Moser, Aline I.; Keller, Peter M.; Campos-Madueno, Edgar I.; Poirel, Laurent; Nordmann, Patrice; Endimiani, Andrea (2021). A Patient With Multiple Carbapenemase Producers Including an Unusual Citrobacter sedlakii Hosting an IncC blaNDM-1- and armA-carrying Plasmid. Pathogens and Immunity, 6(2), pp. 119-134. Case Western Reserve University, Cleveland, OH 10.20411/pai.v6i2.482
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Background. Patients colonized with multiple species of carbapenemase-producing Enterobacterales (CPE) are increasingly observed. This phenomenon can be due to the high local prevalence of these pathogens, the presence of important host risk factors, and the great genetic promiscuity of some carbapenemase genes.
Methods. We analyzed four CPE (Escherichia coli, Klebsiella pneumoniae, Providencia stuartii, Citrobacter sedlakii), one extended-spectrum cephalosporin resistant K. pneumoniae (ESC-R-Kp), and one carbapenemase-producing Acinetobacter baumannii simultaneously isolated from a patient transferred from Macedonia. Susceptibility tests were performed using a microdilution MIC system. The complete genome sequences were obtained by using both short- and long-read whole-genome sequencing technologies.
Results. All CPE presented high-level resistance to all aminoglycosides due to the expression of the armA 16S rRNA methylase. In C. sedlakii and E. coli (ST69), both the carbapenemase blaNDM-1 and armA genes were located on an identical IncC plasmid of type 1a. K. pneumoniae (ST268) and P. stuartii carried chromosomal blaNDM-1 and blaOXA-48, respectively, while the ESC-R-Kp (ST395) harbored a plasmid-located blaCTX-M-15. In the latter three isolates, armA-harboring IncC plasmids similar to that found in C. sedlakii and E. coli were also detected. The A. baumannii strain possessed the blaOXA-40 carbapenemase gene.
Conclusions. The characterization of the genetic organization of IncC type plasmids harbored by three different species from the same patient offered insights into the evolution of these broad host-range plasmid. Moreover, we characterized here the first complete genome sequence of a carbapenemase-producing C. sedlakii strain providing a reference for future studies on this rarely reported species.
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