Coexistence of , and in -producing of clinical origin in China.

PURPOSE

To explore the genetic characteristics of the IMP-4, NDM-1, OXA-1, and KPC-2 co-producing multidrug-resistant (MDR) clinical isolate, wang9.

METHODS

MALDI-TOF MS was used for species identification. PCR and Sanger sequencing analysis were used to identify resistance genes. In addition to agar dilution, broth microdilution was used for antimicrobial susceptibility testing (AST). We performed whole genome sequencing (WGS) of the strains and analyzed the resulting data for drug resistance genes and plasmids. Phylogenetic trees were constructed with maximum likelihood, plotted using MAGA X, and decorated by iTOL.

RESULTS

carrying , , , and are resistant to most antibiotics, intermediate to tigecycline, and only sensitive to polymyxin B, amikacin, and fosfomycin. The coexists with the and the on a novel transferable plasmid variant pwang9-1, located on the integron In, transposon Tn, and integron In, respectively. The gene cassette sequence of integron In is , while the gene cassette sequence of In is The is located on the transposon Tn, and its sequence is ISISISIS The is located on the transposon Tn of plasmid pwang9-1, and its sequence is ISIS Phylogenetic analysis showed that most of the 34\u00B0 isolates from China were divided into three clusters. Among them, wang1 and wang9 belong to the same cluster as two strains of from environmental samples from Zhejiang.

CONCLUSION

We found carrying , , , and for the first time, and conducted in-depth research on its drug resistance mechanism, molecular transfer mechanism and epidemiology. In particular, we found that , , and coexisted on a new transferable hybrid plasmid that carried many drug resistance genes and insertion sequences. The plasmid may capture more resistance genes, raising our concern about the emergence of new resistance strains.