Emergence of tigecycline resistance in Escherichia coli co-producing MCR-1 and NDM-5 during tigecycline salvage treatment

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2018
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Abstract
Emergence of tigecycline resistance in Escherichia coli co-producing MCR-1 and NDM-5 during tigecycline salvage treatment Qian Wang,1 Ping Zhang,2,3 Dongdong Zhao,2 Yan Jiang,2,3 Feng Zhao,4 Yanfei Wang,3 Xi Li,5 Xiaoxing Du,2 Yunsong Yu2,3 1Department of General Practice, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 2Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 3Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; 4Department of Clinical Laboratory, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 5Centre of Laboratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China Objective: Here, we report a case of severe infection caused by Escherichia coli that harbored mcr-1, bla NDM-5, and acquired resistance to tigecycline during tigecycline salvage therapy. Methods: Antimicrobial susceptibility testing, Southern blot hybridization, and complete genome sequence of the strains were carried out. The genetic characteristics of the mcr-1 and bla NDM-5 plasmids were analyzed. The whole genome sequencing of mcr-1-containing plasmid was completed. Finally, putative single nucleotide polymorphisms and deletion mutations in the tigecycline-resistant strain were predicted. Results: Three E. coli isolates were obtained from ascites, pleural effusion, and stool of a patient; they were resistant to almost all the tested antibiotics. The first two strains separated from ascites (E-FQ) and hydrothorax (E-XS) were susceptible to amikacin and tigecycline; however, the third strain from stool (E-DB) was resistant to tigecycline after nearly 3 weeks’ treatment with tigecycline. All three isolates possessed both mcr-1 and bla NDM-5. The bla NDM-5 gene was found on the IncX3 plasmid, whereas the mcr-1, fosA3 and blaCTX-M-14 were located on the IncHI2 plasmid. Mutations in acrB and lon were the reason for the resistance to tigecycline. Conclusion: This is the first report of a colistin-, carbapenem-, and tigecycline-resistant E. coli in China. Tigecycline resistance acquired during tigecycline therapy is of great concern for us because tigecycline is a drug of last resort to treat carbapenem-resistant Gram-negative bacterial infections. Furthermore, the transmission of such extensively drug-resistant isolates may pose a great threat to public health. Keywords: mcr-1, blaNDM-5, tigecycline-resistance, acrB, lon
Reference Key
qian2018emergenceinfection Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Qian Wang;Ping Zhang;Dongdong Zhao;Yan Jiang;Feng Zhao;Yanfei Wang;Xi Li;Xiaoxing Du;Yunsong Yu and
Journal Infection and drug resistance
Year 2018
DOI
10.2147/IDR.S179618
URL
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