Distinctive Mobile Genetic Elements Observed in the Clonal Expansion of Carbapenem-Resistant in India.

(Kp), a common multidrug-resistant pathogen, causes a wide spectrum of nosocomial infections with high rates of morbidity and mortality. The emergence of pan drug-resistant international high-risk clones such as ST258, ST14, ST15, ST147, and ST101 is a global concern. This study was performed to investigate the carbapenemases, the plasmid profile, and the clonal relationship among Indian . A total of 290 isolates from seven centers in India were characterized to determine sequence types (STs) and carbapenemases. A subset of isolates was subjected to whole genome sequencing and hybrid genome assembly to obtain the complete genome. Plasmids carrying carbapenemases were characterized to determine the dissemination of carbapenem-resistant (CR) . From this study, 75 different STs were observed with ST231 being predominant. About 79% of the analyzed isolates were CR with 59% ( = 136) producing OXA48-like carbapenemases. While ST231 was the predominant clone among the OXA48-like producers; NDM producers and NDM+OXA48-like producers were mostly associated with ST14. Interestingly, 61% ( = 138) of the total CR were colistin resistant, belonging to 22 different STs. Plasmid profiling shows that was exclusively carried by ColKP3, whereas was associated with IncFII-like plasmids. The highly mosaic genome of coupled with the diverse ecological niches in India makes it a hotspot for antimicrobial resistance, leading to increased morbidity and mortality. Extensive molecular surveillance of the clonal spread of could help in understanding AMR dynamics and thus rework therapeutic management.