<p>Co-Occurrence of <em>mcr-9</em> and <em>bla</em><sub>NDM-1</sub> in <em>Enterobacter cloacae</em> Isolated from a Patient with Bloodstream Infection</p>
Minmin Lin, Yongqiang Yang, Yanxian Yang, Guanping Chen, Ruowen He, Yiping Wu, Lan‐Lan Zhong, Mohamed Abd El-Gawad El-Sayed Ahmed, Siyuan Feng, Cong Shen, Xin Wen, Jin Huang, Hongyu Li, Xiaobin Zheng, Guo‐Bao Tian
Abstract
Background: Bloodstream infection (BSI) caused by carbapenem-resistant Enterobacteriaceae are potentially life-threatening related to poorer outcomes. Colistin is considered one of the last-resort treatments against human infections caused by multidrug-resistant (MDR) Gram-negative bacteria. Therefore, emergence of strains from the blood that co-harboring mcr and carbapenem resistance genes were considered as a serious problem. Purpose: In this study, two mcr-9 -harboring MDR Enterobacter cloacae isolates BSI034 and BSI072 recovered from BSI patients were identified, one of which co-harbored mcr-9 and bla NDM-1. The genetic characteristics of the MDR plasmid needed to be clarified. Methods: S1-PFGE and Southern blotting were conducted to determine the location of mcr-9 . Whole-genome sequencing was performed to obtain the complete genome and plasmid sequences. The resistome and virulence genes of the strains, accompanied by the genetic characteristics of mcr-9 - and bla NDM-1 -harboring plasmids, were analyzed. Results: Whole-genome sequencing showed that BSI034 harbored mcr-9 -carrying IncHI2-type pBSI034-MCR9 and bla NDM-1 -carrying IncX3-type pBSI034-NDM1. The 278,517 bp pBSI034-MCR9 carried mcr-9 along with the other 19 resistance genes. mcr-9 was flanked by IS 903B (1057 bp) and IS 26 (820 bp) in the same orientation. In addition to resistance genes, strain BSI034 also carried a chromosome-located Yersinia high-pathogenicity island, which harbored genes of yersiniabactin biosynthesis operon ybtSXQPAUTE, irp1/2 , and fyuA . Conclusion: We described the complete genome and mcr-9 / bla NDM-1 -co-harboring plasmid of E. cloacae from a BSI patient. Notable differences were observed within mosaic modules between pBSI034-MCR9 and other mcr-9 -harboring plasmids due to extensive recombination via horizontal gene transfer. Keywords: MDR, mcr-9 , colistin, virulence genes