AUTHOR=Shafiq Muhammad , Zeng Mi , Permana Budi , Bilal Hazrat , Huang Jinhu , Yao Fen , Algammal Abdelazeem Mohamed , Li Xin , Yuan Yumeng , Jiao Xiaoyang 

TITLE=Coexistence of blaNDM–5 and tet(X4) in international high-risk Escherichia coli clone ST648 of human origin in China

JOURNAL=Frontiers in Microbiology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.1031688

DOI=10.3389/fmicb.2022.1031688

ISSN=1664-302X

ABSTRACT=<p>The emergence of pathogens is conferring resistance to last-resort therapies such as tigecycline, colistin, and carbapenems, limiting the therapeutic options, and raising concerns about the emergence of new “superbugs.” This study reports the first incident of a <italic>bla</italic><sub>NDM–5</sub> and <italic>tet</italic>(X4) co-harboring <italic>Escherichia coli</italic> with resistance to carbapenem and tigecycline recovered as the causative agent of a urinary tract infection in a 94-year-old patient. The <italic>E. coli</italic> strain ECCL209 carries multiple resistance genes [i.e., <italic>bla</italic><sub>TEM–1<italic>B</italic></sub>, <italic>bla</italic><sub>NDM–5</sub>, <italic>bla</italic><sub><italic>CMY–</italic>2</sub>, <italic>aadA22, florR, erm</italic>(B), <italic>mph</italic>(A), <italic>erm</italic>(42), <italic>lnuG</italic>, <italic>qnrS1</italic>, and <italic>sul</italic>2] and exhibits resistance to almost all clinically used antibiotics. MLST analysis found that the strain belongs to ST648, considered a worldwide high-risk pandemic clone. Moreover, multiple plasmid incompatibility types were detected, i.e., IncHI1A, IncHI1B, IncFII, IncFIA, IncFIB, IncQ1, Col, and IncX4. Genetic analysis revealed that <italic>bla</italic><sub>NDM–5</sub> and <italic>tet</italic>(X4) genes were localized on two hybrid plasmids with multiple replicons. Continuous monitoring studies are suggested to quantify the antimicrobial resistance and assess the dissemination of such superbugs into a human healthcare setting.</p>