Abstract
The wide dissemination of New Delhi metallo-β-lactamase genes (blaNDM) has resulted in the treatment failure of most available β-lactam antibiotics, with IncX3-type blaNDM-5-carrying plasmids recognised as having spread worldwide. In China, bacteria carrying these plasmids are increasingly being detected from diverse samples, including hospitals, communities, livestock and poultry, and the environment, suggesting that IncX3 plasmids are becoming a vital vehicle for blaNDM dissemination. To elucidate the fitness cost of these plasmids on the bacterial host, we collected blaNDM-negative strains from different sources and tested their ability to acquire the blaNDM-5-harboring p3R-IncX3 plasmid. We then measured changes in antimicrobial susceptibility, growth kinetics, and biofilm formation following plasmid acquisition. Overall, 70.7% (29/41) of our Enterobacteriaceae recipients successfully acquired the blaNDM-5-harboring p3R-IncX3 plasmid. Contrary to previous plasmid burden theory, 75.9% (22/29) of the transconjugates showed little fitness cost as a result of plasmid acquisition, with 6.9% (2/29) of strains exhibiting enhanced growth compared with their respective wild-type strains. Following plasmid acquisition, all transconjugates demonstrated resistance to most β-lactams, while several strains showed enhanced biofilm formation, further complicating treatment and prevention measures. Moreover, the highly virulent Escherichia coli sequence type 131 strain that already harbored mcr-1 also demonstrated the ability to acquire the blaNDM-5-carrying p3R-IncX3 plasmid, resulting in further limited therapeutic options. This low fitness cost may partly explain the rapid global dissemination of blaNDM-5-harboring IncX3 plasmids. Our study highlights the growing threat of IncX3 plasmids in spreading blaNDM-5.
Highlights
The World Health Organization has identified the global spread of antimicrobial resistance as one of the three greatest threats to human health [1,2]
We evaluated the fitness costs associated with plasmid acquisition
The high conjugative transfer rate suggests that p3R-IncX3 plasmids have the potential to increase their host range and further disseminate blaNDM genes
Summary
The World Health Organization has identified the global spread of antimicrobial resistance as one of the three greatest threats to human health [1,2]. A New Delhi metallo-β-lactamase-1 (NDM-1)-encoding gene was first identified in a clinical Klebsiella pneumoniae isolate in 2008 [3]. The worldwide dissemination of NDM-positive strains has become a serious threat to human public health, and to the poultry industry and the environment [4,5,6,7]. NDM enzymes can hydrolyze most β-lactams, including carbapenems, and bacteria producing these enzymes are associated with a high number of infections [8]. BlaNDM is often associated with other resistance genes, which complicates treatment and results in higher mortality rates [9].
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