Molecular Epidemiology of mcr-1-Positive Polymyxin B-Resistant Escherichia coli Producing Extended-Spectrum β-Lactamase (ESBL) in a Tertiary Hospital in Shandong, China

Liu, Yue; Wang, Qian; Qi, Ting; Zhang, Meng; Chen, Ran; Si, Zaifeng; Li, Jinmei; Jin, Yan; Xu, Qingbing; Li, Ping; Hao, Yingying

Molecular Epidemiology of mcr-1-Positive Polymyxin B-Resistant Escherichia coli Producing Extended-Spectrum β-Lactamase (ESBL) in a Tertiary Hospital in Shandong, China

Volume 73 (2024): Issue 3 (September 2024)

By:

Yue Liu, Qian Wang, Ting Qi, Meng Zhang, Ran Chen, Zaifeng Si, Jinmei Li, Yan Jin, Qingbing Xu, Ping Li and Yingying Hao

Open Access

|Sep 2024

Figures & Tables

A dendrogram was constructed using the similarity of pulsed-field gel electrophoresis (PFGE) patterns across the 19 strains of mcr-1 -positive polymyxin-B-resistant extended-spectrum β-lactamase-producing Escherichia coli. Names of the isolates, sequence types, serotypes, and fimH types are displayed on the right side.

Phylogenetic tree distribution of 19 strains of mcr-1-positive polymyxin-B-resistant extended-spectrum β-lactamase-producing Escherichia coli.

a) Detection of resistance genes in 19 mcr-1-positive clinical strains, b) detection of resistance genes in 17 transconjugants.

The external ring is the schematic representation of plasmid pECO-POL-29_mcr1 (GenBank accession number PP721192). Genes are marked with different colors based on their functional annotations. The internal five rings show a comparative analysis of mcr-1-harboring plasmids with pECO-POL-29_mcr1, including pSLy21 (sky blue), pAH01-2 (light purple), pRIVM_C029515_2 (light blue), pmcr1_IncI2 (light purple pink), and pEC26-mcr-1.9 (purple) (constructed using BRIG).

Antibiotic susceptibility testing of Escherichia coli clinical strains, transconjugants, and the recipient bacterium J53AziR_

