Evidence of transmission and dissemination of diverse <i>bla</i> _NDM-5 -producing <i>Escherichia coli</i> clones between refugee and host communities and their environment: a multicenter cross-sectional study

The global rise of CP-Ec strains harboring <i>bla</i>_NDM-5 has been increasingly documented in clinical settings. However, little is known about their emergence and transmission in refugee settlements. This study provides a high-resolution genomic characterization of CP-Ec isolated from human, animal, water, and environmental sources in refugee settlements and surrounding host communities. By integrating whole-genome sequencing data from clinical isolates collected in Lebanese hospitals, we reveal genetically related strains in both community and healthcare settings, highlighting the potential introduction of community-acquired strains into clinical environments and vice versa. The widespread detection of <i>bla</i>_NDM-5 across multiple reservoirs suggests sustained circulation beyond hospital settings. The identification of CP-Ec in river water used for irrigation and emptying into the Mediterranean Sea highlights wider environmental dimensions that may drive regional dissemination of AMR. Our findings highlight the urgent need for One Health-based AMR surveillance strategies to track the spread of carbapenem-resistant pathogens in high-risk settings.