High-Risk Lineages of Hybrid Plasmids Carrying Virulence and Carbapenemase Genes.

Carbapenem-resistant (CRE) are a global health threat due to their high morbidity and mortality rates and limited treatment options. This study examines the plasmid-mediated transmission of virulence and antibiotic resistance determinants in carbapenem-resistant () and () isolated from Russian hospitals. : We performed short- and long-read whole-genome sequencing of 53 clinical isolates (48 and 5 ) attributed to 15 genetic lineages and collected from 21 hospitals across nine Russian cities between 2016 and 2022. : The plasmid analysis identified 18 clusters that showed high concordance with replicon typing, with all clusters having a major replicon type. The majority of plasmids in the IncHI1B(pNDM-MAR)/IncFIB(pNDM-Mar)-like cluster (79.16%) carried both antibiotic resistance genes (e.g., and ) and virulence factors (VFs) such as siderophore genes. We hypothesized that hybrid plasmids could play a critical role in the dissemination of antibiotic resistance genes and VFs. Comparative analyses with global plasmid databases revealed high-risk lineages of hybrid plasmids that are predominantly spread throughout Russia at present. Our findings underscore the importance of monitoring plasmid backbones for clinical management, surveillance, and infection control activities.