{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T06:05:25Z","timestamp":1780380325685,"version":"3.54.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To clarify the molecular epidemiology, resistance gene profiles, virulence characteristics, and clinical prognosis-related factors of Carbapenem-Resistant Enterobacterales (CRE) isolated from sterile body fluids. This study provides microbiological evidence for clinical management and infection control surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>62 non-duplicate sterile fluid CRE strains from 2016\u20132025 were retrospectively analyzed. VITEK-2 Compact detected MICs per CLSI M100. Illumina NovaSeq whole-genome sequencing was assembled via ABySS and GapCloser. Databases analyzed resistance, virulence, plasmid and MLST profiles. SNP phylogenetic analysis identified clonal clusters and strain genetic relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 62 CRE isolates, Klebsiella pneumoniae was the predominant species (77.4%, 48\/62), followed by Escherichia coli (12.9%, 8\/62) and Enterobacter cloacae complex (6.5%, 4\/62). Additionally, single isolates of Klebsiella aerogenes and Citrobacter freundii were recovered. A total of 6 sequence types (STs) were identified, with ST11 being the most prevalent (87.5%, 42\/48) among K. pneumoniae isolates. Carbapenemase genes were detected in 91.7% (44\/48) of K. pneumoniae strains, with blaKPC-2 (85.4%, 41\/48) and blaNDM-1 (10.4%, 5\/48) as the main types. Three strains co-harbored blaKPC-2 and blaNDM-1, and one strain carried blaNDM-5 alone. These strains also carried class C \u03b2-lactamase (AmpC), extended-spectrum \u03b2-lactamases (ESBLs), and aminoglycoside\/quinolone resistance genes. The rmpA2 virulence gene was detected in 75.0% (36\/48) of K. pneumoniae isolates. Among E. coli, blaNDM-5 (4\/8) and blaNDM-13 (2\/8) were predominant. One ST155 isolate exhibited ertapenem resistance potentially mediated by AmpC promoter mutations and porin loss based on genomic prediction. Additionally, mcr-1.1 was detected in one ST361 isolate. All four E. cloacae complex belonged to ST171 and harboured blaNDM-1; one co-carried mcr-9.1. Clonal analysis revealed five major clusters within ST11 (Clade A-E), with Clade B comprising genetically related dual-carbapenemase isolates from multiple wards (8-10 SNPs). Twelve patients (19.4%) died. Intensive Care Unit (ICU) admission was significantly associated with mortality (83.3% vs. 30.0%, P=0.002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CRE from sterile body fluids were dominated by ST11 K. pneumoniae carrying blaKPC-2, with complex multidrug resistance and frequent carriage of rmpA2 and other virulence-associated genes. Continuous molecular surveillance of dominant clones and monitoring of high-risk patient populations may inform strategies to reduce CRE burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1821740","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:42:57Z","timestamp":1780378977000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Carbapenem-resistant enterobacterales in sterile body fluids: ten-year population genomics and clinical risk factors in a tertiary hospital, 2016-2025"],"prefix":"10.3389","volume":"16","author":[{"given":"Shenyun","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]},{"name":"Shandong Provincial Key Medical and Health Laboratory of Anti-Drug Resistant Drug Research, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Jinan Nanshan People\u2019s Hospital","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Binhai New Area Hospital of Traditional Chinese Medicine (TCM)","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]},{"name":"Shandong Provincial Key Medical and Health Laboratory of Anti-Drug Resistant Drug Research, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Li","sequence":"additional","affiliation":[{"name":"Pharmacy Intravenous Admixture Services, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]},{"name":"Shandong Provincial Key Medical and Health Laboratory of Anti-Drug Resistant Drug Research, The Affiliated Taian City Central Hospital of Qingdao University","place":["Taian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab643","article-title":"Distinctive features of ertapenem-mono-resistant carbapenem-resistant Enterobacterales in the United States: A cohort study","volume":"9","author":"Adelman","year":"2022","journal-title":"Open Forum Infect. 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