Co-occurrence of a novel VIM-1 and FosA3-encoding multidrug-resistant plasmid and a KPC-2-encoding pKP048-like plasmid in a clinical isolate of Klebsiella pneumoniae sequence type 11

Yu Tang; Ying Zhou; Ciwen Meng; Yunkun Huang; Xiaofei Jiang

doi:10.1016/j.meegid.2020.104479

Co-occurrence of a novel VIM-1 and FosA3-encoding multidrug-resistant plasmid and a KPC-2-encoding pKP048-like plasmid in a clinical isolate of Klebsiella pneumoniae sequence type 11

Infect Genet Evol. 2020 Nov:85:104479. doi: 10.1016/j.meegid.2020.104479. Epub 2020 Jul 27.

Authors

Yu Tang¹, Ying Zhou², Ciwen Meng³, Yunkun Huang⁴, Xiaofei Jiang⁵

Affiliations

¹ Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
² Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
³ Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China.
⁴ Department of Laboratory Medicine, Kunming Yan'an Hospital, Kunming, China.
⁵ Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: [email protected].

PMID: 32731043
DOI: 10.1016/j.meegid.2020.104479

Abstract

The spread of carbapenem-resistant Enterobacteriaceae (CRE) worldwide remains a major threat to public health. Notably, carbapenemase-encoding genes are usually located in plasmids harboring other resistance determinants, and isolates having multiple plasmids are often highly resistant to carbapenems. In this study, we characterized the genetic context of coproduction of KPC-2, VIM-1, and FosA3 via two plasmids in the multidrug-resistant Klebsiella pneumoniae sequence type 11 (ST11) isolate JS187, recovered during an outbreak of KPC-2-producing K. pneumoniae in a Chinese teaching hospital in 2008. Plasmid p187-1, coharboring bla_VIM-1 and fosA3, consisted of a pKOX-R1-like backbone and two multidrug resistant (MDR) regions separated by pKHS1-like backbone sequences involving plasmid replication and stability. The MDR region 1 was a chimera composed of the bla_VIM-1-bearing In916-like integron and Tn1721-like transposon, and was disrupted by sequential insertion of an IS26-based transposition unit carrying bla_CTX-M-3 and a ΔTn3-like transposon bearing bla_TEM-1. MDR region 2 was an IS26-array structure with fosA3 and bla_SHV-12. Plasmid p187-2 harboring bla_KPC-2 was closely related to pKP048. bla_KPC-2 in p187-2 was carried by a Tn1721 variant, which differed from the prototype Tn1721-bla_KPC-2 transposon observed in pKP048 by disruption of an IS26 at Tn3 and deletion of a 31-kb MDR fragment. Co-existence of the novel VIM-1- and FosA3-encoding MDR plasmid p187-1 and the KPC-2-encoding pKP048-like plasmid p187-2 made K. pneumoniae JS187 highly resistant to carbapenems. Moreover, p187-1 still carried genes conferring resistance to cephalosporins, fosfomycin, chloramphenicol, and quaternary ammonium, posing substantial challenges for the treatment of Enterobacteriaceae infections. Thus, monitoring the prevalence and evolution of these plasmids and/or strains is critical.

Keywords: Carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae sequence type 11; Multidrug resistant bacteria; Plasmid evolution.

Publication types

Case Reports
Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Carbapenem-Resistant Enterobacteriaceae / genetics*
Carbapenem-Resistant Enterobacteriaceae / immunology*
China / epidemiology
Genes, Bacterial
Genetic Variation
Genomics
Humans
Klebsiella Infections / drug therapy*
Klebsiella Infections / immunology*
Klebsiella Infections / urine
Klebsiella pneumoniae / drug effects
Klebsiella pneumoniae / genetics*
Klebsiella pneumoniae / immunology*
Male
Microbial Sensitivity Tests
Plasmids / genetics*
Plasmids / immunology*

Substances

Anti-Bacterial Agents