Carbapenemase production is constantly increasing among different Enterobacterales species. We analyzed the microbiological characteristics and population structure of all carbapenemase-producing Enterobacter spp. (CP-Ent) isolates recovered at the Ramón y Cajal Hospital between 2005 and 2018. Overall, 178 CP-Ent isolates (60.7% colonization, 39.3% clinical) were recovered from 165 hospitalized patients (165/176, 93.7%; medical [102/165], surgical [34/165], and intensive care unit [29/165] areas), emergency unit (4/176, 2.3%), and ambulatory patients (7/176, 4.0%). In addition, three CP-Ent were found in environmental sources. Clinical samples were mainly urine (37.1%). The most frequent matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF)-identified species were Enterobacter cloacae (n = 85) and Enterobacter asburiae (n = 49). hsp60 gene sequencing showed a higher species diversity than MALDI-TOF: 70 Enterobacter hormaechei-clusters III, VI, VIII; 69 Enterobacter roggenkampii-IV; 15 Enterobacter kobei-II; 9 E. asburiae-I; 3 Enterobacter ludwigii-V; and 1 E. cloacae subsp. dissolvens-XII. Nine Klebsiella aerogenes were also identified. Overall, a high clonal diversity (Simpson Diversity Index >0.90) was found among CP-Ent-clusters. Environmental isolates were clonally related to clinical ones. Amikacin and tigecycline showed the highest susceptibility (>93%). VIM-1 (n = 133/181, 73.5%) and OXA-48 (n = 34/181, 18.8%) carbapenemases were predominant, followed by KPC-2 (n = 9/181, 5.0%), KPC-3 (n = 2/181, 1.1%), VIM-2 (n = 1/181, 0.6%), and two coproducers (VIM-1+KPC-2 and VIM-1+KPC-3). Extended-spectrum beta-lactamase (ESBL) coproduction (14.4%) emerged in 2012, mainly associated with bla_SHV-12 (p < 0.001), E. roggenkampii (p < 0.001), and colonization (p = 0.03). VIM-1- and OXA-48-CP-Ent fecal carriers increased in our hospital, particularly between 2011 and 2018 (p < 0.001). Moreover, KPC and OXA-48 producers emerged in 2010 and 2012, respectively. They superimposed over VIM producers, which were persistently recovered since first detection in 2005. These results depict increased complexity over time of CP-Ent.

中文翻译：

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西班牙马德里西班牙大学医院产碳青霉烯酶肠杆菌分离株的出现和持续时间（2005-2018）

不同肠杆菌属物种之间的碳青霉烯酶产量不断增加。我们分析了所有产碳青霉烯酶的肠杆菌属的微生物特征和种群结构。(CP-Ent) 分离株于 2005 年至 2018 年在 Ramón y Cajal 医院回收。总体而言，从 165 名住院患者中回收了 178 株 CP-Ent 分离株（定植率为 60.7%，临床率为 39.3%；医疗 [ 102/165]、外科 [34/165] 和重症监护室 [29/165] 区）、急诊室 (4/176, 2.3%) 和非卧床患者 (7/176, 4.0%)。此外，在环境源中发现了三种 CP-Ent。临床样本主要是尿液（37.1%）。最常见的基质辅助激光解吸/电离飞行时间 (MALDI-TOF) 鉴定的物质是阴沟肠杆菌( n  = 85) 和Asburiae 肠杆菌( n  = 49)。hsp 60 基因测序显示出比 MALDI-TOF 更高的物种多样性：70 个肠杆菌属 hormaechei- cluster III、VI、VIII；69 Enterobacter roggenkampii-IV ; 15 kobei-II 肠杆菌；9 E. asburiae-I ; 3路德维希肠杆菌-V ; 和1 E. cloacae subsp。溶解-XII。九种产气克雷伯菌也被识别。总体而言，在 CP-Ent 簇中发现了高克隆多样性（辛普森多样性指数 >0.90）。环境分离株与临床分离株无性系相关。阿米卡星和替加环素显示出最高的敏感性（>93%）。VIM-1 ( n  = 133/181, 73.5%) 和 OXA-48 ( n  = 34/181, 18.8%) 碳青霉烯酶占优势，其次是 KPC-2 ( n  = 9/181, 5.0%)、KPC-3 ( n  = 2/181, 1.1%)、VIM-2 ( n  = 1/181, 0.6%) 和两个联合制作人（VIM-1+KPC-2 和 VIM-1+KPC-3）。2012 年出现了超广谱 β-内酰胺酶 (ESBL) 联产 (14.4%)，主要与bla _SHV-12 ( p  < 0.001)、E. roggenkampii (p  < 0.001）和定植（p  = 0.03）。我们医院的 VIM-1- 和 OXA-48-CP-Ent 粪便携带者有所增加，尤其是在 2011 年至 2018 年之间（p  < 0.001）。此外，KPC 和 OXA-48 生产商分别出现在 2010 年和 2012 年。它们叠加在自 2005 年首次发现以来持续恢复的 VIM 生成器上。这些结果描述了 CP-Ent 随时间增加的复杂性。