A Multispecies Cluster of VIM-1 Carbapenemase-Producing <i>Enterobacterales</i> Linked by a Novel, Highly Conjugative, and Broad-Host-Range IncA Plasmid Forebodes the Reemergence of VIM-1

Abstract

In this study, we investigated VIM-1-producing <i>Escherichia coli</i>, <i>Klebsiella oxytoca</i>, <i>Klebsiella pneumoniae</i>, <i>Citrobacter freundii</i>, and <i>Enterobacter cloacae</i> strains, isolated in 2019 during a period of active surveillance of carbapenem-resistant <i>Enterobacterales</i> in a large university hospital in Italy. VIM-1-producing strains colonized the gut of patients, with up to three different VIM-1-positive bacterial species isolated from a single rectal swab, but also caused bloodstream infection in one colonized patient. In the multispecies cluster, <i>bla</i>_VIM-1 was identified in a 5-gene cassette class 1 integron, associated with several genetic determinants, including the <i>bla</i>_SHV-12, <i>qnrS1</i>, and <i>mph</i>(A) genes, located on a highly conjugative and broad-host-range IncA plasmid. The characteristics and origin of this IncA plasmid were studied.