Emergence of - and (A)-Producing Isolated from Hospital Sewage.

Cephalosporins and azithromycin are clinical antibiotics used to treat infections. Co-resistance to cephalosporins and azithromycin has been observed in some , but it has only rarely been reported in species. In this study, we isolated a cephalosporin- and azithromycin-resistant strain, VFN3, from hospital sewage. Whole-genome sequencing results showed that the strain VFN3 possesses an IncA/C2 plasmid, pVFN3-blaOXA-193K. This conjugative plasmid carries several clinically relevant drug resistance genes, including (A) and . We also found that in the strain VFN3, (A) and are surrounded by insertion sequences and class I integrons, respectively. These data suggest that mobile elements mediate the transfer of (A) and . This is the first reported species that possesses an (A)- and -bearing conjugative plasmid. The emergence of this conjugative multi-drug-resistance plasmid is of great concern to public health.