title: Sequential isolation in a patient of Raoultella planticola and Escherichia coli bearing a novel ISCR1 element carrying blaNDM-1.
abstract: BACKGROUND
  The gene for New Delhi metallo-β-lactamase 1 (NDM-1) has been reported to be transmitted via plasmids which are easily transferable and capable of wide distribution. We report the isolation of two NDM-1 producing strains and possible in vivo transfer of blaNDM-1 in a patient.
  
  
  METHODS
  Clinical samples were collected for bacterial culture and antibiotic susceptibility testing from a patient during a 34-day hospitalization. The presence of blaNDM-1 was detected by PCR and sequencing. Plasmids of interest were sequenced. Medical records were reviewed for evidence of association between the administration of antibiotics and the acquisition of the NDM-1 resistance.
  
  
  RESULTS
  A NDM-1 positive Raoultella planticola was isolated from blood on the ninth day of hospitalization without administration of any carbapenem antibiotics and a NDM-1 positive Escherichia coli was isolated from feces on the 29th day of hospitalization and eight days after imipenem administration. The blaNDM-1 was carried by a 280 kb plasmid pRpNDM1-1 in R. planticola and a 58 kb plasmid pEcNDM1-4 in E. coli. The two plasmids shared a 4812 bp NDM-1-ISCR1 element which was found to be excisable from the plasmid as a free form and transferrable in vitro to a NDM-1 negative plasmid from E. coli.
  
  
  CONCLUSIONS
  blaNDM-1 was embedded in an ISCR1 complex class 1 integron as a novel 4812 bp NDM-1-ISCR1 element. The element was found to be able to self excise to become a free form, which may provide a new vehicle for NDM-1 dissemination. This mechanism could greatly accelerate the spread of NDM-1 mediated broad spectrum β-lactam resistance.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.affiliation: School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Ruiting
authors.initials: R
authors.lastname: Lan
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Yanwen
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Changyun
authors.initials: C
authors.lastname: Ye
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Gansu Provincial Center for Disease Control and Prevention, Lanzhou, Gansu Province, China.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Chen
authors.affiliation: Gansu Provincial Center for Disease Control and Prevention, Lanzhou, Gansu Province, China.
authors.forename: Deshan
authors.initials: D
authors.lastname: Yu
authors.affiliation: College of Life Sciences, Nankai University, Tianjin, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.affiliation: College of Life Sciences, Nankai University, Tianjin, China.
authors.forename: Wenchao
authors.initials: W
authors.lastname: Lin
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Bai
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Qiangzheng
authors.initials: Q
authors.lastname: Sun
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Yiting
authors.initials: Y
authors.lastname: Wang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Hongqing
authors.initials: H
authors.lastname: Zhao
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Meng
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Ailan
authors.initials: A
authors.lastname: Zhao
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Xu
mesh_terms: D002681:China; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001618:beta-Lactamases; C552864:beta-lactamase NDM-1