Isolates	MIC (μg/ml)
Isolates	AMP	SAM	TZP	CZO	CTT	CRO	CAZ	FEP	ATM	ETP	IPM	AK	CN	TOB	CIP	LEV	NIT	STX	POL
ECO-POL-4	≥ 32	≥ 32	≥ 128	≥ 64	≥ 64	≥ 64	≥ 64	≥ 64	16	≥ 8	≥ 16	≤ 2	≤ 1	≤ 1	≥ 4	≥ 8	32	≥ 320	8
ECO-POL-6	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	32	≥ 64	≤ 1	16	≤ 0.5	≤ 1	≤ 2	≥ 16	≥ 16	≥ 4	≥ 8	64	40	4
ECO-POL-7	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	16	≤ 0.5	≤ 1	≤ 2	≥ 16	≥ 16	≥ 4	≥ 8	≤ 16	≥ 320	4
ECO-POL-8	≥ 32	8	≤ 4	≥ 64	≤ 4	≥ 64	16	2	16	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≥ 4	≥ 8	32	≥ 320	4
ECO-POL-9	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	4	2	16	≤ 0.5	≤ 1	≤ 2	≥ 16	8	≥ 4	≥ 8	≤ 16	≥ 320	4
ECO-POL-10	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	16	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≥ 4	4	32	≥ 320	4
ECO-POL-15	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	≥ 64	≤ 0.5	≤ 1	≥ 64	≥ 16	≥ 16	≥ 4	≥ 8	64	≤ 20	8
ECO-POL-17	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	≥ 64	≤ 0.5	≤ 1	≥ 64	≥ 16	≥ 16	≥ 4	≥ 8	32	≤ 20	4
ECO-POL-18	≥ 32	≥ 32	16	≥ 64	≤ 4	≥ 64	16	32	≥ 64	≤ 0.5	≤ 1	16	≥ 16	≥ 16	≥ 4	≥ 8	≤ 16	≥ 320	≥ 64
ECO-POL-19	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	32	32	≤ 0.5	≤ 1	≥ 64	≥ 16	≥ 16	≥ 4	≥ 8	64	≥ 320	4
ECO-POL-21	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≥ 16	≥ 16	≥ 4	≥ 8	64	≥ 320	4
ECO-POL-22	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	≤ 1	2	16	≤ 0.5	≤ 1	≥ 64	≥ 16	≥ 16	≥ 4	≥ 8	64	≥ 320	4
ECO-POL-23	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≥ 16	≥ 16	≥ 4	≥ 8	64	≥ 320	4
ECO-POL-24	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	32	16	≤ 0.5	≤ 1	≤ 2	≥ 16	8	≥ 4	≥ 8	≤ 16	≥ 320	4
ECO-POL-25	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	4	≥ 64	32	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≥ 4	≥ 8	128	≤ 20	4
ECO-POL-27	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	4	2	16	≤ 0.5	≤ 1	≤ 2	≥ 16	8	≥ 4	≥ 8	64	≤ 20	4
ECO-POL-28	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	≤ 1	2	4	≤ 0.5	≤ 1	≥ 64	≥ 16	≥ 16	≥ 4	≥ 8	64	≥ 320	4
ECO-POL-29	≥ 32	8	≤ 4	≥ 64	≤ 4	≥ 64	4	2	16	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≥ 4	≥ 8	32	≥ 320	4
ECO-POL-30	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	16	32	16	≤ 0.5	≤ 1	≤ 2	≥ 16	8	≥ 4	≥ 8	≤ 16	≥ 320	4
J4	≥ 32	≥ 32	64	≥ 64	≤ 4	≥ 64	16	≥ 64	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	8
J6	8	8	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J7	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	≥ 64	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≥ 320	4
J8	4	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J9	4	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	8
J10	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	≥ 64	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J15	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	4	2	16	≤ 0.5	≤ 1	≤ 2	8I	≥ 16	≤ 0.25	≤ 0.25	32	≤ 20	16
J18	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	8
J19	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J21	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J22	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J23	8	4	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J24	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	≥ 64	8	≥ 64	≤ 0.5	≤ 1	≤ 2	≥ 16	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≥ 320	8
J25	≥ 32	16	≤ 4	≥ 64	≤ 4	≥ 64	16	≥ 64	≥ 64	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	4
J27	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	8
J29	4	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	8
J30	≥ 32	≥ 32	≤ 4	≥ 64	≤ 4	≥ 64	≥ 64	8	≥ 64	≤ 0.5	≤ 1	≤ 2	≥ 16	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≥ 320	8
J53Azi^R	8	≤ 2	≤ 4	≤ 4	≤ 4	≤ 1	≤ 1	≤ 1	≤ 1	≤ 0.5	≤ 1	≤ 2	≤ 1	≤ 1	≤ 0.25	≤ 0.25	≤ 16	≤ 20	0.125

The number, approximate size and replicon types of plasmids in 19 strains of mcr-1-positive polymyxin B-resistant Escherichia coli producing extended-spectrum β-lactamase and 17 transconjugants_

