Genomic epidemiology of globalKlebsiella pneumoniaecarbapenemase (KPC)-producingEscherichia coli
Stoesser N., Sheppard AE., Peirano G., Anson LW., Pankhurst L., Sebra R., Phan HTT., Kasarskis A., Mathers AJ., Peto TEA., Brandford P., Motyl MR., Walker AS., Crook DW., Pitout JD.
ABSTRACTThe dissemination of carbapenem resistance inEscherichia colihas major implications for the management of common human infections.blaKPC,encoding a transmissible carbapenemase (KPC), has historically largely been associated withKlebsiella pneumoniae,a predominant plasmid (pKpQIL), and a specific transposable element (Tn4401,~10kb). Here we characterize the genetic features of the emergence ofblaKPCin globalE. coli,2008-2013, using both long-and short-read whole genome sequencing.Amongst 43/45 successfully sequencedblaKPC-E. colistrains, we identified high strain (n=21 sequence types, 18% of annotated genes in the core genome); plasmid (≥9 replicon types); andblaKPC-associated, mobile genetic element (MGE) diversity (50% not within complete Tn4401elements). We also found evidence of interspecies, regional and international plasmid spread. In several casesblaKPCwas found on high copy number, small Col-like plasmids, previously associated with horizontal transmission of resistance genes in the absence of antimicrobial selection pressures.E. coliis a common human pathogen, but also a commensal in a multiple environmental and animal reservoirs, and easily transmissible. The association ofblaKPCwith a range of MGEs previously linked to the successful spread of widely endemic resistance mechanisms (e.g.blaTEM,blaCTX-M) suggests that it is likely to become similarly prevalent.