Department of Clinical Laboratory, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an City, Shandong, PR China.
Department of Intensive Care Medicine, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an City, Shandong, PR China.
Int J Antimicrob Agents. 2024 Sep;64(3):107290. doi: 10.1016/j.ijantimicag.2024.107290. Epub 2024 Jul 29.
Carbapenem-resistant Klebsiella pneumoniae (CRKP), a superbug that can be difficult or impossible to treat, has become a worldwide problem. This study presents the first report of a CRKP strain carrying a plasmid co-harbouring bla, bla, and tet(A) and the subsequent analysis of its genomic features.
Isolation and identification of bacteria, antimicrobial susceptibility test, whole genome sequencing, and conjugation experiments assay were conducted in clinical epidemiological investigations and plasmid genetic characterisation analysis.
A total of 116 strains of bacteria were isolated from patients with bloodstream infections (BSI) between 2018 and 2023. A total of 89.66% of the isolates were carbapenem-resistant Enterobacteriaceae (CRE), with the majority (75/116) being CRKP. Among these, a novel plasmid co-harbouring bla, bla, and tet(A) simultaneously was found in CRKP46, and the three genes mediated conjugation by IS26, ISAba125, and IS26, respectively. This plasmid conferred carbapenem resistance to E. coli J53 after conjugative transfer, which was 2 times greater than that of CRKP46.
The present study identified the occurrence of a rare plasmid co-harbouring bla, bla, and tet(A), and the spread of these genes was mediated by the corresponding mobile elements. The increased carbapenem resistance created by this novel plasmid challenges public health security and poses a potential threat to human health; therefore, it deserves attention.
碳青霉烯类耐药肺炎克雷伯菌（CRKP）是一种超级细菌，治疗起来可能比较困难甚至无法治疗，已成为全球性问题。本研究首次报道了一株携带同时bla、bla 和 tet(A) 的质粒的 CRKP 菌株，并对其基因组特征进行了分析。
在临床流行病学调查和质粒遗传特征分析中进行了细菌的分离和鉴定、药敏试验、全基因组测序和接合实验。
从 2018 年至 2023 年血流感染（BSI）患者中分离出 116 株细菌。分离物中 89.66%为碳青霉烯类耐药肠杆菌科（CRE），其中大部分（75/116）为 CRKP。在这些菌株中，CRKP46 中发现了一种同时携带 bla、bla 和 tet(A) 的新型质粒，这三个基因分别通过 IS26、ISAba125 和 IS26 介导接合。该质粒在接合转移后赋予大肠杆菌 J53 对碳青霉烯类的耐药性，是 CRKP46 的 2 倍。
本研究发现了一种罕见的同时携带 bla、bla 和 tet(A) 的质粒，这些基因的传播是由相应的移动元件介导的。这种新型质粒引起的碳青霉烯类耐药性增加对公共卫生安全构成了挑战，对人类健康构成了潜在威胁，因此值得关注。
