Figure. Geographic and temporal trends of carbapenem nonsusceptibility and resistance in Enterobacteriaceae seen at Veterans Health Administration facilities, United States, 2006–2015. A) Dissemination of carbapenem-resistant Klebsiella pneumoniae after an initial focus in the eastern United States. B) Nationwide percentage of carbapenem nonsusceptibility and resistance in K. pneumoniae. C) Emergence and dissemination ("second epidemic") of carbapenem-nonsusceptible and -resistant Enterobacter cloacae complex. D) Nationwide percentage of carbapenem nonsusceptibility and resistance in E. cloacae complex. Isolates from patients in Puerto Rico were not included in the maps.