A Patient With Multiple Carbapenemase Producers Including an Unusual Hosting an IncC - and -carrying Plasmid.

BACKGROUND

Patients colonized with multiple species of carbapenemase-producing Enterobacterales (CPE) are increasingly observed. This phenomenon can be due to the high local prevalence of these pathogens, the presence of important host risk factors, and the great genetic promiscuity of some carbapenemase genes.

METHODS

We analyzed 4 CPE (), 1 extended-spectrum cephalosporin-resistant (ESC-R-), and 1 carbapenemase-producing simultaneously isolated from a patient transferred from Macedonia. Susceptibility tests were performed using a microdilution MIC system. The complete genome sequences were obtained by using both short-read and long-read whole-genome sequencing technologies.

RESULTS

All CPE presented high-level resistance to all aminoglycosides due to the expression of the 16S rRNA methylase. In and (ST69), both the carbapenemase and genes were located on an identical IncC plasmid of type 1a. The (ST268) and carried chromosomal and , respectively, while the ESC-R- (ST395) harbored a plasmid-located . In the latter 3 isolates, -harboring IncC plasmids similar to plasmids found in and were also detected. The strain possessed the carbapenemase gene.

CONCLUSIONS

The characterization of the genetic organization of IncC-type plasmids harbored by 3 different species from the same patient offered insights into the evolution of these broad-host-range plasmids. Moreover, we characterized here the first complete genome sequence of a carbapenemase-producing strain, providing a reference for future studies on this rarely reported species.