<p>Epidemic IncX3 plasmids spreading carbapenemase genes in the United Arab Emirates and worldwide</p>

Abstract

Purpose Plasmids of the incompatibility group X type 3 (IncX3) were described carrying various carbapenemase genes in carbapenemase-producing Enterobacteriaceae (CPE) worldwide and in the United Arab Emirates (UAE), as well. To understand the driving force behind the emergence of such plasmids in the UAE, the relationship between IncX3 plasmids encountered locally and globally was investigated. Methods CPE strains isolated in the UAE during 2009–2014 were screened by X3 PCR-based replicon typing. The clonal relationship of CPE carrying IncX3 plasmids was determined by multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Complete sequence of selected IncX3 plasmids was determined. Phylogenetic relationship between the carbapenemase carrying IncX3 plasmids from the UAE and of those reported worldwide was established by comparing the plasmid backbones. Results 10.2% of the 295 CPE tested were identified to carry IncX3 plasmids: 13 Escherichia coli , 13 Klebsiella pneumoniae , two Enterobacter cloacae , one Citrobacter freundii and one Morganella morganii isolate, respectively. Most of them were non-clonal; with small clusters of triplets and pairs of E. coli and K. pneumoniae , and a cluster of five K. pneumoniae ST11 exhibiting >90% similar PFGE patterns, respectively. The 30 isolates harbored either bla NDM-1 , bla NDM-4 , bla NDM-5 , bla NDM-7 , bla OXA-181 or bla KPC-2 carbapenemase genes on IncX3 plasmids. Phylogenetic analysis of the backbone region of IncX3 plasmids carrying various beta-lactamase genes from the UAE (n=23) and that of North-America, Europe, Asia and Australia (n=35) revealed three clusters based on the carbapenemase genes carried: plasmids harboring bla OXA-181 and bla NDM-5 formed two distinct groups, whereas backbones of plasmids with bla NDM-1 , bla NDM-4 and bla NDM-7 clustered together. Each cluster contained plasmids of diverse geographical origin. Conclusion The findings suggest that different carbapenemase gene carrying IncX3 plasmids encountered in the UAE do not evolve locally, rather are subtypes of this epidemic plasmid emerging in this country due to international transfer.

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

“…Although the transfer frequency was not high (average transfer frequency, 10 Ϫ6 ), it is possible that the NDM-encoded plasmids are transferred to other species and strains. Indeed, IncX3 plasmids carrying various carbapenemases, such as NDM and KPC, were isolated from both clinical settings and sewage in the United Arab Emirates (UAE) (29), Myanmar (30), and China (31). Therefore, monitoring the prevalence of IncX3 plasmids in clinical settings and in sewage is necessary.…”

Precision Medicine and Mysteries in Clinical Microbiology: Rationalizing Epidemiology, Genotype, and Phenotype To Guide Therapeutics

“…The strain of E. coli identified in this case, sequence type 167 (ST167), usually harbors bla NDM-5 or bla OXA-181 within a plasmid of the IncX3 type, which can also be hosted by other sequence types of E. coli and other bacterial species (4). The IncX3 plasmid found in this isolate did not contain carbapenemase genes but contained the cephalosporinase bla CTX-M-15 .…”

Genotypic and Phenotypic Characterization of blaNDM–7-Harboring IncX3 Plasmid in a ST11 Klebsiella pneumoniae Isolated From a Pediatric Patient in China

“…NDM-7 contains Asp-130-Asn and Met-154-Leu substitutions and has the greatest carbapenem-hydrolyzing activity ( Yoon et al, 2018 ). To date, NDM-7-producing enterobacteria have been reported in more than 10 countries ( Solgi et al, 2017 ; Ahmad et al, 2018 ; Yoon et al, 2018 ; Mouftah et al, 2019 ). In China, NDM-7 has been detected and described in E. coli but not in K. pneumoniae ( Wang et al, 2016 ; Bi et al, 2018 ; Hao et al, 2018 ; Xu and He, 2019 ).…”