Healthcare Associated Infections, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis Division, UK Health Security Agency, London, UK.
Reference Services Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5HT, UK.
J Med Microbiol. 2022 Aug;71(8). doi: 10.1099/jmm.0.001569.
. The New Delhi metallo-β-lactamase (NDM) variant NDM-5 was first described in 2011 in an isolate of . We noted that a high proportion of isolates of positive for carbapenemase genes submitted to the UK Health Security Agency (formerly Public Health England) between 2019 and mid-2021 carried the allele, with many co-harbouring , rendering them highly resistant to aminoglycosides as well as to most β-lactams.. This observation suggested that a common plasmid may be circulating.. To compare these isolates and describe the plasmids carrying these resistance elements.. All isolates were sequenced on an Illumina platform, with five also subjected to long-read nanopore sequencing to provide complete assemblies. The locations of , and other associated genetic elements were identified. Susceptibility testing to a wide range of antibiotics was carried out on representative isolates.. The 34 isolates co-harbouring and were from 14 hospital groups and six different regions across England and consisted of 11 distinct sequence types. All carried IncF plasmids. Assembly of the NDM plasmids in five isolates revealed that they carried and in an IncF conjugative plasmid ranging in size from 85.5 to 161 kb. All carried a highly conserved region, previously described in plasmid pHC105-NDM, that included and followed by sequence bounded by two IS elements containing ΔIS, , , and followed by IS and an integron with , and cassettes. This arrangement has been described in isolates from other countries and continents, suggesting that such plasmids are widely distributed, at least in , with similar plasmids also found in . Tested isolates were resistant to most antibiotics except colistin, fosfomycin and tigecycline.. These observations suggest that conjugative plasmids carrying a highly conserved resistance gene segment have become widespread in England and elsewhere. This study highlights the value of routine whole-genome sequencing in identifying genetic elements responsible for resistance dissemination.
新德里金属β-内酰胺酶（NDM）变体 NDM-5 于 2011 年在一个 分离株中首次描述。我们注意到，2019 年至 2021 年年中期间，向英国卫生安全局（前身为英国公共卫生署）提交的 阳性的 分离株中，有很大比例的分离株携带 等位基因，其中许多还共同携带 ，使其对氨基糖苷类药物以及大多数β-内酰胺类药物高度耐药。这一观察结果表明，一种常见的质粒可能在传播。为了比较这些分离株并描述携带这些耐药元件的质粒。所有分离株均在 Illumina 平台上进行测序，其中 5 个分离株还进行了长读长纳米孔测序，以提供完整的组装。鉴定了 、 和其他相关遗传元件的位置。对代表性分离株进行了广泛抗生素敏感性测试。14 个医院组和英格兰六个不同地区的 34 个共同携带 和 的分离株由 11 个不同的序列型组成。所有分离株均携带 IncF 质粒。对 5 个分离株的 NDM 质粒进行组装显示，它们在大小为 85.5 至 161kb 的 IncF 可接合质粒上携带 和 。所有分离株都携带一个高度保守的区域，该区域以前在 pHC105-NDM 质粒中被描述过，该区域包括 和 ，后面是由两个包含 ΔIS 的 IS 元件、 、 和 、IS 和一个整合子组成，该整合子带有 、 和 盒。这种排列方式在来自其他国家和大陆的分离株中也有描述，这表明这种质粒在至少在英格兰广泛分布，并且在 中也发现了类似的质粒。测试的分离株除了对黏菌素、磷霉素和替加环素耐药外，对大多数抗生素都有耐药性。这些观察结果表明，携带高度保守耐药基因片段的可接合质粒已在英格兰和其他地方广泛传播。本研究强调了常规全基因组测序在识别耐药传播相关遗传元件方面的价值。
