Xu Lin,* Zhiwen Lin,* Da Chen, Renhuai Huang, Hui Liang

First Department of General Surgery, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated to Jinan University), Zhuhai City, Guangdong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hui Liang, Zhuhai People’s Hospital, Zhuhai, Guangdong, People’s Republic of China, Email zhlianghui@126.com

Abstract: Carbapenems are the last-resort antibiotics used to treat infections caused by bacterial pathogens. Many bacterial pathogens have evolved to produce NDM carbapenemases to hydrolyze carbapenems, posing a great challenge to public health. In this study, we report a multidrug resistant clinical E. coli strain 673. Strain 673 belongs to sequence type (ST) 1431 and carries several plasmids, p673-blaTEM-1B, p673-blaCTX-M-55, p673-blaNDM-5, p673-13272, and p673-6468. p673-blaNDM-5 is an IncHI2/IncHI2A-type plasmid harboring several antibiotic resistance genes, including blaNDM-5, strA, strB, and dfrA. The blaNDM-5 gene was surrounded by two IS 26 elements in p673-blaNDM-5, indicating that IS 26 could mediate the integration of blaNDM-5 into p673-blaNDM-5. p673-blaCTX-M-55 is an IncFII-type plasmid harboring fosA, aadA1, and blaCTX-M-55. p673-blaTEM-1B is an IncFIB-type plasmid harboring blaTEM-1B and dfrA5. p673-13272 is a ColRNAI-type plasmid that does not carry any drug resistance genes. This is the first report that a blaNDM-5-bearing IncHI2/IncHI2A-type plasmid has emerged in a clinical E. coli strain in China. Our findings suggest that IS 26 mediates the integration of blaNDM-5 into p673-blaNDM-5. The spread of blaNDM-5-bearing plasmids is a clinical challenge and endangers public health.

Keywords: NDM-5, IncHI2/IncHI2A plasmid, E. coli