Klebsiella pneumoniae ST147: and then there were three carbapenemases.

Gram-negative bacteria containing three different carbapenemases are extremely rare. Klebsiella pneumoniae (N22-925) with KPC-2, NDM-1, and OXA-48 was obtained from a Canadian patient with recent hospitalization in Romania. Short and long read whole genome sequencing showed that the bla was situated on a 214 kb IncFIB(K)/IncFII(K) plasmid, the bla on a 104 kb IncFIB (pQil)/IncFII(K) plasmid, and the bla on a 64 kb IncL plasmid. These plasmids were conjugated to Escherichia coli J53. N22-925 belonged to a unique ST147 cluster that is likely endemic in Romania. This case emphasizes the need for rapid carbapenemase screening in patients from endemic regions. We described the first complete genome sequence of a K. pneumoniae isolate with three different carbapenemases, providing a reference for future studies on this rarely reported occurrence.