1. Emergence of a multidrug-resistant Citrobacter freundii ST8 harboring an unusual VIM-4 gene cassette in Poland
- Author
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Dominika Ojdana, Piotr Wieczorek, Piotr Majewski, Elzbieta Tryniszewska, Janusz Kloczko, Paweł Sacha, Izabela Łapuć, and Anna Sieńko
- Subjects
0301 basic medicine ,Microbiology (medical) ,Modern medicine ,Carbapenem resistance ,030106 microbiology ,Microbial Sensitivity Tests ,Multidrug resistance ,Integron ,Metallo-β-lactamases ,beta-Lactamases ,lcsh:Infectious and parasitic diseases ,Integrons ,Microbiology ,03 medical and health sciences ,symbols.namesake ,Plasmid ,Drug Resistance, Bacterial ,Escherichia coli ,polycyclic compounds ,Humans ,Hospital infection ,lcsh:RC109-216 ,Genetics ,Sanger sequencing ,biology ,Enterobacteriaceae Infections ,General Medicine ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Drug Resistance, Multiple ,Anti-Bacterial Agents ,Citrobacter freundii ,Isoenzymes ,Multiple drug resistance ,Leukemia, Myeloid, Acute ,Infectious Diseases ,Gene cassette ,Carbapenems ,Genes, Bacterial ,symbols ,biology.protein ,Multilocus sequence typing ,Female ,Poland ,Class I integron ,Multilocus Sequence Typing - Abstract
Objectives The growing incidence of multidrug-resistant (MDR) bacteria is an emerging challenge in modern medicine. The utility of carbapenems, which are considered ‘last-line' agents, is being diminished by the growing incidence of various resistance mechanisms in Gram-negative bacteria. A molecular investigation was performed of an MDR carbapenem-resistant Citrobacter freundii of sequence type 8 (ST8) isolated from a hematology patient with acute myeloid leukemia. Methods Multilocus sequence typing and analysis of the nucleotide sequence of the class I integron were performed using PCR and Sanger sequencing. Transformation of the resistance plasmid isolated following the alkaline lysis method was performed using chemically competent E. coli TOP10. Results Molecular analysis of the carbapenem-resistant C. freundii revealed the presence of the VIM-4 isoenzyme located on the ∼55-kb transferable resistance plasmid. Interestingly, the bla VIM-4 gene was inserted into an unusual gene cassette containing a 169-bp direct repeat of the 3′ segment of the bla VIM-4 gene. Conclusions All unusual gene cassettes containing VIM-DR (direct repeat) described thus far have been harbored by non-fermenters, i.e., Acinetobacter and Pseudomonas, underscoring the importance of resistance determinant mobility, which may go even beyond genus, family, and order boundaries. Great efforts need to be taken to explore pathways of resistance to ‘last-resort' antimicrobials, especially among clinically relevant pathogens.
- Published
- 2017
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