Plasmid genomic epidemiology of bla KPC carbapenemase-producing Enterobacterales in Canada, 2010-2021

• Published in: Antimicrobial agents and chemotherapy 2023-12, Vol.67 (12), p.e0086023
• Main Authors: Lerminiaux, Nicole, Mitchell, Robyn, Bartoszko, Jessica, Davis, Ian, Ellis, Chelsey, Fakharuddin, Ken, Hota, Susy S, Katz, Kevin, Kibsey, Pamela, Leis, Jerome A, Longtin, Yves, McGeer, Allison, Minion, Jessica, Mulvey, Michael, Musto, Sonja, Rajda, Ewa, Smith, Stephanie W, Srigley, Jocelyn A, Suh, Kathryn N, Thampi, Nisha, Tomlinson, Jen, Wong, Titus, Mataseje, Laura
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Bacterial Proteins - genetics; beta-Lactamases - genetics; beta-Lactamases - metabolism; Canada - epidemiology; Carbapenems - pharmacology; Genomics; Humans; Klebsiella Infections - epidemiology; Klebsiella pneumoniae; Microbial Sensitivity Tests; Plasmids - genetics
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/aac.00860-23

Carbapenems are considered last-resort antibiotics for the treatment of infections caused by multidrug-resistant , but carbapenem resistance due to acquisition of carbapenemase genes is a growing threat that has been reported worldwide. carbapenemase ( ) is the most common type of carbapenemase in Canada and elsewhere; it can hydrolyze penicillins, cephalosporins, aztreonam, and carbapenems and is frequently found on mobile plasmids in the Tn transposon. This means that alongside clonal expansion, can disseminate through plasmid- and transposon-mediated horizontal gene transfer. We applied whole genome sequencing to characterize the molecular epidemiology of 829 carbapenemase-producing isolates collected by the Canadian Nosocomial Infection Surveillance Program from 2010 to 2021. Using a combination of short-read and long-read sequencing, we obtained 202 complete and circular -encoding plasmids. Using MOB-suite, 10 major plasmid clusters were identified from this data set which represented 87% (175/202) of the Canadian -encoding plasmids. We further estimated the genomic location of incomplete -encoding contigs and predicted a plasmid cluster for 95% (603/635) of these. We identified different patterns of carbapenemase mobilization across Canada related to different plasmid clusters, including clonal transmission of IncF-type plasmids (108/829, 13%) in clonal complex 258 and novel repE(pEh60-7) plasmids (44/829, 5%) in ST316, and horizontal transmission of IncL/M (142/829, 17%) and IncN-type plasmids (149/829, 18%) across multiple genera. Our findings highlight the diversity of genomic loci and indicate that multiple, distinct plasmid clusters have contributed to spread and persistence in Canada.