Epidemiological characteristics and molecular features of carbapenem-resistant
Enterobacter
(CR-
Ent
) species remain unclear in China. In this study, we performed a genomic study on 92 isolates from
Enterobacter
-caused infections from a multicenter study in China. Whole genome sequencing (WGS) was used to determine the genome sequence of 92 non-duplicated CR-
Ent
strains collected from multiple tertiary health centres. The precise species of
Enterobacter
strains were identified by average nucleotide identity (ANI) and in silico DNA–DNA hybridization (isDDH). Molecular features of high-risk CR-
Ent
sequence type (ST) lineages and carbapenemase-encoding plasmids were determined. The result revealed that the most common human-source CR-
Ent
species in China was
E. xiangfangensis
(66/92, 71.93%), and the proportion of carbapenemase-producing
Enterobacter
(CP-
Ent
) in CR-
Ent
was high (72/92, 78.26%) in comparison to other global regions. Furthermore, ST171 and ST116
E. xiangfangensis
were the major lineages of CP-
Ent
strains, and ST171
E. xiangfangensis
was more likely to cause infections in older patients. Genomic analysis also highlighted the likelihood of intra-hospital/inter-hospital clonal transmission of ST171 and ST116
E. xiangfangensis
. In addition, the
bla
NDM
-harbouring IncX3-type plasmid was identified as the prevalent carbapenemase-encoding plasmid carried by CR-
Ent
strains, and was experimentally confirmed to be able to self-transfer with high frequency. This study detailed the genomic and clinical characteristics of CR-
Ent
in China in the form of multicenter for the first time. The high risk of carbapenemase-producing ST171 and ST116
E. xiangfangensis
, and the
bla
NDM
-harbouring IncX3-type plasmid were detected and emphasized.
Osteomyelitis is difficult to cure, and the rapidly rising morbidity is a thorny problem accompanied by a large number of joint replacement applications.
Staphylococcus aureus
is the main pathogen of osteomyelitis. Circular RNAs (circRNAs), as emerging noncoding RNAs, play important roles in multiple physiopathological processes which could provide novel insights into osteomyelitis.
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