Complete Nucleotide Sequence of Plasmids of Two Strains Carrying and and From the Same Patient.

Aim of this study was to genetically characterize two carbapenemase-producing strains obtained from a pediatric patient affected by diarrhea, expressing OXA-181 and/or NDM-5 type enzymes. The above microorganisms were collected in the same Desenzano hospital (Northern Italy) where the gene was detected for the first time in Italy 3 years ago. One strain (5P), belonged to sequence type ST405/ST477 (according to Pasture/Oxford schemes) and serotype O102:H6. It was characterized by a 130562 bp multi-replicon plasmid IncFII/IncFIA/IncFIB (pVSI_NDM-5) enclosing two main antibiotic resistance islands: (i) ARI-I, 10030 bp in size, carried genes coding for β-lactam- ( , ), fluoroquinolone/aminoglycoside- () and phenicol- resistance (), (ii) ARI-II, 15326 bp in size, carried genes coding for sulfonamide- (), β-lactam- ( , ), phenicol- (), trimethoprim- (), antiseptic- (Δ), and aminoglycoside- (, ) resistance. The other isolate (5M), belonged to sequence type ST2659/ST759 and serotype O50/02:H18, and carried four plasmids: a 153866 bp multi-replicon IncFII/IncFIA/IncFIB (pISV_IncFII_NDM-5), an 89866 bp IncI1 plasmid, a 51480 bp IncX3 plasmid (pISV_IncX3_OXA181), and a 41143 bp IncI plasmid (pISV_IncI_CMY-42). pISV_IncFII_NDM-5 carried two main antibiotic resistance islands: (i) ARI-III, 12220 bp in size, carried genes coding for β-lactam- ( ), fluoroquinolone/aminoglycoside- (), tetracycline- () and phenicol- resistance (, ), and ii) ARI-IV, 26527 bp in size, carried determinants coding for macrolide- (, ), sulfonamide- (), beta-lactam- ( , ), trimethoprim- (, ), antiseptic- (Δ), and aminoglycoside- resistance (). pISV_IncI_CMY-42 harbored the gene coding for beta-lactam resistance, pISV_IncX3_OXA181 harbored genes encoding fluoroquinolone- () and beta-lactams- resistance ( ). In conclusion, the detection of two different NDM-5 strains from a pediatric patient with a history of travel to the Far East countries strongly highlight an increasing trend and risk of importation from such areas.