TY - JOUR T1 - Molecular epidemiology of carbapenem-resistant <em>Enterobacter cloacae</em> complex infections uncovers high frequency of non-carbapenemase-producers in five tertiary care hospitals from Colombia JF - bioRxiv DO - 10.1101/494807 SP - 494807 AU - Astrid V. Cienfuegos-Gallet AU - Ana M. Ocampo AU - Kalyan Chavda AU - Liang Chen AU - Barry N. Kreiswirth AU - J. Natalia Jiménez Y1 - 2018/01/01 UR - http://biorxiv.org/content/early/2018/12/12/494807.abstract N2 - Background Infections caused by carbapenem-resistant Enterobacter cloacae (CR-Ecl) have been increasingly reported in the clinical setting; here we describe the clinical and molecular characteristics of CR-Ecl infections in a KPC endemic region.Methods A cross-sectional study was conducted in five tertiary-care hospitals in Medellín-Colombia. All patients infected by CR-Ecl from June-2012 to June-2014 were included. Sociodemographics and clinical information was retrieved from medical records. Antimicrobial susceptibility testing, phenotypic and molecular carbapenemase detection were performed. Analysis of hsp60 and PFGE was done in a subset of isolates.Results Of 109 patients enrolled, 60.55% (66/109) were infected with non-carbapenemase-producing-Ecl (non-CP-Ecl). CP-Ecl patients were frequently hospitalized in the ICU (37.21% vs 12.12%) and had exposure to carbapenems (39.53% vs 15.15%) compared to non-CP-Ecl infected patients. All-cause 30-day mortality was higher in CP-Ecl than non-CP-Ecl infected patients (27.91% vs 19.70%). CP-Ecl harbored KPC-2 (83.72%) and KPC-3 (6.97%). Analysis of hsp60 showed that CP-Ecl belonged primarily to cluster-VI of Enterobacter xiangfangensis (12/34) and cluster-XI (12/34) corresponding to E. cloacae subsp. cloacae. Non-CP-Ecl isolates belonged to cluster-VII/VIII (45/54), of E. hormaechi subsp. steigerwaltii. PFGE revealed isolates in cluster VII/VIII and XI were closely related within their own clusters.Conclusions The results revealed a high frequency of non-CP-Ecl among the CR-Ecl infections in a KPC endemic region, displaying distinct clinical and molecular characteristics in comparison to CP-Ecl. The study highlights a significant contribution of non-CP-Ecl to the prevalence of CR-Ecl. Infection control measures to curtail dissemination of CR-Ecl should not only focus on CP-Ecl but should also include non-CP-Ecl. ER -