Genome sequencing of Enterobacter cloacae and Citrobacter. Enterobacteriaceae

Enterobacter cloacae is an emerging pathogen in critical care and is thought to cause sporadic outbreaks of disease. Although it is intrinsically resistant to a number of beta-lactam antibiotics, it is becoming increasingly associated with transmissible carbapenemases, such as NDM-1, making its clinical management difficult. In this study we Illumina sequenced a set of strains from a neonatal unit in Nepal, a setting of high antimicrobial resistance prevalence, as well as several Citrobacter isolates. The molecular epidemiology of Enterobacter cloacae isolates, including a subset containing blaNDM, was complex, and represented a number of distinct clusters, as opposed to either unique acquisition events or a single clonal outbreak. Transmission occurred at both the host strain and plasmid levels, over a range of time periods, and across the community/hospital divide.