Whole-genome sequencing of clinical isolates from a tertiary hospital in Terengganu, Malaysia (2011-2020), revealed the predominance of the Global Clone 2 lineage.

Carbapenem-resistant is recognized by the World Health Organization (WHO) as one of the top priority pathogens. Despite its public health importance, genomic data of clinical isolates from Malaysia remain scarce. In this study, whole-genome sequencing was performed on 126 . isolates collected from the main tertiary hospital in the state of Terengganu, Malaysia, over a 10-year period (2011-2020). Antimicrobial susceptibilities determined for 20 antibiotics belonging to 8 classes showed that 77.0% (=97/126) of the isolates were categorized as multidrug resistant (MDR), with all MDR isolates being carbapenem resistant. Multilocus sequence typing analysis categorized the Terengganu clinical isolates into 34 Pasteur and 44 Oxford sequence types (STs), with ST2 of the Global Clone 2 lineage identified as the dominant ST (=76/126; 60.3%). The ST2 isolates could be subdivided into six Oxford STs with the majority being ST195 (=35) and ST208 (=17). Various antimicrobial resistance genes were identified with the -encoded carbapenemase being the predominant acquired carbapenemase gene (=90/126; 71.4%). Plasmid-encoded genes were identified in nearly all (=122/126; 96.8%) of the isolates with the majority being Rep_3 family (=121). Various virulence factors were identified, highlighting the pathogenic nature of this bacterium. Only 14/126 (11.1%) of the isolates were positive for the carriage of CRISPR-Cas arrays with none of the prevalent ST2 isolates harbouring them. This study provided a genomic snapshot of the isolates obtained from a single tertiary healthcare centre in Malaysia over a 10-year period and showed the predominance of a single closely related ST2 lineage, indicating the entrenchment of this clone in the hospital.