{
  "abstract": "Enterobacterales pathogens that encode multiple carbapenemase genes are an emerging public health threat. The genomic and plasmid context of the multi-carbapenemase producers has not yet been explored at scale. We analysed 1501 publicly-available global genomes that encoded two or more genes from the five prevalent carbapenemase families (IMP, KPC, NDM, OXA-48-like, and VIM). We observed 241 distinct allelic combinations, with NDM/OXA-48-like (25.6%), multiple KPC (25.3%), KPC/NDM (18.8%), and multiple NDM (10.9%) being the most common groups. We found that many genomes were part of high-risk lineages (48.0%). Most genomes carried carbapenemase genes on two plasmids (59.2%) or one plasmid (23.5%), and most genomes encoded different carbapenemase families (56.2%) rather than copies of the same allele (36.2%). We observed multiple mechanisms of multi-carbapenemase evolution including plasmid co-integration, convergence with virulence, and generation of novel allele diversity through duplication. Multi-carbapenemase plasmids had more AMR genes that conferred resistance to more AMR classes compared to plasmids encoding a single carbapenemase. The proportion of cross-class combinations (KPC/NDM and NDM/OXA-48-like) increased significantly over time, with NDM-5/OXA-181 (3.3-fold) and NDM-4/OXA-181 (8.9-fold) combinations enriched. These findings provide valuable insights into the genomic features of multi-carbapenemase Enterobacterales to support the development of effective surveillance programmes.",
  "abstract_shown": true,
  "affiliations": [
    "Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"
  ],
  "article_type": "New results",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "N. Lerminiaux"
    },
    {
      "name": "D. Nagy"
    },
    {
      "name": "S. Lipworth"
    },
    {
      "name": "The NEKSUS Consortium"
    },
    {
      "name": "L. P. Shaw"
    },
    {
      "name": "L. Mataseje"
    },
    {
      "name": "K. L. Hopkins"
    },
    {
      "name": "K. Chau"
    },
    {
      "name": "N. Stoesser"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/abcrp5heywx8g.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.07.757280",
  "fulltext_url": "https://www.biorxiv.org/content/10.64898/2026.10.07.757280v1.full",
  "id": "abcrp5heywx8g",
  "issns": [],
  "landing_url": "https://www.biorxiv.org/content/10.64898/2026.10.07.757280v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "biorxiv",
      "microbiology"
    ],
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7221060353",
  "pdf_url": "https://www.biorxiv.org/content/10.64898/2026.10.07.757280v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/abcrp5heywx8g.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:26:40Z",
      "native_id": "10.64898/2026.10.07.757280",
      "source": "biorxiv",
      "url": "https://www.biorxiv.org/content/10.64898/2026.10.07.757280v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "biorxiv:microbiology",
      "subfield": "microbiology"
    }
  ],
  "title": "Global genomic epidemiology of multi-carbapenemase Enterobacterales",
  "title_text": "Global genomic epidemiology of multi-carbapenemase Enterobacterales",
  "type": "preprint",
  "updated_at": "2026-10-30T12:26:40Z",
  "url": "https://research.draconitic.com/paper/abcrp5heywx8g",
  "venue": "bioRxiv",
  "versions": []
}