Isolates	Plasmid numbers	Size (kbp)	Replicon types
ECO-POL-4	3	~ 110, ~ 65, ~ 45	ColRNAI, IncFIA, IncFIC, IncFIC, IncX3
ECO-POL-6	6	~ 210, ~ 140, ~ 110, ~ 104.5, ~ 78.2, ~ 65	Col, ColRNAI, ColpVC, IncFIB, IncFII, IncHI1B, IncHI2A,
			IncHI2, IncI1, IncI2, RepA, p0111
ECO-POL-7	5	~ 220, ~ 138, ~ 100, ~ 65, ~ 54	IncFIB, IncFIC, IncFII, IncHI2A, IncHI2, IncI2a,
			RepA_1_pKPC-CAV1321
ECO-POL-8	4	~ 140, ~ 100, ~ 33, ~ 21	IncFIB, IncFIC, IncX4
ECO-POL-9	3	~ 140, ~ 100, < 20	Col156, Col440II, ColRNAI, IncB/O/K/Z, IncFIA, IncFIB1,
			IncFIC, IncI2, IncX1, IncY
ECO-POL-10	4	~ 140, ~ 65, ~ 34, ~ 30	Col, Col156, Col8282, IncFIB, IncFII, IncI2, IncX4
ECO-POL-15	3	~ 265, ~ 65, ~ 45	Col, IncFII, IncHI2A, IncHI2, IncN, IncX1, RepA
ECO-POL-17	3	~ 104.5, ~ 65, ~ 48	Col440I, ColRNAI, IncI1, IncI2, IncN, IncR, IncX1
ECO-POL-18	3	~ 110, ~ 104.5, ~ 65	IncFIB, IncFIC, IncHI2A, IncHI2, IncI2, RepA
ECO-POL-19	3	~ 265, ~ 140, ~ 48	Col156, Col440I, IncFIB, IncFIC, IncFII, IncHI2A, IncHI2, RepA
ECO-POL-21	2	~ 140, ~ 65	Col156, IncFIB, IncFIC, IncI2
ECO-POL-22	3	~ 180, ~ 110, ~ 65	Col440II, ColRNAI, IncFIB, IncFIC, IncI2, IncI
ECO-POL-23	2	~ 140, ~ 65	Col156, IncFIB, IncFIC, IncI2
ECO-POL-24	2	~ 140, ~ 65	IncFIB, IncI2
ECO-POL-25	3	~ 140, ~ 95, ~ 65	IncB/O/K/Z, IncFIB, IncI2, p0111
ECO-POL-27	6	~ 140, ~ 130, ~ 95, ~ 70, ~ 65, ~ 43	Col(MG828), ColE10, ColRNAI, IncB/O/K/Z, IncFIB, IncFIC,
			IncFII, IncI2, IncX1, p0111
ECO-POL-28	2	~ 90, ~ 28	Col, Col156, Col440I, ColRNAI, IncFIA, IncFIB, IncI, IncX1
ECO-POL-29	4	128.293, 83.176, 62.869, 30.619	IncFIB/IncFIC, IncFIC, IncI2, IncX4
ECO-POL-30	2	~ 130, ~ 60	IncFIB, IncI2
J4	1	~ 65	IncI2
J6	1	~ 65	IncI2
J7	4	~ 103, ~ 100, ~ 65, ~ 60	IncI2, IncFIB, IncFII, IncFIC
J8	2	~ 100, ~ 33	IncFIB, IncX4
J9	1	~ 65	IncI2
J10	3	~ 65, ~ 33, ~ 30	IncI2, IncX4
J15	1	~ 255	IncHI2, RepA, IncHI2A, IncN
J18	1	~ 65	IncI2
J19	1	~ 255	IncHI2A, IncHI2, RepA
J21	1	~ 65	IncI2
J22	1	~ 65	IncI2, ColRNAI
J23	1	~ 65	IncI2
J24	2	~ 140, ~ 65	IncI2, IncFIB
J25	1	~ 65	IncI2
J27	1	~ 65	IncI2
J29	2	~ 65, ~ 33	IncI2, IncX4
J30	2	~ 140, ~ 65	IncI2, IncFIB

Clinical data of patients infected with mcr-1 -positive Escherichia coli isolates producing extended-spectrum β-lactamase_

