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Background: <p>Carbapenemase-producing <i>Enterobacterales</i> (CPE) have been designated by the World Health Organization as critical global priority pathogens. Their widespread dissemination and nosocomial outbreaks pose a major public health threat. This study examined the transmission patterns and genetic characteristics of CPE isolated in New Caledonia between 2013 and 2022.</p> Methods: <p>A total of 214 CPE isolates were collected, comprising 199 non-duplicate clinical isolates from 164 patients and 15 environmental isolates from hospital surfaces. Isolates were characterized using phenotypic methods and whole-genome sequencing.</p> Results: <p>Among clinical isolates, the most prevalent genera was <i>Enterobacter</i> (<i>n</i> = 68; 34%) and <i>Klebsiella</i> (<i>n</i> = 50; 25%), with 194 isolates (98%) harbouring IMP-type carbapenemases. WGS of 89 selected CPE revealed the predominance of the <i>bla</i><sub>IMP-4</sub> gene (<i>n</i> = 82; 92%). This gene was primarily associated with IncM2-type plasmids carrying a class 1 integron, identified in 65 sequenced isolates. Long-read sequencing resolved these plasmids into seven distinct variants, differentiated by integron structures and a 9305-bp insertion. Genomic, phenotypic, and epidemiological triangulation have identified 12 hospital spread events, with 10 linked to IMP-4 IncM2 plasmids, whose transferability is confirmed by conjugation assays.</p> Conclusion: <p>These results highlighted the pivotal role of plasmid-mediated dissemination in CPE spread and emphasize the urgency of enhanced surveillance to curb silent transmission. The study provided critical insights for targeted infection control strategies in New Caledonia healthcare system, with broader implications for regional antimicrobial resistance containment.</p>

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Systematic surveillance of Carbapenemase-producing Enterobacterales reveals persistent spread of IMP-4 IncM2 plasmids in New Caledonia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月29日

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  • Alexandre Bourles,
  • Léo Cousin,
  • Gauthier Delvallez,
  • Antoine Biron,
  • Tiffany Ruge,
  • Rémy A. Bonnin,
  • Laurent Dortet,
  • Sylvain Brisse,
  • Federica Palma,
  • Philippe Saliou,
  • Malia Kainiu,
  • Thibaut Objois,
  • Elena Natiello-Menkes,
  • Matthieu Pot,
  • Frederic Veyrier,
  • Cyrille Goarant,
  • Julien Colot

摘要

Background:

Carbapenemase-producing Enterobacterales (CPE) have been designated by the World Health Organization as critical global priority pathogens. Their widespread dissemination and nosocomial outbreaks pose a major public health threat. This study examined the transmission patterns and genetic characteristics of CPE isolated in New Caledonia between 2013 and 2022.

Methods:

A total of 214 CPE isolates were collected, comprising 199 non-duplicate clinical isolates from 164 patients and 15 environmental isolates from hospital surfaces. Isolates were characterized using phenotypic methods and whole-genome sequencing.

Results:

Among clinical isolates, the most prevalent genera was Enterobacter (n = 68; 34%) and Klebsiella (n = 50; 25%), with 194 isolates (98%) harbouring IMP-type carbapenemases. WGS of 89 selected CPE revealed the predominance of the blaIMP-4 gene (n = 82; 92%). This gene was primarily associated with IncM2-type plasmids carrying a class 1 integron, identified in 65 sequenced isolates. Long-read sequencing resolved these plasmids into seven distinct variants, differentiated by integron structures and a 9305-bp insertion. Genomic, phenotypic, and epidemiological triangulation have identified 12 hospital spread events, with 10 linked to IMP-4 IncM2 plasmids, whose transferability is confirmed by conjugation assays.

Conclusion:

These results highlighted the pivotal role of plasmid-mediated dissemination in CPE spread and emphasize the urgency of enhanced surveillance to curb silent transmission. The study provided critical insights for targeted infection control strategies in New Caledonia healthcare system, with broader implications for regional antimicrobial resistance containment.