Dynamics of Dissemination from Non-CG258 to Other via IncN Plasmids in an Area of High Endemicity.

Carbapenem-resistant (CRE) pose a significant threat to global public health. The most important mechanism for carbapenem resistance is the production of carbapenemases. carbapenemase (KPC) represents one of the main carbapenemases worldwide. Complex mechanisms of dissemination have been reported in Colombia, a country with a high endemicity of carbapenem resistance. Here, we characterized the dynamics of dissemination of gene among CRE infecting and colonizing patients in three hospitals localized in a highly endemic area of Colombia (2013 and 2015). We identified the genomic characteristics of KPC-producing recovered from patients infected/colonized and reconstructed the dynamics of dissemination of using both short and long read sequencing. We found that spread of among in the participating hospitals was due to intra- and interspecies horizontal gene transfer (HGT) mediated by promiscuous plasmids associated with transposable elements that was originated from a multispecies outbreak of KPC-producing in a neonatal intensive care unit. The plasmids were detected in isolates recovered in other units within the same hospital and nearby hospitals. The gene "epidemic" was driven by IncN-pST15-type plasmids carrying a novel Tnb structure and non-Tn elements (NTE) in spp., , spp., and spp. Of note, was found to coexist with in species of the complex. Our findings suggest that the main mechanism for dissemination of is HGT mediated by highly transferable plasmids among species of in infected/colonized patients, presenting a major challenge for public health interventions in developing countries such as Colombia.