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dc.contributor.authorLam, Margaret M.C.en_US
dc.contributor.authorWyres, Kelly L.en_US
dc.contributor.authorWick, Ryan R.en_US
dc.contributor.authorJudd, Louise M.en_US
dc.contributor.authorFostervold, Aasmunden_US
dc.contributor.authorHolt, Kathryn E.en_US
dc.contributor.authorLöhr, Iren Høylanden_US
dc.PublishedLam MMC, Wyres KL, Wick RR, Judd LM, Fostervold A, Holt KE, Löhr IH. Convergence of virulence and MDR in a single plasmid vector in MDR Klebsiella pneumoniae ST15. Journal of Antimicrobial Chemotherapy. 2019;74(5):1218-1222eng
dc.description.abstractBackground: MDR and hypervirulence (hv) are typically observed in separate Klebsiella pneumoniae populations. However, convergent strains with both properties have been documented and potentially pose a high risk to public health in the form of invasive infections with limited treatment options. Objectives: Our aim was to characterize the genetic determinants of virulence and antimicrobial resistance (AMR) in two ESBL-producing K. pneumoniae isolates belonging to the international MDR clone ST15. Methods: The complete genome sequences of both isolates, including their plasmids, were resolved using Illumina and Oxford Nanopore sequencing. Results: Both isolates carried large mosaic plasmids in which AMR and virulence loci have converged within the same vector. These closely related mosaic hv-MDR plasmids include sequences typical of the K. pneumoniae virulence plasmid 1 (KpVP-1; including aerobactin synthesis locus iuc) fused with sequences typical of IncFIIK conjugative AMR plasmids. One hv-MDR plasmid carried three MDR elements encoding the ESBL gene blaCTX-M-15 and seven other AMR genes (blaTEM, aac3'-IIa, dfrA1, satA2, blaSHV, sul1 and aadA1). The other carried remnants of these elements encoding blaTEM and aac3'-IIa, and blaCTX-M-15 was located in a second plasmid in this isolate. The two isolates originated from patients hospitalized in Norway but have epidemiological and genomic links to Romania. Conclusions: The presence of both virulence and AMR determinants on a single vector enables simultaneous transfer in a single event and potentially rapid emergence of hv-MDR K. pneumoniae clones. This highlights the importance of monitoring for such convergence events with stringent genomic surveillance.en_US
dc.publisherOxford University Presseng
dc.rightsAttribution-NonCommercial CC BY-NCeng
dc.titleConvergence of virulence and MDR in a single plasmid vector in MDR Klebsiella pneumoniae ST15en_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2019 The Author(s)
dc.source.journalJournal of Antimicrobial Chemotherapy

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