Novel chromosomal insertions of ISEcp1-bla CTX-M-15 and diverse antimicrobial resistance genes in Zambian clinical isolates of Enterobacter cloacae and Escherichia coli.

Background: The epidemiology of extended-spectrum β-lactamases (ESBLs) has undergone dramatic changes, with CTX-M-type enzymes prevailing over other types. bla _CTX-M genes, encoding CTX-M-type ESBLs, are usually found on plasmids, but chromosomal location is becoming common. Given that bla _CTX-M -harboring strains often exhibit multidrug resistance (MDR), it is important to investigate the association between chromosomally integrated bla _CTX-M and the presence of additional antimicrobial resistance (AMR) genes, and to identify other relevant genetic elements.
Methods: A total of 46 clinical isolates of cefotaxime-resistant Enterobacteriaceae (1 Enterobacter cloacae, 9 Klebsiella pneumoniae, and 36 Escherichia coli) from Zambia were subjected to whole-genome sequencing (WGS) using MiSeq and MinION. By reconstructing nearly complete genomes, bla _CTX-M genes were categorized as either chromosomal or plasmid-borne.
Results: WGS-based genotyping identified 58 AMR genes, including four bla _CTX-M alleles (i.e., bla _CTX-M-14 , bla _CTX-M-15 , bla _CTX-M-27 , and bla _CTX-M-55 ). Hierarchical clustering using selected phenotypic and genotypic characteristics suggested clonal dissemination of bla _CTX-M genes. Out of 45 bla _CTX-M gene-carrying strains, 7 harbored the gene in their chromosome. In one E. cloacae and three E. coli strains, chromosomal bla _CTX-M-15 was located on insertions longer than 10 kb. These insertions were bounded by ISEcp1 at one end, exhibited a high degree of nucleotide sequence homology with previously reported plasmids, and carried multiple AMR genes that corresponded with phenotypic AMR profiles.
Conclusion: Our study revealed the co-occurrence of ISEcp1-bla _CTX-M-15 and multiple AMR genes on chromosomal insertions in E. cloacae and E. coli, suggesting that ISEcp1 may be responsible for the transposition of diverse AMR genes from plasmids to chromosomes. Stable retention of such insertions in chromosomes may facilitate the successful propagation of MDR clones among these Enterobacteriaceae species.