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The first-line agents to treat\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    infections are carbapenems. However, the emergence of carbapenem-resistant\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    strains greatly compromised the effectiveness of carbapenem treatment, which makes the surveillance on their spreading and transmission important. Here we characterized the full-length genomes of two carbapenem-resistant\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    clinical isolates that are capable of producing New Delhi metallo-\u03b2-lactamase-1 (NDM-1). We show that\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    is carried by a novel integrative and conjugative element (ICE) ICE\n                    <jats:sub>\n                      Tn\n                      <jats:italic>4371<\/jats:italic>\n                    <\/jats:sub>\n                    <jats:italic>6385<\/jats:italic>\n                    , which also carries the macrolide resistance gene\n                    <jats:italic>msr(E)<\/jats:italic>\n                    and the florfenicol resistance gene\n                    <jats:italic>floR<\/jats:italic>\n                    . By exogenously expressing\n                    <jats:italic>msr(E)<\/jats:italic>\n                    in\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    laboratory strains, we show that Msr(E) can abolish azithromycin-mediated quorum sensing inhibition in vitro and anti-Pseudomonas effect in vivo. We conclude that ICEs are important in transmitting carbapenem resistance, and that anti-virulence treatment of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    infections using sub-inhibitory concentrations of macrolides can be challenged by horizontal gene transfer.\n                  <\/jats:p>","DOI":"10.1038\/s42003-018-0064-0","type":"journal-article","created":{"date-parts":[[2018,5,23]],"date-time":"2018-05-23T07:41:24Z","timestamp":1527061284000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Acquisition of resistance to carbapenem and macrolide-mediated quorum sensing inhibition by Pseudomonas aeruginosa via ICETn43716385"],"prefix":"10.1038","volume":"1","author":[{"given":"Yichen","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette W. 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