Emergence of a Multidrug-Resistant Clinical Isolate from Egypt Co-Harboring and .

This study describes the first full genomic sequence of an and -carrying multidrug-resistant clinical isolate from Egypt. The strain was isolated in April 2015 from the sputum of a patient in Cairo, Egypt. The and genes were identified by PCR screening and DNA sequencing; the isolate was subjected to antimicrobial susceptibility testing, conjugation experiments, and whole genomic sequencing. and were carried by an IncHI2 plasmid, pAMS-38a (281,121 bp in size); the plasmid also carried genes conferring resistance against sulfonamides (), quinolones (), trimethoprim (), β-lactams (), aminoglycosides (, , , and ). The strain was susceptible to colistin (MIC, <0.25 μg/mL); this could be due to the absence of the / regulatory system located downstream of in Enterobacterales, which is involved in the induction of colistin-resistance. The genetic context of and was identified as IS--IS- and -----IS-, respectively. This is the first report of an and /IncHI2-carrying multidrug-resistant clinical isolate from Africa and the Middle East. Plasmids of the IncHI2 group and the two insertion sequences (IS, and IS) might be the main vehicles for dissemination of . Further screening for is essential for identifying its incidence and to prevent its dissemination.