NOVEL INCM1 PLASMID HARBOURING BLAKPC-2 DISSEMINATING IN KLEBSIELLA PNEUMONIAE AND ENTEROBACTER HORMAECHEI WITHIN A PATIENT

C. KNECHT; A. GAMBINO; A. LEGUINA; N. GARCÍA ALLENDE; V. ÁLVAREZ; B. PRACK MC CORMICK ;; M. MASSÓ ; A. GONZALES MACHUCA ; L. CARRERA PÁEZ ; M. PIEKAR ; J. CAMPOS; B. FOX; G. CAMICIA ; T. AYALA NÚÑEZ ; C. VARGAS; F. ALONSO ; N. DONIS; L. FERNÁNDEZ CANIGIA; D. CENTRÓN 1 ; M. QUIROGA

Virtual

Congreso; Microbiological adaptation in times of ecological disturbance and disruption; 2022

International Union of Microbiological Societies

Background and Aims According to the World Health Organization, carbapenem resistant Enterobacterales (CRE) bacteria belong to the highest priority group. WHONET data from Argentina showed that Gram-negative resistance levels to imipenem have been increasing since 2010 mostly in two CRE species: Klebsiella pneumoniae and Enterobacter cloacae Complex. Our aim was to analyze the bla KPC-2 genetic platform of two strains  belonging to these species colonizing a patient during hospitalization.Methods We isolated two CRE strains from one patient in a hospital from Argentina and sequenced their whole genome by Illumina MiSeq-I. The genome was assembled with SPAdes 3.9.0, and annotated with PROKKA, RAST andBlastn. Plasmids were identified with PlasmidFinder. Antibiotic resistance genes were detected using RESfinder, CARD and Blastn. Sequence types (ST) were identified with pubMLST. In vitro competition assay was done.Results The first isolated strain was a Klebsiella pneumoniae strain which  belonged to ST18. The second one was an Enterobacter hormaechei strain that belonged to the pandemic lineage ST45. Both strains were multidrugresistant and carried the same conjugative IncM1 plasmid (77.2 Kb) with bla KPC-2 embedded in the genetic element ISKpn27-blaKPC-2-ISKpn6-HP-Tn3, previously detected in IncP and R plasmids. In vitro competitiondid not show a clear advantage of a strain over the other nor over K. pneumoniae ST258. Secretion system IV present in Enterobacter and not in Klebsiella could account for prevalence of the latter in the patient.Conclusions This study describes a novel plasmid and further confirms that bla KPC-2 is highly mobilizable and prone to horizontal genetic transfer events between species of Enterobacteriaceae.