting resistance to almost all antibiotics currently in use and harboring diverse transmissible carbapenemase genes. Besides the predominating\n bla<\/jats:italic>\n NDM-1<\/jats:sub>\n and\n bla<\/jats:italic>\n CTX-M-15<\/jats:sub>\n , we document diverse carbapenemase and\n AmpC<\/jats:italic>\n genes, such as\n bla<\/jats:italic>\n NDM-4<\/jats:sub>\n ,\n bla<\/jats:italic>\n NDM-7<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-181<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-232<\/jats:sub>\n ,\n bla<\/jats:italic>\n KPC-3<\/jats:sub>\n ,\n bla<\/jats:italic>\n CMH-3<\/jats:sub>\n ,\n bla<\/jats:italic>\n SFO-1<\/jats:sub>\n , and\n bla<\/jats:italic>\n DHA-7<\/jats:sub>\n , in CR-ECC, which were not previously reported from India. Furthermore, novel integrons and sequence types were identified. Our findings emphasize the need for strengthened vigilance for molecular epidemiological surveillance of CR-ECC due to the presence of epidemic clones with a phylogenetically diverse and wide array of antimicrobial resistance genes in vulnerable populations.\n <\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1128\/spectrum.03529-23","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T09:02:25Z","timestamp":1708592545000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":16,"title":["Whole genome sequence-based molecular characterization of blood isolates of carbapenem-resistant\n Enterobacter cloacae<\/i>\n complex from ICU patients in Kolkata, India, during 2017\u20132022: emergence of phylogenetically heterogeneous\n Enterobacter hormaechei<\/i>\n subsp.\n xiangfangensis<\/i>"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3873-3280","authenticated-orcid":false,"given":"Gourab","family":"Halder","sequence":"first","affiliation":[{"name":"Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar Narayan","family":"Chaudhury","sequence":"additional","affiliation":[{"name":"Division of Microbiology, Peerless Hospitex Hospital, Panchasayar, Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhranshu","family":"Mandal","sequence":"additional","affiliation":[{"name":"Division of Microbiology, CNCI, Rajarhat, New Town, Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Denny","sequence":"additional","affiliation":[{"name":"Collaborative Research Center for Infectious Diseases in India, Okayama University, 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