title: The use of whole-genome sequencing for molecular epidemiology and antimicrobial surveillance: identifying the role of IncX3 plasmids and the spread of blaNDM-4-like genes in the Enterobacteriaceae.
abstract: OBJECTIVE
  To characterise the resistome of a multi-drug resistant Klebsiella pneumoniae (Kp0003) isolated from an Australian traveller who was repatriated to a Sydney Metropolitan Hospital from Myanmar with possible prosthetic aortic valve infective endocarditis.
  
  
  METHODS
  Kp0003 was recovered from a blood culture of the patient and whole genome sequencing was performed. Read mapping and de novo assembly of reads facilitated in silico multi-locus sequence and plasmid replicon typing as well as the characterisation of antibiotic resistance genes and their genetic context. Conjugation experiments were also performed to assess the plasmid (and resistance gene) transferability and the effect on the antibiotic resistance phenotype.
  
  
  RESULTS
  Importantly, and of particular concern, the carbapenem-hydrolysing β-lactamase gene blaNDM-4 was identified on a conjugative IncX3 plasmid (pJEG027). In this respect, the blaNDM-4 genetic context is similar (at least to some extent) to what has previously been identified for blaNDM-1 and blaNDM-4-like variants.
  
  
  CONCLUSIONS
  This study highlights the potential role that IncX3 plasmids have played in the emergence and dissemination of blaNDM-4-like variants worldwide and emphasises the importance of resistance gene surveillance.
authors.affiliation: Molecular Medicine Research Group, School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia Antibiotic Resistance & Mobile Elements Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Björn A
authors.identifier: http://orcid.org/0000-0003-1117-6223
authors.initials: BA
authors.lastname: Espedido
authors.affiliation: Molecular Medicine Research Group, School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia Antibiotic Resistance & Mobile Elements Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Borce
authors.initials: B
authors.lastname: Dimitrijovski
authors.affiliation: Antibiotic Resistance & Mobile Elements Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Sebastiaan J
authors.initials: SJ
authors.lastname: van Hal
authors.affiliation: Molecular Medicine Research Group, School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia Antibiotic Resistance & Mobile Elements Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Slade O
authors.initials: SO
authors.lastname: Jensen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D055106:Genome-Wide Association Study; D005838:Genotype; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000472:pathogenicity; D017720:Molecular Epidemiology; D002052:Myanmar / Q000453:epidemiology; D010641:Phenotype; D010957:Plasmids / Q000235:genetics*; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D014195:Travel; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases
keywords: ANTIBIOTICS; MICROBIAL GENETICS; MOLECULAR PATHOLOGY