<p>Coexistence Of Plasmid-Mediated <em>mcr-1</em> And <em>bla</em>_NDM-4</em> Genes In A Klebsiella pneumoniae Clinical Strain In Vietnam</p>

Abstract

In this study, we characterized the first clinical Klebsiella pneumoniae strain co- harboring mcr-1 and blaNDM-4 genes in Vietnam, which was recovered from a patient admitted to hospital in 2015. This strain demonstrated nonsusceptible to all tested antibiotics, including last-line antibiotics such as carbapenems (MICs ≥128 μg/mL) and colistin (MIC =32 μg/mL), except tigecycline (MIC =1 μg/mL). Whole-genome analysis using both MinION and MiSeq data revealed that the strain carried 29 resistance genes. Particularly, mcr-1 and blaNDM-4 genes were carried by different self-conjugative plasmids and able to be transferred to a recipient by conjugation. The colistin resistance of this strain was conferred by mcr-1 and additional chromosomal resistance determinants. Eight amino acid substitutions found in PmrA, PmrB, PmrC, PmrI, and PmrJ, all proteins that are involved in lipopolysaccharide modifications, may be associated with chromosomal colistin resistance. The accumulation of multiple antibiotic resistance mechanisms in this clinical isolate raises alarm on potential spread of extensively drug-resistant K. pneumoniae in healthcare settings.

Molecular Mechanism of Polymyxin Resistance in Multidrug-Resistant Klebsiella pneumoniae and Escherichia coli Isolates from Henan Province, China: A Multicenter Study

“…Two carbapenemase genes, bla KPC and bla NDM , are responsible for the phenotypic resistance of 90% of carbapenem-resistant Enterobacteriaceae strains in China. 26 The co-existence of mcr and carbapenemase genes, such as bla NDM-5 , 27 bla NDM-4 , 28 bla KPC , 29 and bla OXA , 30 has been sporadically reported in different countries. In the national monitoring data from China, one report showed that the mcr-1 was detected in 4.6% (13/282) of carbapenem-resistant E. coli isolates and coexisted with New Delhi metallo-enzyme (NDM)-5 in one strain.…”

Colonization with Staphylococcus aureus and Klebsiella pneumoniae causes infections in a Vietnamese intensive care unit

“…In contrast, two infections were classified as XDR, and only susceptible to colistin ( n =2), and amikacin ( n =1) (). These include an ST15 carrying the carbapenemase-producing plasmid pKP27-NDM4 [aac(3)-Iid , aac(6′)-lb , aadA1 , qnrS1 , bla LAP-2 , bla OXA-9 , bla CTX-M-14 , and bla NDM-4 ; accession number: NZ_CP041642], which was previously isolated in HCMC, Vietnam [52]; and an ST17 carrying pCFI-3 [aac(6′)-lb-cr , arr-3 , bla OXA-1 , sul1 , catB3 , qnrB4 , and bla DHA-1 ; accession number: NC_019984]. The presence of bla DHA-1 in several ST17 and ST86 strains underlay their resistance to ceftriaxone and ticarcillin/clavulanate.…”

Emergence of mobilized colistin resistance-1 in multidrug-resistant Klebsiella pneumoniae and Escherichia coli isolates from the Henan province in China: a multicentre study

“…Two carbapenemase genes, bla KPC and bla NDM , are responsible for the phenotypic resistance of 90% of carbapenem-resistant Enterobacteriaceae strains in China [18]. The co-existence of mcr and carbapenemase genes, such as bla NDM-5 [19], bla NDM-4 [20], bla KPC [21], and bla OXA [22], has been sporadically reported in different countries. In the national monitoring data from China, one report showed that the mcr-1 gene was detected in 4.6% (13/282) of carbapenem-resistant E. coli isolates and coexisted with the New Delhi metallo-enzyme (NDM)-5 in one strain [23].…”