Ann Lab Med.  2018 Jan;38(1):17-22. 10.3343/alm.2018.38.1.17.

Extensively Drug-Resistant Escherichia coli Sequence Type 1642 Carrying an IncX3 Plasmid Containing the blaKPC-2 Gene Associated with Transposon Tn4401a

Affiliations
  • 1Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea. kscpjsh@yuhs.ac
  • 3Department of Dental Hygiene, College of Medical and Life Science, Shilla University, Busan, Korea.
  • 4Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Ilsan, Korea.

Abstract

BACKGROUND
Extensively drug-resistant (XDR) Enterobacteriaceae carrying the bla(KPC) gene have emerged as a major global therapeutic concern. The purpose of this study was to analyze the complete sequences of plasmids from KPC-2 carbapenemase-producing XDR Escherichia coli sequence type (ST) 1642 isolates.
METHODS
We performed antimicrobial susceptibility testing, PCR, multilocus sequence typing (MLST), and whole-genome sequencing to characterize the plasmid-mediated KPC-2-producing E. coli clinical isolates.
RESULTS
The isolates were resistant to most available antibiotics, including meropenem, ampicillin, ceftriaxone, gentamicin, and ciprofloxacin, but susceptible to tigecycline and colistin. The isolates were identified as the rare ST1642 by MLST. The isolates carried four plasmids: the first 69-kb conjugative IncX3 plasmid harbors bla(KPC-2) within a truncated Tn4401a transposon and bla(SHV-11) with duplicated conjugative elements. The second 142-kb plasmid with a multireplicon consisting of IncQ, IncFIA, and IncIB carries bla(TEM-1b) and two class 1 integrons. This plasmid also harbors a wide variety of additional antimicrobial resistance genes including aadA5, dfrA17, mph(A), sul1, tet(B), aac(3"²)-IId, strA, strB, and sul2.
CONCLUSIONS
The complete sequence analysis of plasmids from an XDR E. coli strain related to persistent infection showed the coexistence of a bla(KPC-2)-carrying IncX3-type plasmid and a class 1 integron-harboring multireplicon, suggesting its potential to cause outbreaks. Of additional clinical significance, the rare ST1642, identified in a cat, could constitute the source of human infection.

Keyword

Escherichia coli; ST1642; bla(KPC); Tn4401a; IncX3

MeSH Terms

Ampicillin
Animals
Anti-Bacterial Agents
Cats
Ceftriaxone
Ciprofloxacin
Colistin
Disease Outbreaks
Enterobacteriaceae
Escherichia coli*
Escherichia*
Gentamicins
Humans
Integrons
Multilocus Sequence Typing
Plasmids*
Polymerase Chain Reaction
Sequence Analysis
Ampicillin
Anti-Bacterial Agents
Ceftriaxone
Ciprofloxacin
Colistin
Gentamicins

Figure

  • Fig. 1 Circular map of pECSEV_01 containing blaKPC-2, blaSHV-11, and duplicated conjugative elements.

  • Fig. 2 Circular map of pECSEV_02 containing blaTEM-1, two class 1 integrons, virulence elements, and transconjugative elements.


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