High diversity of blaNDM-1-encoding plasmids in Klebsiella pneumoniae isolated from neonates in a Vietnamese hospital

OBJECTIVES

The carbapenemase-encoding gene bla_NDM-1 has been reported in Vietnam over the last ten years, and bla_NDM-producing Enterobacteriaceae are now silently and rapidly spreading. A key factor behind dissemination of bla_NDM-1 are plasmids, mobile genetic elements that commonly carry antibiotic resistance genes and spread via conjugation. Here, we characterized the diversity of bla_NDM-1-encoding plasmids from neonates at a large Vietnamese hospital .

METHODS

18 fecal Klebsiella pneumoniae and Klebsiella quasipneumoniae isolates collected from 16 neonates at a large pediatric hospital in Vietnam were studied with optical DNA mapping (ODM) and next-generation sequencing (NGS). We identified the plasmid(s) carrying bla_NDM-1 by combining ODM with Cas9 restriction. By comparing the plasmids between isolates, we could investigate if the same plasmid was present in different patients.

RESULTS

Although the same plasmid was found among some isolates, ODM confirmed that there were at least 10 different plasmids encoding bla_NDM-1 among the 18 isolates collected from 16 neonates, suggesting a large plasmid diversity. The ODM results were in large agreement with the NGS data. Interestingly, some isolates had two distinct plasmids encoding bla_NDM-1, which could be readily detected with ODM. Thus far, the coexistence of different plasmids carrying the same carbapenem resistance gene in an isolate encoding bla_NDM-1 has rarely been reported, likely due to limitations in existing plasmid characterization techniques.

CONCLUSIONS

Our results show that the plasmids encoding bla_NDM-1 in this cohort were very diverse, suggesting a similar picture in the Vietnamese society. The study also highlights important aspects of the usefulness of ODM for plasmid analysis.

Genetic variation in the conjugative plasmidome of a hospital effluent multidrug resistant Escherichia coli strain

Bacteria harboring conjugative plasmids have the potential for spreading antibiotic resistance through horizontal gene transfer. It is described that the selection and dissemination of antibiotic resistance is enhanced by stressors, like metals or antibiotics, which can occur as environmental contaminants. This study aimed at unveiling the composition of the conjugative plasmidome of a hospital effluent multidrug resistant Escherichia coli strain (H1FC54) under different mating conditions. To meet this objective, plasmid pulsed field gel electrophoresis, optical mapping analyses and DNA sequencing were used in combination with phenotype analysis. Strain H1FC54 was observed to harbor five plasmids, three of which were conjugative and two of these, pH1FC54_330 and pH1FC54_140, contained metal and antibiotic resistance genes. Transconjugants obtained in the absence or presence of tellurite (0.5 μM or 5 μM), arsenite (0.5 μM, 5 μM or 15 μM) or ceftazidime (10 mg/L) and selected in the presence of sodium azide (100 mg/L) and tetracycline (16 mg/L) presented distinct phenotypes, associated with the acquisition of different plasmid combinations, including two co-integrate plasmids, of 310 kbp and 517 kbp. The variable composition of the conjugative plasmidome, the formation of co-integrates during conjugation, as well as the transfer of non-transferable plasmids via co-integration, and the possible association between antibiotic, arsenite and tellurite tolerance was demonstrated. These evidences bring interesting insights into the comprehension of the molecular and physiological mechanisms that underlie antibiotic resistance propagation in the environment.

Interspecies plasmid transfer appears rare in sequential infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae

From a cohort of 1836 Swedish patients infected with ESBL-producing Enterobacteriaceae (EPE) during 2004-2014, 513 patients with recurrent EPE infection were identified. Only in 14 of the 513 patients was a change of species (ESBL-E. coli to ESBL-K. pneumoniae or vice versa) found between the index and subsequent infection. Eleven sequential urine isolates from 5 of the 14 patients were available for further analysis of possible transfer of ESBL-carrying plasmids. The plasmid content was studied using optical DNA mapping (ODM), PCR-based replicon typing, and ESBL gene sequencing. ODM allowed us to directly compare whole plasmids between isolates and found similar ESBL-carrying plasmids in 3 out of the 5 patients. The ODM results and the rarity in shift of species between ESBL-E. coli and ESBL-K. pneumoniae imply that in recurrent EPE infections interspecies plasmid transfer is uncommon.