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Carbapenem-resistant  Enterobacteriaceae  (CRE) has been considered a serious global threat, but carbapenem resistance remains relatively uncommon in  E. cloacae , especially in China. The aim of this study was to characterize carbapenem-resistant  E. cloacae  (CR-ECL) isolates from 2012 to 2016 in Southwest China. Our study revealed that 20 (15.2%) of the 132 CR-ECL isolates obtained from patients were identified as NDM-1, with most isolates carrying the IncFIIA plasmids. Notably, we initially observed that the  E. cloacae  strain co-harbored NDM-1 and IMP-8 carbapenemases simultaneously. Analysis of the genetic environment of these two genes has revealed that the highly conserved regions ( bl a NDM-1 - ble  MBL - trpF - tat ) are associated with the dissemination of NDM-1, while IS26,  intI1 , and  tniC  could be involved in the spread of IMP-8. Molecular epidemiology studies showed the nosocomial outbreak caused by NDM-1-producing  E. cloacae  ST88. Transferring from another hospital and previous carbapenem exposure were identified as independent risk factors for the acquisition of NDM-1-producing  E. cloacae.  These findings emphasize the need for intensive surveillance and precautions to monitor the further spread of NDM-1 in China.

Carbapenem-Resistant E. cloacae in Southwest China: Molecular Analysis of Resistance and Risk Factors for Infections Caused by NDM-1-Producers