Emergence of a Multidrug-Resistant Enterobacter hormaechei Clinical Isolate from Egypt Co-Harboring mcr-9 and blaVIM-4

Abstract

This study describes the first full genomic sequence of an mcr-9 and blaVIM-4-carrying multidrug-resistant Enterobacter hormaechei clinical isolate from Egypt. The strain was isolated in April 2015 from the sputum of a patient in Cairo, Egypt. The mcr-9 and blaVIM-4 genes were identified by PCR screening and DNA sequencing; the isolate was subjected to antimicrobial susceptibility testing, conjugation experiments, and whole genomic sequencing. mcr-9 and blaVIM-4 were carried by an IncHI2 plasmid, pAMS-38a (281,121 bp in size); the plasmid also carried genes conferring resistance against sulfonamides (sul1), quinolones (qnrA1), trimethoprim (dfrA1), β-lactams (blaTEM-1B), aminoglycosides (aac (6’)-II, aadA23, aadA2b, and ant(2’’)-Ia). The strain was susceptible to colistin (MIC, <0.25 μg/mL); this could be due to the absence of the qseC/qseB regulatory system located downstream of mcr-9 in Enterobacterales, which is involved in the induction of colistin-resistance. The genetic context of mcr-9 and blaVIM-4 was identified as IS1-mcr-9-IS903-pcoS-∆pcoE-rcnA and intI1-blaVIM-4—aac (6’)-II-dfrA1-∆aadA23-smr-ISPa21-qacE∆1, respectively. This is the first report of an mcr-9 and blaVIM-4 /IncHI2-carrying multidrug-resistant E. hormaechei clinical isolate from Africa and the Middle East. Plasmids of the IncHI2 group and the two insertion sequences (IS1, and IS903) might be the main vehicles for dissemination of mcr-9. Further screening for mcr-9 is essential for identifying its incidence and to prevent its dissemination.

Genomic Insights of Multidrug-Resistant Escherichia coli From Wastewater Sources and Their Association With Clinical Pathogens in South Africa

“…Isolates harboring mcr-9 were subsequently identified in 21 countries covering six continents, including Europe, Asia, America, Oceania, South America, and Africa (27). An mcr-9 harboring Enterobacter hormaechei isolate obtained from the sputum of a patient in Cairo, Egypt, is to date the only mcr-9 positive isolate reported in Africa (28). Thus, this is the second report of the mcr-9 positive isolate in Africa and the first in Southern Africa.…”

First Report of Foodborne Klebsiella pneumoniae Coharboring bla VIM-1 , bla NDM-1 , and mcr-9

“…infections caused by multidrug-resistant bacteria (1)(2)(3). Fortunately, most carbapenemase producers are susceptible to colistin, and many colistin-resistant strains have been reported to be sensitive to carbapenems (2)(3)(4)(5). The present study is the first report of a Klebsiella pneumoniae strain LM22-1 harboring bla NDM-1 , bla VIM-1 , and mcr-9, which was recovered from food in Japan.…”

Genomic Characterization of VIM and MCR Co-Producers: The First Two Clinical Cases, in Italy

“…The reports of VIM and MCR co-production in ECC isolates are increasing, as described elsewhere [ 30 , 31 , 32 , 33 , 34 ]. The presence of mcr-9 -like genes bound by two insertion sequences as in p3849_IncHI2_mcr and as reported in Sadek et al 2020 and Bitar et al 2020 will not express colistin resistance and such plasmids can circulate silently until detected.…”