Characterization of NDM-Encoding Plasmids From Recovered From Czech Hospitals.

The aim of the present study was to characterize sporadic cases and an outbreak of NDM-like-producing recovered from hospital settings, in Czechia. During 2016, 18 isolates including 10 complex (9 and 1 ), 4 , 1 , 1 , 1 , and 1 that produced NDM-like carbapenemases were isolated from 15 patients. Three of the patients were colonized or infected by two different NDM-like producers. Moreover, an NDM-4-producing isolate of complex, isolated in 2012, was studied for comparative purposes. All isolates of complex, except the , recovered from the same hospital, were assigned to ST182. Additionally, two belonged to ST167, while the remaining isolates were not clonally related. Thirteen isolates carried , while six isolates carried ( = 3) or ( = 3). Almost all isolates carried -like-carrying plasmids being positive for the IncX3 allele, except ST58 and ST14 isolates producing NDM-1. Analysis of plasmid sequences revealed that all IncX3 -like-carrying plasmids exhibited a high similarity to each other and to previously described plasmids, like pNDM-QD28, reported from worldwide. However, NDM-4-encoding plasmids differed from other IncX3 plasmids by the insertion of a Tn-like transposon. On the other hand, the ST58 and ST14 isolates carried two novel NDM-1-encoding plasmids, pKpn-35963cz, and pEsco-36073cz. Plasmid pKpn-35963cz that was an IncFIB(K) molecule contained an acquired sequence, encoding NDM-1 metallo-β-lactamase (MβL), which exhibited high similarity to the mosaic region of pS-3002cz from an ST11 from Czechia. Finally, pEsco-36073cz was a multireplicon A/C+R NDM-1-encoding plasmid. Similar to other type 1 A/C plasmids, the gene was located within the ARI-A resistance island. These findings underlined that IncX3 plasmids have played a major role in the dissemination of -like genes in Czech hospitals. In combination with further evolvement of NDM-like-encoding MDR plasmids through reshuffling, NDM-like producers pose an important public threat.