Prevalence of insertion sequence elements in plasmids relating to mgrB gene disruption causing colistin resistance in Klebsiella pneumoniae

Colistin is a last resort antibiotic for the treatment of carbapenemase producing Klebsiella pneumoniae. The disruption of the mgrB gene by insertion sequences (ISs) is a mechanism mediating colistin resistance. Plasmids encode mobilizable IS elements which integrate into the mgrB gene in K. pneumoniae causing gene inactivation and colistin resistance. The species prevalence of mgrB-gene disrupting insertion elements ISL3 (ISKpn25), IS5 (ISKpn26), ISKpn14, and IS903B present on plasmids were assessed. IS containing plasmids were also scanned for antimicrobial resistance genes, including carbapenem resistant genes. Plasmids encoding ISs are abundant in K. pneumoniae. IS903B was found in 28 unique Inc groups, while ISKpn25 was largely carried by IncFIB(pQil) plasmids. ISKpn26 and ISKpn14 were most often found associated with IncFII(pHN7A8) plasmids. Of the 34 unique countries which contained any of the IS elements, ISKpn25 was identified from 26. ISKpn26, ISKpn14, and IS903B ISs were identified from 89.3%, 44.9%, and 23.9% plasmid samples from China. Plasmids carrying ISKpn25, ISKpn14, and ISKpn26 IS have a 4.6-, 6.0-, and 6.6-fold higher carbapenemase gene count, respectively, relative to IS903B-carrying plasmids. IS903B bearing plasmids have a 20-, 5-, and 5-fold higher environmental source isolation count relative to ISKpn25, ISKpn14, and ISKpn26 bearing plasmids. ISKpn25 present on IncFIB(pQil) sourced from clinical settings is established across multiple countries, while ISKpn26, ISKpn14, and IS903B appear most often in China. Carbapenemase presence in tandem with IS elements may help promote an extensively drug resistant profile in K. pneumoniae limiting already narrow treatment options.

Automated summary

Colistin is a last resort antibiotic for treating carbapenemase producing Klebsiella pneumoniae. The insertion of IS elements into the mgrB gene is a mechanism that causes colistin resistance. Plasmids carrying IS elements are common in K. pneumoniae, with ISKpn25 being mostly carried by IncFIB(pQil) plasmids, while ISKpn26 and ISKpn14 are often associated with IncFII(pHN7A8) plasmids. ISKpn25 is identified in 26 out of 34 countries that contain any of the IS elements, while ISKpn26, ISKpn14, and IS903B are most frequently found in China. Plasmids carrying ISKpn25, ISKpn14, and ISKpn26 have a higher count of carbapenemase genes compared to IS903B-carrying plasmids. IS903B-bearing plasmids have a higher count of environmental source isolations compared to ISKpn25, ISKpn14, and ISKpn26 bearing plasmids. The presence of carbapenemase in combination with IS elements could lead to an extensively drug-resistant profile in K. pneumoniae, limiting treatment options.