Table I
The clinical information and antimicrobial susceptibility of the clinical strains, AZJ065 and three ST111 K63 strains
| Strain | AZJ065 | SCQ159 | SYF150 | SZS111 | |
|---|---|---|---|---|---|
| Province | Zhejiang | Chongqing | Zhejiang | Shanghai | |
| Hospital | The First Affiliated Hospital of Zhejiang University | The First Affiliated Hospital of Zhejiang University | Sir Run Run Shaw Hospital | Zhongshan Hospital of Fu Dan University | |
| Gender | Male | Male | Male | Female | |
| Age (year) | 79 | 66 | 82 | 69 | |
| Department | ICU | Medical ward | ICU | Surgery | |
| Primary Infection Site | Urinary tract infection | Liver abscess | Intra-abdominal infection | Intra-abdominal infection | |
| Duration of fever (Day) | 6-14 | >14 | 6-14 | 3-15 | |
| Peak of fever (°C) | >39 | >39 | 38-39 | >39 | |
| Laboratory data* | WBC (1×109/I) | 10.1 | 35.25 | 17.5 | 6.78 |
| N% | 92.8 | 94.4 | 94.8 | 58.9 | |
| CRP (mg/l) | 101 | >90 | 256.2 | 11.5 | |
| PCT (ng/ml) | 0.77 | >200 | 5.43 | 2.53 | |
| ICU Admission | Yes | No | Yes | No | |
| Antibiotic use 2g q12h | Fluconazole, Cefoperazone sulbactam | Imipenem/cilastatin 1g q8h | Meropenem 0.5g q6h Vancomycin 1g q12h | Meropenem 1g q12h | |
| Cefoxitin 2g q8h | |||||
| Discharge status | Treatment failure | Improved | Died | Improved | |
| MIC (μg/ml) | Colistin (S≤2 mg/L) | ≤1 | ≤1 | ≤1 | ≤1 |
| Levofloxacin (S≤0.5 mg/L) | 1 | ≤0.5 | ≤0.5 | ≤0.5 | |
| Amikacin (S≤16 mg/L) | ≤4 | ≤4 | ≤4 | ≤4 | |
| Ceftazidime-avibactam (S≤8 mg/L) | 0.5 | ≤0.12 | 0.25 | ≤0.12 | |
| Ciprofloxacin (S≤0.25 mg/L) | 1 | ≤0.25 | ≤0.25 | ≤0.25 | |
| Aztreonam (S≤ 4 mg/L) | >128 | ≤1 | ≤1 | ≤1 | |
| Ceftazidime (S≤ 4 mg/L) | 32 | ≤1 | ≤1 | ≤1 | |
| Cefoxitin (S≤ 8 mg/L) | >16 | ≤2 | 8 | ≤2 | |
| Ceftriaxone (S≤ 1 mg/L) | >8 | ≤1 | ≤1 | ≤1 | |
| Ertapenem (S≤0.5 mg/L) | >4 | ≤0.06 | ≤0.06 | ≤0.06 | |
| Meropenem (S≤ 1 mg/L) | >16 | ≤0.12 | ≤0.12 | ≤0.12 | |
| Imipenem (S≤ 1 mg/L) | >16 | ≤0.12 | ≤0.12 | ≤0.12 | |
| Cefepime (S≤ 2 mg/L) | >32 | ≤1 | ≤1 | ≤1 | |
| Imipenem-relebactam (S≤ 1 mg/L) | 1 | 0.25 | 0.25 | ≤0.12 | |
| Ceftolozone-tazobactam (S≤ 2/4 mg/L) | >16 | ≤0.12 | 0.5 | 0.25 | |
| Piperacillin-tazobactam (S≤ 8 mg/L) | >64 | ≤2 | 8 | ≤2 | |
Fig. 1.
The survival curve of six-week CD1 mice after the intraperitoneal infection with the clinical strain, AZJ065 and the controls, NTUH-K2044 (K2044) and QD110. Each strain was tested by 1×107 CFU in 100μl PBS with five mice. P value from the log-rank (Mantel-Cox) test was 0.0442 (<0.05) between AZJ065 and K2044, indicating the virulence of AZJ065 was significantly different from that of K2044 and was even higher than that of K2044.
Fig. 2.
Circular representation of AZJ065 genome (chromosome and two plasmids). Circles are shown as follows (outside to inside): (1) A physical map scaled in megabases (Mb) from base 1 (the start of the putative replication origin); (2) coding sequences transcribed in a clockwise direction; (3) coding sequences transcribed in a counter-clockwise direction; (4) G + C content; (5) GC skew; (6) tRNA genes; (7) rRNA genes. Genes displayed in (2) and (3) are color-coded according to different functional categories shown on the right.
Fig. 3.
Genomic structure comparison of pAZJ065-Hv and pM186-2. (A) Alignments of resemble plasmids are shown as concentric rings. The outermost shows the main coding genes of pAZJ065-Hv. Virulence genes are highlighted in red. (B) Linear structure comparison of region harboring virulence genes on plasmids pAZJ065-Hv and pM186-2. Genes, mobile elements, and other features are colored based on functional classification. Shading denotes the regions with high homology (>95% nucleotide identity).
Fig. 4.
Genomic structure comparison of pAZJ065-KPC and three most similar plasmids (Klebsiella pneumoniae p24169-KPC, Escherichia coli pBK32602, Raoultella planticola pFDAARGOS_430). (A) Alignments of similar plasmids are shown as concentric rings. The outermost shows the main coding genes of pAZJ065-KPC. Resistance genes are highlighted in red. (B) The upper figure presents the related transposons and integrons comparison of plasmids pAZJ065-KPC and the three most similar plasmids in linear structure pattern. The lower one presents regions harboring resistance genes on plasmids. Genes, mobile elements, and other features are colored based on functional classification. Shading denotes the regions with high homology (>95% nucleotide identity).
Fig. 5.
(A) Gene homology cluster of four ST111 K63 clinical strains. ‘1’ represents the presence of the genes in the strain and “0” represents the absence of the genes in the strain. (B) The phylogenetic tree of four ST111 K63 clinical strains based on core gene SNPs from whole-genome sequence.