First Report of an Extensively Drug-Resistant ST23 of Capsular Serotype K1 Co-Producing CTX-M-15, OXA-48 and ArmA in Spain.

An extensively drug-resistant (XDR) isolate MS3802 from a tracheostomy exudate was whole-genome sequenced using MiSeq and Oxford Nanopore MinION platforms in order to identify the antimicrobial resistance and virulence determinates and their genomic context. Isolate MS3802 belonged to the clone ST23 and presented a capsular serotype K1, associated with hypervirulent (hvKp) isolates. The isolate harboured a chromosomally encoded gene and contained a large IncHI1B hybrid virulence/resistance plasmid carrying another copy of the and the virulence factors and The carbapenemase gene was found in a Tn-like transposon and the 16S rRNA methylase gen located in the vicinity of other antibiotic-resistant genes on an IncM2 plasmid. This study represents, to the best of our knowledge, the first description of a -, - and -harbouring of ST23 and capsular serotype K1 in Spain. Our report emphasizes the importance of implementing new surveillance strategies to monitor the risk of emergence and spread of such XDR and hypervirulent isolates.