Integrated chromosomal and plasmid sequence analyses reveal diverse modes of carbapenemase gene spread among <i>Klebsiella pneumoniae</i>
Sophia David, Victoria Cohen, Sandra Reuter, Anna E. Sheppard, Tommaso Giani, Julian Parkhill, the European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group, the ESCMID Study Group for Epidemiological Markers (ESGEM), Gian María Rossolini, Edward J. Feil, Hajo Grundmann, David M. Aanensen, Andi Koraqi, Denada Lacej, Petra Apfalter, Rainer Hartl, Y. Glupczynski, Te‐Din Huang, Tanya Strateva, Yuliya Marteva-Proevska, Arjana Tambić Andrašević, Iva Butić, Despo Pieridou-Bagatzouni, Panagiota Maikanti-Charalampous, Jaroslav Hrabák, Helena Žemličková, Anette M. Hammerum, Lotte Jakobsen, Marina Ivanova, Anastasia Pavelkovich, Jari Jalava, Monica Österblad, Laurent Dortet, Sophie Vaux, Martin Kaase, Sören Gatermann, Alkiviadis Vatopoulos, Kyriaki Tryfinopoulou, Ákos Tóth, Laura Jánvári, Teck Wee Boo, Elaine McGrath, Yehuda Carmeli, Amos Adler, Annalisa Pantosti, Monica Monaco, Lul Raka, Arsim Kurti, Arta Balode, Māra Saule, Jolanta Miciulevičienė, Aistė Mierauskaitė, Monique Perrin-Weniger, Paul Reichert, Nina Nestorova, Sonia Debattista, Gordana Mijović, Milena Lopičić, Ørjan Samuelsen, Bjørg Haldorsen, Dorota Żabicka, Elżbieta Literacka, Manuela Caniça, Vera Manageiro, Ana Kaftandzieva, Elena Trajkovska-Dokic, Maria Damian, Brânduşa Elena Lixandru, Zora Jelesić, Anika Trudić, M Nikś, Eva Schréterová, Mateja Pirš, Tjaša Cerar, Jesús Oteo, Marı́a Pérez-Vázquez, Christian G. Giske, Karin Sjöström, Deniz Gür, Aslı Çakar, Neil Woodford, Katie L. Hopkins, Camilla Wiuff, Derek Brown, Guido Werner, Natacha Couto
Abstract
Significance In many clinically important bacteria, antibiotic resistance genes are primarily carried on plasmids. These can spread horizontally between different strains and species. However, current surveillance systems track chromosomal lineages of bacteria only, leading to an incomplete understanding of how resistance spreads, from within an individual hospital to across country borders. We present an integrated, high-resolution analysis of both chromosome and plasmid sequences using Klebsiella pneumoniae isolates sampled during a European survey. We show that carbapenemase genes, which confer resistance to last-line antibiotics, have spread in diverse ways including via one plasmid/multiple lineages ( bla OXA-48-like ), multiple plasmids/multiple lineages ( bla VIM , bla NDM ), and multiple plasmids/one lineage ( bla KPC ). These different trajectories must be considered in genomic surveillance systems and the design of new interventions.