Abstract
Background.Patients colonized with multiple species of carbapenemase-producing Enterobacterales (CPE) are increasingly observed. This phenomenon can be due to the high local prevalence of these pathogens, the presence of important host risk factors, and the great genetic promiscuity of some carbapenemase genes.Methods.We analyzed 4 CPE (Escherichia coli, Klebsiella pneumoniae, Providencia stuartii, Citrobacter sedlakii), 1 extended-spectrum cephalosporin-resistant K. pneumoniae (ESC-R-Kp), and 1 carbapenemase-producing Acinetobacter baumannii simultaneously isolated from a patient transferred from Macedonia. Susceptibility tests were performed using a microdilution MIC system. The complete genome sequences were obtained by using both short-read and long-read whole-genome sequencing technologies.Results.All CPE presented high-level resistance to all aminoglycosides due to the expression of the armA 16S rRNA methylase. In C. sedlakii and E. coli (ST69), both the carbapenemase blaNDM-1 and armA genes were located on an identical IncC plasmid of type 1a. The K. pneumoniae (ST268) and P. stuartii carried chromosomal blaNDM-1 and blaOXA-48, respectively, while the ESC-R-Kp (ST395) harbored a plasmid-located blaCTX-M-15. In the latter 3 isolates, armA-harboring IncC plasmids similar to plasmids found in C. sedlakii and E. coli were also detected. The A. baumannii strain possessed the blaOXA-40 carbapenemase gene.Conclusions.The characterization of the genetic organization of IncC-type plasmids harbored by 3 different species from the same patient offered insights into the evolution of these broad-host-range plasmids. Moreover, we characterized here the first complete genome sequence of a carbapenemase-producing C. sedlakii strain, providing a reference for future studies on this rarely reported species.
Highlights
The spread of carbapenemase-producing Enterobacterales (CPE) represents a major public health issue
In C. sedlakii and E. coli (ST69), both the carbapenemase blaNDM-1 and armA genes were located on an identical IncC plasmid of type 1a
We noted that while OXA-40-producing A. baumannii strains have been extensively described [1], the 4 CPE carried by the patient presented unusual patterns of antimicrobial resiswww.PaiJournal.com tance
Summary
The spread of carbapenemase-producing Enterobacterales (CPE) represents a major public health issue. Some conjugative plasmids harbor additional antimicrobial resistance genes (ARGs) conferring co-resistances to other antibiotic families, such as the ArmA 16S rRNA methylase enzyme that modifies the target of aminoglycosides resulting in resistance to all clinically-used aminoglycosides, including the most recently developed plazomicin [4,5,6] In this overall scenario, reports of patients simultaneously infected and/or colonized with multiple species of CPE are becoming a source of real concern. Several cases of interspecies exchange www.PaiJournal.com of identical blaKPC- [7, 8], blaOXA-48- [9, 10], and blaNDM-1-carrying plasmids have been described [9, 11,12,13] Those involving the blaNDM-1 were mainly due to the horizontal spread of broad-host-range IncC plasmids (formerly IncA/C2) [14]. This phenomenon can be due to the high local prevalence of these pathogens, the presence of important host risk factors, and the great genetic promiscuity of some carbapenemase genes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
