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Carbapenem-resistantEnterobacter cloacae complex isolates submitted to a reference laboratory from 2010 to 2015 were screened by PCR for seven common carbapenemase gene groups, namely, KPC, NDM, OXA-48, VIM, IMP, GES, and NMC-A/IMI. Nineteen of the submitted isolates (1.7%) were found to harbor Ambler class Abla NMC-A orbla IMI -type carbapenemases. All 19 isolates were resistant to at least one carbapenem but susceptible to aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, and ciprofloxacin. Most isolates (17/19) gave positive results with the Carba-NP test for phenotypic carbapenemase detection. Isolates were genetically diverse by pulsed-field gel electrophoresis macrorestriction analysis, multilocus sequence typing, andhsp60 gene analysis. The genes were found in variousEnterobacter cloacae complex species; however,bla NMC-A was highly associated withEnterobacter ludwigii . Whole-genome sequencing and bioinformatics analysis revealed that all NMC-A (n = 10), IMI-1 (n = 5), and IMI-9 (n = 2) producers harbored the carbapenemase gene on EludIMEX-1-like integrative mobile elements (EcloIMEXs) located in the identical chromosomal locus. Two novel genes,bla IMI-5 andbla IMI-6 , were harbored on different IncFII-type plasmids.Enterobacter cloacae complex isolates harboringbla NMC-A/IMI -type carbapenemases are relatively rare in Canada. Though mostly found integrated into the chromosome, some variants are located on plasmids that may enhance their mobility potential.

antimicrobial agents and chemotherapy

Enterobacter cloacae Complex Isolates Harboring bla NMC-A or bla IMI -Type Class A Carbapenemase Genes on Novel Chromosomal Integrative Elements and Plasmids