Coexistence of bla NDM-5 and tet(X4) in international high-risk Escherichia coli clone ST648 of human origin in China

Muhammad Shafiq; Mi Zeng; Budi Permana; Hazrat Bilal; Jinhu Huang; Fen Yao; Abdelazeem Mohamed Algammal; Xin Li; Yumeng Yuan; Xiaoyang Jiao

doi:10.3389/fmicb.2022.1031688

Coexistence of bla _NDM-5 and tet(X4) in international high-risk Escherichia coli clone ST648 of human origin in China

Front Microbiol. 2022 Nov 10:13:1031688. doi: 10.3389/fmicb.2022.1031688. eCollection 2022.

Authors

Affiliations

¹ Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, China.
² School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia.
³ Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
⁴ Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.
⁵ Department of Pharmacology, Shantou University Medical College, Shantou, China.
⁶ Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.

Abstract

The emergence of pathogens is conferring resistance to last-resort therapies such as tigecycline, colistin, and carbapenems, limiting the therapeutic options, and raising concerns about the emergence of new "superbugs." This study reports the first incident of a bla _NDM-5 and tet(X4) co-harboring Escherichia coli with resistance to carbapenem and tigecycline recovered as the causative agent of a urinary tract infection in a 94-year-old patient. The E. coli strain ECCL209 carries multiple resistance genes [i.e., bla _TEM-1B , bla _NDM-5, bla _CMY-2, aadA22, florR, erm(B), mph(A), erm(42), lnuG, qnrS1, and sul2] and exhibits resistance to almost all clinically used antibiotics. MLST analysis found that the strain belongs to ST648, considered a worldwide high-risk pandemic clone. Moreover, multiple plasmid incompatibility types were detected, i.e., IncHI1A, IncHI1B, IncFII, IncFIA, IncFIB, IncQ1, Col, and IncX4. Genetic analysis revealed that bla _NDM-5 and tet(X4) genes were localized on two hybrid plasmids with multiple replicons. Continuous monitoring studies are suggested to quantify the antimicrobial resistance and assess the dissemination of such superbugs into a human healthcare setting.

Keywords: Escherichia coli; antimicrobial resistance; blaNDM–5; coexistence; hybrid plasmids; superbugs; tet(X4).

Grants and funding

This study was graciously supported by the National Natural Science Foundation of China for International Young Scientists (No. 42150410383) and the 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (project number: 2020LKSFG03E).