Comprehensive analysis of plasmid-mediated tet(X4)-positive Escherichia coli isolates from clinical settings revealed a high correlation with animals and environments-derived strains

The emergence of novel plasmid-mediated high-level tigecycline resistance genes tet(X) in the Enterobacteriaceae has increased public health risk for treating severe bacterial infections. Despite growing reports of tet(X)-positive isolates detected in animal sources, the epidemiological association of animal-and environment-derived isolates with human-derived isolates remains unclear. Here, we performed a comprehensive analysis of tet(X4)-positive Escherichia coli isolates collected in a hospital in Guangdong province, China. A total of 48 tet(X4)-positive E. coli isolates were obtained from 1001 fecal samples. The tet(X4)-positive E. coli isolates were genetically diverse but certain strains that belonged to ST48, ST10, and ST877 etc. also have clonally transmitted. Most of the tet(X4) genes from these patient isolates were located on conjugative plasmids that were successfully transferred (64.6%) and generally coexisted with other antibiotic resistance genes including aadA, floR, blaTEM and qnrS. More importantly, we found the IncX1 type plasmid was a common vector for tet(X4) and was prevalent in these patient-derived strains (31.3%). This plasmid type has been detected in animal derived strains from different species in different regions demonstrating its strong transmission ability and wide host range. Furthermore, phylogenetic analysis revealed that certain strains of patient and animal origin were closely related indicating that the tet(X4)-positive E. coli isolates were likely to have cross-sectorial clonal transmission between humans, animals, and farm environments. Our research greatly expands the limited epidemiological knowledge of tet(X4)-positive strains in clinical settings and provides definitive evidence for the epidemiological link between human-derived tet(X4)-positive isolates and animal-derived isolates. (C) 2021 Published by Elsevier B.V.

Automated summary

The emergence of novel plasmid-mediated high-level tigecycline resistance genes tet(X) in Enterobacteriaceae poses a public health risk. A comprehensive analysis of tet(X4)-positive Escherichia coli isolates from a hospital in Guangdong province, China revealed genetic diversity among these isolates, with certain strains showing clonal transmission. Most tet(X4) genes were located on conjugative plasmids and coexisted with other antibiotic resistance genes in patient isolates. The IncX1 plasmid type was a common vector for tet(X4) and demonstrated strong transmission ability and wide host range. Phylogenetic analysis indicated potential cross-sectorial clonal transmission between human and animal-derived tet(X4)-positive E. coli isolates.