Dongan Cui, Panpan Liu, Ling Wang, Jiongjie He, Yuzhang Yan, Mengke Ru, Baocheng Hao, Yan Sun, Shengyi Wang
Accepted: 2024-09-26
Colistin serves as a crucial treatment for multidrug-resistant (MDR) Gram-negative bacterial infections. However, its excessive use has contributed to an increase in colistin-resistant strains within livestock production (Binsker et al. 2022). The mobile colistin resistance gene, mcr, which reduces colistin affinity by incorporating phosphoethanolamine (pEtN) into the bacterial lipopolysaccharide, significantly compromises the effectiveness of colistin treatments (Liu et al. 2016). To date, ten slightly different variants of the mcr-1 gene, ranging from mcr-1 to mcr-10, have been identified in various bacteria isolated from animals, agricultural settings, humans, and environmental samples (Hussein et al. 2021). Klebsiella pneumoniae(K. pneumoniae)is a major pathogen causing a variety of infections in humans, which is known to harbor mobile genetic elements that help it acquire and spread resistance genes, leading to the emergence of MDR strains (Faccone et al. 2020; Pu et al. 2022). A recent study reported a high prevalence of colistin-resistant K. pneumoniae, accounting for 56% of the isolates in chicken flocks (Mourão et al. 203). Chicken production has the potential to serve as a natural reservoir of colistin resistance K. pneumoniae, posing a public health threat (Talat et al. 2023).
Herein, as part of our routine resistance surveillance, we characterized a colistin-resistant strain of K. pn NXQY01 producing extended-spectrum beta-lactamases (ESBLs) from deceased chicks at a breeder farm in Ningxia, China. Antimicrobial susceptibility testing was performed using the VITEK® 2 COMPACT System (bioMérieux Inc. France) with the AST-GN 96 card (Lot No. 6862595203), following the manufacturer's recommendations. The K. pn NXQY01 isolates were resistant to multiple antibiotics including ampicillin, ticarcillin/clavulanic acid, cefalexin, cephalothin, cefoperazone, ceftiofur, cefquinome, gentamicin, neomycin, flumequine, enrofloxacin, marbofloxacin, tetracycline, polymyxin B, and sulfamethoxazole/trimethoprim (Table 1). To elucidate the genetic basis of antibiotic resistance in K. pn NXQY01, whole genome sequencing was performed using the PacBio RSII platform (Pacific Biosciences, Menlo Park, California, USA) and de novo assembly. The genome annotation was performed using Diamond software and the NCBI Prokaryotic Genome Annotation Pipeline. The genome of K. pn NXQY01 comprised a circular chromosome, which encompassed 5,279,178 base pairs and exhibited a GC content of 57.28%. Additionally, it harbored six plasmids, namely: pNXQY01-1 (227,409 bp), pNXQY01-2 (110,028 bp), pNXQY01-3 (71,848 bp), pNXQY01-4 (71,087 bp), pNXQY01-5 (66,252 bp), and pNXQY01-7 (8,159 bp). K. pn NXQY01 was determined to be sequence type 15 (ST15) by MLST. Resfinder analysis indicated that the K. pn NXQY01 isolate harbored 28 resistance genes including mcr-1.1, mcr-8.1, blaCTX-M-55, blaCTX-M-65 and others (Supplementary Table 1). Notably, pNXQY01-2 carried mcr-8.1, whereas pNXQY01-5 had both mcr-1.1 and blaCTX-M-55. To our knowledge, this constitutes the first report of an ST15 K. pneumoniae isolate co-harboring mcr-1.1, mcr-8.1 and ESBLs.