Clinical isolates	Gender	Department	Specimen	Clinical diagnosis	Antimicrobial therapy
ECO-POL-4	male	Intensive Care Unit	urine	aspiration pneumonia, ARDS	cefoperazone sodium/sulbactam sodium
ECO-POL-6	female	Orthopedic Oncology and Joint Surgery Department	urine	recurrence of intradural teratoma	levofloxacin, levofloxacin sodium chloride, ceftazidime
ECO-POL-7	female	Gastroenterology Department	bile	postoperative recurrence of pancreatic cancer	piperacillin/tazobactam
ECO-POL-8	female	Emergency Department	secretion	acute purulent appendicitis	meropenem sodium/sulbactam sodium
ECO-POL-9	female	Urology Department	urine	ureteral stone	–
ECO-POL-10	female	Minimally Invasive Urology Department	urine	left renal abscess	cefotaxime
ECO-POL-15	male	Minimally Invasive Urology Department	urine	post-prostatectomy for prostate cancer	cefotaxime
ECO-POL-17	male	General Surgery Department	puncture fluid	post-pancreaticoduodenectomy	cefoperazone sodium/sulbactam sodium, imipenem/cilastatin
ECO-POL-18	female	Urology Department	urine	bilateral ureteral stones	meropenem
ECO-POL-19	female	Minimally Invasive Urology Department	urine	urinary retention	ceftriaxone sodium
ECO-POL-21	male	Respiratory Department	sputum	severe pneumonia	fluconazole, cefoperazone sodium/sulbactam sodium, carbapenem
ECO-POL-22	male	Intensive Care Unit	drainage fluid	open pelvic fracture with ARDS	imipenem/cilastatin
ECO-POL-23	male	Intensive Care Unit	bronchoalveolar lavage fluid	septic shock	carbapenem, imipenem/cilastatin, daptomycin, meropenem + polymyxin B, vancomycin + fluconazole
ECO-POL-24	male	Trauma and Orthopedics	secretion	traumatic hemorrhagic shock	cefotaxime, clindamycin hydrochloride
ECO-POL-25	female	Spinal Surgery Department	puncture fluid	postoperative infection following lumbar spine surgery	penicillin, cefepime + levofloxacin, imipenem/cilastatin
ECO-POL-27	male	Thoracic Surgery Department	sputum	post-chemotherapy for right upper lobe lung cancer	cefuroxime
ECO-POL-28	male	Intensive Care Unit	pus	gastrointestinal bleeding, gastric ulcer	cefoperazone sodium/sulbactam sodium, linezolid
ECO-POL-29	male	General Surgery Department	ascitic puncture fluid	post-appendectomy for appendiceal cancer, colonic lesion	imipenem/cilastatin
ECO-POL-30	male	Trauma and Orthopedics	secretion	hemorrhagic shock	cefotaxime

DOI: https://doi.org/10.33073/pjm-2024-032 | Journal eISSN: 2544-4646 | Journal ISSN: 1733-1331

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Language: English

Page range: 363 - 375

Submitted on: May 15, 2024

Accepted on: Jul 23, 2024

Published on: Sep 13, 2024

Published by: Polish Society of Microbiologists

In partnership with: Paradigm Publishing Services

Publication frequency: 4 times per year

Keywords:

xtended-spectrum β-lactamase (ESBL),

resistance gene,

insertion sequence IS

Related subjects:

Life sciences,

Microbiology and virology

© 2024 Yue Liu, Qian Wang, Ting Qi, Meng Zhang, Ran Chen, Zaifeng Si, Jinmei Li, Yan Jin, Qingbing Xu, Ping Li, Yingying Hao, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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Molecular Epidemiology of mcr-1-Positive Polymyxin B-Resistant Escherichia coli Producing Extended-Spectrum β-Lactamase (ESBL) in a Tertiary Hospital in Shandong, China

Figures & Tables

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Antibiotic susceptibility testing of Escherichia coli clinical strains, transconjugants, and the recipient bacterium J53AziR_

The number, approximate size and replicon types of plasmids in 19 strains of mcr-1-positive polymyxin B-resistant Escherichia coli producing extended-spectrum β-lactamase and 17 transconjugants_

Clinical data of patients infected with mcr-1 -positive Escherichia coli isolates producing extended-spectrum β-lactamase_

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