Coexistence Of Plasmid-Mediated mcr-1 And [bla.sub.NDM-4] Genes In A Klebsiella pneumoniae Clinical Strain In Vietnam

• Published in: Infection and drug resistance 2019-12, p.3703
• Main Authors: Le, Lien, Tran, Linh Khanh, Le-Ha, Tam-Duong, Tran, Bich-Phuong, Le-Vo, Hong-Ngoc, Nguyen, Yen-Nhi, Nguyen, Hanh-Lan, Hoang-Ngoc, Khanh-Quynh, Matsumoto, Yuki, Motooka, Daisuke, Nakamura, Shota, Jones, James W, Ida, Tetsuya, Cao, Van
• Format: Article
• Language: English
• Subjects: Antibacterial agents; Antibiotics; Drug resistance; Genes; Genomes; Genomics; Imipenem; Meropenem; Metronidazole; Microbial drug resistance; Mitogens; Pneumonia; Proteins; Tetracyclines; Tigecycline
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S226612

In this study, we characterized the first clinical Klebsiella pneumoniae strain coharboring mcr-1 and [bla.sub.NDM-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 [greater than or equal to]128 [micro]g/mL) and colistin (MIC =32 [micro]g/mL), except tigecycline (MIC =1 [micro]g/mL). Whole-genome analysis using both MinION and MiSeq data revealed that the strain carried 29 resistance genes. Particularly, mcr-1 and [bla.sub.NDM-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. Keywords: coexistence, mcr-1, [bla.sub.NDM-4], Klebsiella pneumoniae, Vietnam