A Novel blaCTX-M-65-Harboring IncHI2 Plasmid pE648CTX-M-65 Isolated from a Clinical Extensively-Drug-Resistant Escherichia coli ST648

Background: An ESBL, carbapenemase- and MCR-1-producing Escherichia coli ST648 strain was isolated from the urine sample of a patient in a Chinese tertiary hospital in 2016. Methods: The strain was fully sequenced by GridION X5 platform of Oxford Nanopore Technology. Results: The sequence analysis showed that the extended-spectrum beta-lactamases CTX-M-65 and OXA-1, the carbapenemase NDM-5, the MCR-1 were encoded, respectively, by three different resistance plasmids. The pE648CTX-M-65-carrying bla(CTX-M-)(65) was a novel conjugative plasmid belonging to IncHI2 type; except for the bla(CTX-M-)(65), it also carried resistance genes ble, floR, sul1, aph(4)-Ia, aac(3)-VI, aac(6')-II, bla(OXA-1), catB, arr3 and tetA. Besides, an IncX4 plasmid pE648MCR-1-carrying mcr-1 and an IncX3 plasmid pE648NDM-5-carrying bla(NDM-)(5) were also identified. Conclusion: The three transferable resistance plasmids coexisting in the E. coli ST648 isolate indicated the high risk to disseminate the extensively-drug-resistance among Enterobacteriaceae.