Complete Nucleotide Sequence of Plasmids of Two Escherichia coli Strains Carrying blaNDM-5 and blaNDM-5 and blaOXA-181 From the Same Patient

Aim of this study was to genetically characterize two carbapenemase-producing Escherichia coli strains obtained from a pediatric patient affected by diarrhea, expressing OXA-181 and/or NDM-5 type enzymes. The above microorganisms were collected in the same Desenzano hospital (Northern Italy) where the bla(NDM-)(5) gene was detected for the first time in Italy 3 years ago. One strain (5P), belonged to sequence type ST405/ST477 (according to Pasture/Oxford schemes) and serotype O102:H6. It was characterized by a 130562 bp multi-replicon plasmid IncFII/IncFIA/IncFIB (pVSI_NDM-5) enclosing two main antibiotic resistance islands: (i) ARI-I, 10030 bp in size, carried genes coding for beta-lactam- (bla(OXA-)(1), bla(CTX-M-)(15)), fluoroquinolone/aminoglycoside- (aac(6 ')-lb-cr) and phenicol- resistance (catB3), (ii) ARI-II, 15326 bp in size, carried genes coding for sulfonamide- (sul1), beta-lactam- (bla(NDM-)(5), bla(TEM-)(1)(B)), phenicol- (catB3), trimethoprim- (dfrA17), antiseptic- (qacE Delta 1), and aminoglycoside- (aadA5, rmtB) resistance. The other isolate (5M), belonged to sequence type ST2659/ST759 and serotype O50/02:H18, and carried four plasmids: a 153866 bp multi-replicon IncFII/IncFIA/IncFIB (pISV_IncFII_NDM-5), an 89866 bp IncI1 plasmid, a 51480 bp IncX3 plasmid (pISV_IncX3_OXA181), and a 41143 bp IncI plasmid (pISV_IncI_CMY-42). pISV_IncFII_NDM-5 carried two main antibiotic resistance islands: (i) ARI-III, 12220 bp in size, carried genes coding for beta-lactam- (bla(OXA-)(1)), fluoroquinolone/aminoglycoside- (aac(6 ')-lb-cr), tetracycline- (tet(B)) and phenicol- resistance (catB3, catA1), and ii) ARI-IV, 26527 bp in size, carried determinants coding for macrolide- (erm(B), mph(A)), sulfonamide- (sul1), beta-lactam- (bla(NDM-)(5), bla(TEM-)(1)(B)), trimethoprim- (dfrA14, dfrA12), antiseptic- (qacE Delta 1), and aminoglycoside- resistance (aadA5). pISV_IncI_CMY-42 harbored the bla(CMY-)(42) gene coding for beta-lactam resistance, pISV_IncX3_OXA181 harbored genes encoding fluoroquinolone- (qnrS1) and beta-lactams- resistance (bla(OXA-)(181)). In conclusion, the detection of two different NDM-5 E. coli strains from a pediatric patient with a history of travel to the Far East countries strongly highlight an increasing trend and risk of importation from such areas.