626. Mobile Genetic Element Dynamics of Co-Circulating Klebsiella pneumoniae Sequence Types Carrying blaKPC in Houston, Texas

Abstract

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CR-Kpn) are a significant cause of hospital-associated infections. Class A β-lactamases, e.g., Klebsiella pneumoniae carbapenemases (KPCs), are major contributors to carbapenem resistance. Sequence type 258 (ST258) is the most common genetic lineage of CR-Kpn associated with blaKPC carriage. Recently, a newly emergent lineage ST307 has been identified within the Houston metropolitan region. The transmission of blaKPC and other antimicrobial resistance (AMR) genes is driven largely by exchange of mobile genetic elements (MGEs). We sought to describe the dynamics of horizontal gene transfer (HGT) in particular between co-circulating strains of ST307 and ST258.MethodsLong-read sequencing technologies allow us to resolve plasmid sequences and their associated AMR genes as well as characterize a comprehensive range of MGEs enabling transmission of these clinically important resistance mechanisms. CR-Kpn isolates were collected as part of a study to describe CRE burden within a Houston metropolitan hospital system. The Oxford Nanopore Technology (ONT) GridION X5 was used for long-read sequencing with Illumina short-read data used to refine and generate high-quality, consensus assemblies. A custom bioinformatic pipeline was used to resolve plasmid structures and identify the genomic context of plasmids carrying blaKPC variants.Results95 Kpn isolates were collected from May to December 2017. Phylogenetic and in silico MLST analysis revealed 38/95 (40%) and 35/95 (37%) were ST258 and ST307, respectively. 86% of Kpn isolates carried one or more IncF-type conjugative plasmids, which were the prime vectors for blaKPC intercellular transmission. Interestingly, we found similar AMR-harboring plasmids within ST258 and ST307 composed of mosaic, modular IS26 and Tn3-like transposase mediated elements that carried multiple AMR determinants including blaKPC variants (Figure 1).ConclusionWe were able to characterize mechanisms by which ST307 and ST258 lineages may transfer AMR determinants. There are clinically relevant implications to these HGT events that occur between these lineages as they may provide insights into how resistance differentially develops. Disclosures All authors: No reported disclosures.