Global genomic epidemiology and plasmid-mediated dissemination of and in the complex.

The global spread of complex strains harboring and/or genes poses a growing threat to carbapenem resistance control in clinical and environmental settings. However, the complex's genetic diversity hampers species classification, resistance surveillance, and treatment strategies. We analyzed 2632 genomes from 49 countries/regions and identified 350 (13.3 %) harboring and/or genes, including 256 clinical (73.14 %) and 89 environmental (25.43 %) isolates. Among them, 284 harbored , 64 , and 2 both, including one newly sequenced isolate in this study. We identified five KPC subtypes (KPC-2, KPC-3, KPC-4, KPC-18, KPC-97) and three NDM subtypes (NDM-1, NDM-5, NDM-7), mainly from the USA and China. KPC-2 and NDM-1 were the most prevalent subtypes across both clinical and environmental sources. Phylogenomic and comparative analyses revealed five distinct species (, and ) with clear clustering by species and geography. We identified 126 antimicrobial resistance genes (ARGs), with species-specific profiles and greater ARG co-occurrence in wastewater isolates. Genetic context analysis revealed distinct distributions of Tn and NTE transposons and plasmid types across species. Plasmid replicon analysis showed species-specific patterns, such as the exclusive presence of IncL/M in and the adaptive dissemination of and in other species via IncU and IncX3, respectively. These findings provide insights into the global distribution, species-level diversity, and resistance mechanisms of complex strains harboring and/or , underscoring the need for integrated clinical and environmental surveillance to mitigate the spread of carbapenem-resistant pathogens.