Department of Microbiology, School of Basic Medical Science, Xinxiang Medical University, Xinxiang, China.
Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
mSphere. 2021 May 19;6(3):e00088-21. doi: 10.1128/mSphere.00088-21.
The emergence of carbapenem-resistant (CRKP) isolates in Egyptian hospitals has been reported. However, the genetic basis and analysis of the plasmids associated with carbapenem-resistant hypervirulent (CR-HvKP) in Egypt have not been presented. Therefore, we attempted to decipher the plasmid sequences that are responsible for transferring the determinants of carbapenem resistance, particularly and Out of 34 isolates collected from two tertiary hospitals in Egypt, 31 were CRKP. Whole-genome sequencing revealed that our isolates were related to 13 different sequence types (STs). The most prevalent ST was ST101, followed by ST383 and ST11. Among the CRKP isolates, one isolate named EBSI036 has been reassessed by Nanopore sequencing. Genetic environment analysis showed that EBSI036 carried 20 antibiotic resistance genes and was identified as a CR-HvKP strain: it harbored four plasmids, namely, pEBSI036-1-NDM-VIR, pEBSI036-2-KPC, pEBSI036-3, and pEBSI036-4. The two carbapenemase genes and were located on plasmids pEBSI036-1-NDM-VIR and pEBSI036-2-KPC, respectively. The IncFIB:IncHI1B hybrid plasmid pEBSI036-1-NDM-VIR also carried some virulence factors, including the regulator of the mucoid phenotype (), the regulator of mucoid phenotype 2 (), and aerobactin ( and ). Thus, we set out in this study to analyze in depth the genetic basis of the pEBSI036-1-NDM-VIR and pEBSI036-2-KPC plasmids. We report a high-risk clone ST11 KL47 serotype of a CR-HvKP strain isolated from the blood of a 60-year-old hospitalized female patient from the intensive care unit (ICU) in a tertiary care hospital in Egypt, which showed the cohabitation of a novel hybrid plasmid coharboring the and virulence genes and a -carrying plasmid. CRKP has been registered in the critical priority tier by the World Health Organization and has become a significant menace to public health. The emergence of CR-HvKP is of great concern in terms of both disease and treatment. In-depth analysis of the carbapenemase-encoding and virulence plasmids may provide insight into ongoing recombination and evolution of virulence and multidrug resistance in Thus, this study serves to alert contagious disease clinicians to the presence of hypervirulence in CRKP isolates in Egyptian hospitals.
埃及医院已经报告了碳青霉烯类耐药（CRKP）分离株的出现。然而，埃及尚未报道与碳青霉烯类耐药超毒力（CR-HvKP）相关的质粒的遗传基础和分析。因此，我们试图破译负责转移碳青霉烯类耐药决定因素的质粒序列，特别是 和 。
在从埃及两家三级医院收集的 34 株分离株中，有 31 株为 CRKP。全基因组测序显示，我们的分离株与 13 种不同的序列类型（ST）有关。最常见的 ST 是 ST101，其次是 ST383 和 ST11。在 CRKP 分离株中，一株名为 EBSI036 的分离株已通过纳米孔测序重新评估。遗传环境分析表明，EBSI036 携带 20 个抗生素耐药基因，被鉴定为 CR-HvKP 菌株：它携带四个质粒，即 pEBSI036-1-NDM-VIR、pEBSI036-2-KPC、pEBSI036-3 和 pEBSI036-4。两种碳青霉烯酶基因 和 分别位于质粒 pEBSI036-1-NDM-VIR 和 pEBSI036-2-KPC 上。IncFIB:IncHI1B 杂合质粒 pEBSI036-1-NDM-VIR 还携带一些毒力因子，包括粘液表型调节剂 ()、粘液表型调节剂 2 () 和铁载体 ()。因此，我们在这项研究中深入分析了 pEBSI036-1-NDM-VIR 和 pEBSI036-2-KPC 质粒的遗传基础。
我们报告了一株从埃及一家三级医院重症监护病房（ICU）住院 60 岁女性血液中分离的 CR-HvKP 菌株，其血清型为 KL47 ST11，为高风险克隆，携带新型混合质粒，同时携带 和 毒力基因以及一个携带 基因的质粒。碳青霉烯类耐药已被世界卫生组织列为关键优先事项，并已成为公共卫生的重大威胁。CR-HvKP 的出现不仅对疾病本身，而且对治疗都令人担忧。对碳青霉烯酶编码和毒力质粒的深入分析可能有助于了解 中毒力和多药耐药性的持续重组和进化。因此，本研究提醒传染病临床医生注意埃及医院 CRKP 分离株的高毒力。