The pNXQY01-2 plasmid was 110,028 bp in length and comprised two replicons, characterized as an atypical IncFIB(pQil)/IncFII(K) type (Supplementary Table 2). Homology analysis suggested that the pNXQY01-2 is likely a novel recombinant plasmid resulting from recombination between plasmids pKP4 (Accession No. OL804388.1) and pPK45_NDM1 (accession no. LC521854.1). Fig. 1-A demonstrated that the presence of insertion sequences IS903B flanking the mcr-8 gene indicated its association with a composite transposon formed by IS903B elements. Additionally, pNXQY01-2 might contain ampC1 and ampC2 genes encoding AmpC β-lactamase. As shown in Fig. 1-B, pNXQY01-2-mcr-8.1 was nearly identical to the flanking structures of pKP4 (accession no. OL804388) and p5589 (accession no. CP102079), exhibiting only minor base sequence variations. Notably, the upstream region of the mcr-8 gene on pKP46 shows significant dissimilarities to the corresponding region in pNXQY01-2, primarily due to an incomplete ΔIS903B gene in the upstream mcr-8 of pNQXY01-2. Wu et al. (2018) documented the genetic diversity associated with the mcr-8 gene, noting that the upstream IS903B may be substituted by other insertion sequences, including IS1X2 and ISKpn21, and that the downstream IS903B region is prone to deletions and mutations. Farzana et al. (2020) also observed that in ST15 K. pneumoniae, the IS903B element upstream of mcr-8 is replaced by ISKpn21. It is therefore reasonable to hypothesize that the genetic context surrounding mcr-8, particularly the upstream IS903B element, exhibits instability and may be prone to replacement. Further research should prioritize investigation into this phenomenon.
The plasmid pNXQY01-5 was 66,252 bp in length, and represented a characteristic IncI2-type plasmid harboring the mcr-1 gene (Supplementary Table 2). IncI2 plasmids are mostly found in E. coli, indicating that pNXQY01-5 may facilitate gene transfer from E. coli to K. pneumoniae. The pNXQY01-5 harbored mcr-1.1 and blaCTX-M-55, and mcr-1.1 is situated between positions 23,875 and 25,500 bp (Fig. 1-C). As shown in Figure 1D, both the pNXQY01-5 and pM-199-232 harbored blaCTX-M-55 and mcr-1; however, the genetic contexts of the mcr-1 gene differ between the two plasmids. The pNXQY01-5 carry the insertion sequence ISApl1 upstream of the mcr-1 gene, which is absent in pM-199-232. The mcr-1 gene is frequently associated with plasmids containing the Tn6330 transposon. However, deletion of the ISApl1 elements within Tn6330 can lead to various configurations, such as ISApl1-mcr-1-pap2 or mcr-1-pap2 (Snesrud et al. 2016). Additionally, the genetic context of blaCTX-M-55, termed "ISEc9-blaCTX-M-55-orf-dnaJ", encompassed two hypothetical proteins, indicating a potential insertion pathway for blaCTX-M-55 through this sequence (Figure 1D). The pNXQY01-5 shared a high degree of similarity with the pHNSHP45, which was the first identified carrier of the mcr-1 gene. The primary distinction between them is the presence of the insertion sequence ISEc9, which harbors the blaCTX-M-55 gene, confirming its integration. Present results suggested that the resistance genes mcr-1.1 and blaCTX-M-55 in pNXQY01-5 may have been acquired through the insertion of foreign DNA sequences and are potentially linked to the insertion sequences ISApl1 and ISEc9, respectively.
The oriTfinder analysis revealed that plasmids pNXQY01-2, pNXQY01-3 and pNXQY01-5 possessed a complete conjugative transfer module (Supplementary Figures 1 and 2), enabling autonomous genetic material transfer via conjugation. To evaluate the transferability of mcr gene, conjugal transfer assays were carried out to identify colistin-resistant transconjugants with rifampicin (1000.0 mg L-1) and colistin (2.0 mg L-1) as previously described (Wang et al. 2023). PCR analysis of transconjugant NXQY01-600 showed the presence of mcr-1.1, mcr-8.1, blaCTX-M-55, and blaCTX-M-65 genes, indicating horizontal gene transfer. The transconjugant exhibited higher MICs for beta-lactam antibiotics, polymyxin B, and gentamicin (Table 1). The findings indicated that resistance in the transconjugant is likely caused by plasmid-encoded genes, including mcr-1.1 and blaCTX-M-55 on pNXQY01-5, blaCTX-M-65 on pNXQY01-3, and mcr-8.1 on pNXQY01-2. This could lead to the spread of antibiotic resistance, highlighting the importance of increased monitoring and control measures.
To the best of our knowledge, this is the first report of an ST15 K. pneumoniae isolate co-harboring mcr-1.1, mcr-8.1 and ESBLs, signifying a new plasmid-mediated antimicrobial resistance profile. Our research also focused on the genetic characterization of plasmids carrying mcr-1.1 and mcr-8.1, shedding light on their transmission mechanisms. The emergence of isolates from breeder flock harboring both ESBLs and colistin resistance genes narrows therapeutic options and highlights the escalating crisis of antimicrobial resistance in poultry production chain.