Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Extensively Drug-Resistant Escherichia coli Sequence Type 1642 Carrying an IncX3 Plasmid Containing the blaKPC-2 Gene Associated with Transposon Tn4401a

  • Jeong, Seri (Department of Laboratory Medicine, Kosin University College of Medicine) ;
  • Kim, Jung Ok (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Yoon, Eun-Jeong (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Bae, Il Kwon (Department of Dental Hygiene, College of Medical and Life Science, Shilla University) ;
  • Lee, Woonhyoung (Department of Laboratory Medicine, Kosin University College of Medicine) ;
  • Lee, Hyukmin (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Park, Yongjung (Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital) ;
  • Lee, Kyungwon (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Jeong, Seok Hoon (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine)
  • Received : 2017.04.24
  • Accepted : 2017.09.07
  • Published : 2018.01.01
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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')-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.

Keywords

Acknowledgement

Supported by : Korea Centers for Disease Control and Prevention

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