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Fluoroquinolone (FQ) agents are a potential resort to treat infection due to  Enterobacteriaceae  producing extended spectrum β-lactamase and susceptible to FQ. In a context of increase of non-susceptibility to carbapenems among  Enterobacteriaceae , we characterized FQ resistance mechanisms in 75  Enterobacter cloacae  isolates non-susceptible to ertapenem in North-Eastern France in 2012 and describe the population structure by pulsed field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Among them, 14.7% (12/75) carried a carbapenemase-encoding gene. Except one isolate producing VIM-1, the carbapenemase-producing isolates carried the well-known IncL/M pOXA48a plasmid. Most of the isolates (59/75) harbored at least a FQ-R determinant.  qnr  genes were predominant (40%, 30/75). The MLST study revealed that  E. cloacae  isolates’ clonality was wide [24 different sequence types (STs)]. The more widespread STs were ST74, ST101, ST110, ST114, and ST133. Carbapenem MICs were higher for  E. cloacae  ST74 than for other  E. cloacae  isolates. Plasmid-mediated quinolone resistance determinants were more often observed in  E. cloacae  ST74 isolates. These findings showed that (i) pOXA-48a is spreading in North-Eastern France, (ii)  qnr  is preponderant in  E. cloacae , (iii)  E. cloacae  comprised a large amount of lineages spreading in North-Eastern France, and (iv) FQ as an alternative to β-lactams to treat ertapenem non-susceptible  Enterobacteriaceae  are compromised.

Fluoroquinolone Resistance Mechanisms and population structure of Enterobacter cloacae non-susceptible to Ertapenem in North-Eastern France