sequence type 131 (ST131) is well known for its multidrug resistance profile. Carbapenems have been considered the treatment of choice for ST131 infections, and resistance to carbapenems is emerging due to the acquisition of carbapenemase-encoding genes. In this study, 45 carbapenem-resistant strains were collected in a hospital. The resistance mechanisms, plasmid profiles, and genetic relatedness of these strains were determined. Phylogenetic relationships between these strains were assessed by molecular profiling and aligned with patient clinical details. The genetic context of was analyzed to trace the potential dissemination of . The 45 carbapenem-resistant ST131 strains were closely related. Initially prevalent only in a single ward, ST131 subsequently spread to other ward, resulting in a respiratory infection outbreak of carbapenem-resistant ST131. Eight of the 30 patients died within 28 days of the first isolation of ST131. The -positive plasmid profiles suggest that the carbapenem resistance was due to the acquisition by ST131 of transmissible plasmids pE0272_KPC and pE0171_KPC carrying . Additionally, diverse multidrug resistance elements were transferred and rearranged between these plasmids mediated by IS26. Our research indicates that clinical attention should be paid to the importance of ST131 in respiratory infections and the spread of -carrying ST131.