Whole-genome sequencing of coexisting blaNDM-1, blaKPC-2, and mcr-9.1 in a clinical carbapenem-resistant Citrobacter braakii isolate.

Objective: We aimed to characterize the molecular characteristics and clinical features of carbapenem-resistant Citrobacter braakii carrying blaNDM-1, blaKPC-2, and mcr-9.1 using whole-genome sequencing.

Methods: The susceptibility of C. braakii (WF0082) to 22 antimicrobial drugs was tested by an automated microbiology system. Whole-genome sequencing was performed using the Illumina and Nanopore platforms. Resistance genes and plasmid replicon types were determined. Gene structure was compared between strains to analyze the plasmid properties and gene environments of carbapenem (blaNDM-1 and blaKPC-2) and mobilized colistin resistance genes (mcr-9.1). The core single-nucleotide polymorphisms were used to construct an evolutionary tree.

Results: WF0082 was resistant to all antibiotics excluding colistin. blaNDM-1 was located on the truncated transposon Tn125 in the IncX3 plasmid. blaKPC-2 was located in the IncP6/IncX6 plasmid, a novel conjugative plasmid whose core blaKPC platform (ISKpn27-blaTEM-1-blaKPC-2-ΔISKpn6-korC-klcA-orf279-orf396-ΔrepB) was derived mainly from the transposon Tn6296. The mcr-9.1 core region consisted of rcnR-rcnA-pcoE-ΔpcoS-IS903B-mcr-9.1-wbuC-IS26, and it was similar to the Tn6725 remnant. Based on phylogenetic analysis, the present strain was categorized into the C1 clade, and it was highly homologous to C. braakii isolates from Australia and China.

Conclusions: The results of this study showed that C. braakii strain WF0082 carrying blaNDM-1, blaKPC-2, and mcr-9.1 located on three plasmids was highly resistant to antimicrobial drugs. The ability of C. braakii to easily integrate foreign genes has the potential to seriously undermine clinical therapy, and it is urgent that the surveillance of strains harboring multiple resistant genes is strengthened.