Abstract
BackgroundThe worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems. Plasmids often play an important role in the spread of genes encoding drug-resistance factors, especially in the horizontal transfer of these genes among species of Enterobacteriaceae. This study describes a patient infected with three species of CPE carrying an identical transferrable IncL/M plasmid.MethodsClinical isolates of CPE were collected at St. Luke’s International Hospital, Tokyo, Japan, from 2015 to 2019. Three species of CPE isolates, Enterobacter cloacae, Klebsiella aerogenes and Serratia marcescens, were isolated from a patient who developed severe gallstone pancreatitis associated with bloodstream infection, with all three isolates producing IMP-1 metallo-β-lactamase. The complete sequences of the plasmids of the three isolates were determined by both MiSeq and MinION. The medical chart of this patient was retrospectively reviewed conducted to obtain relevant clinical information.ResultsThe three CPE species carried an IncL/M plasmid, pSL264, which was 81,133 bp in size and harbored blaIMP-1. The genetic environment surrounding blaIMP-1 consisted of int1-blaIMP-1-aac(6’)-IIc-qacL-qacEdelta1-sul1-istB-IS21. Conjugation experiments showed that S. marcescens could transmit the plasmid to E. cloacae and K. aerogenes. In contrast, pSL264 could not transfer from E. cloacae or K. aerogenes to S. marcescens.ConclusionThe IncL/M plasmid pSL264 harboring blaIMP-1 was able to transfer among different species of Enterobacteriaceae in a patient receiving long-term antimicrobial treatment. The worldwide emergence and spread of IncL/M plasmids harboring carbapenemase-encoding genes among species of Enterobacteriaceae is becoming a serious public health hazard.
Highlights
The worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems
Plasmids often play an important role in the spread of genes encoding drug resistance factors, with these plasmids often involved in the horizontal transfer of drug resistance genes among Enterobacteriaceae [8]
Culture of a blood sample resulted in the isolation of an IMP-1-producing strain of K. aerogenes, designated SL269 (Table 1)
Summary
The worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems. Plasmids often play an important role in the spread of genes encoding drug-resistance factors, especially in the horizontal transfer of these genes among species of Enterobacteriaceae. This study describes a patient infected with three species of CPE carrying an identical transferrable IncL/M plasmid. Plasmids often play an important role in the spread of genes encoding drug resistance factors, with these plasmids often involved in the horizontal transfer of drug resistance genes among Enterobacteriaceae [8]. IncX3 plasmids carrying blaNDMs are effectively transferred among Enterobacteriaceae species and contribute to the worldwide dissemination of NDM producers [10, 11]. IncFII(K) plasmids carrying blaIMPs and several Inc type plasmids, including IncL/M, IncN2, IncHI1B-IncFIB (Mar) and IncX3-IncC-like plasmids, carrying blaVIMs have contributed to the global spread of blaIMPs and blaVIMs among different species of Enterobacteriaceae [12]
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