{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:16:01Z","timestamp":1790417761318,"version":"4.1.0"},"reference-count":42,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100016250","name":"New York Medical College","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016250","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015703","name":"Philips Research North America","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015703","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The extended-spectrum-\u03b2-lactamase (ESBL)- and\n            <jats:named-content content-type=\"genus-species\">Klebsiella pneumoniae<\/jats:named-content>\n            carbapenemase (KPC)-producing\n            <jats:named-content content-type=\"genus-species\">Enterobacteriaceae<\/jats:named-content>\n            represent serious and urgent threats to public health. In a retrospective study of multidrug-resistant\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            , we identified three clinical isolates, CN1, CR14, and NY9, carrying both\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M<\/jats:sub>\n            and\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            genes. The complete genomes of these three\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            isolates were\n            <jats:italic>de novo<\/jats:italic>\n            assembled by using both short- and long-read whole-genome sequencing. In CR14 and NY9,\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M<\/jats:sub>\n            and\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            were carried on two different plasmids. In contrast, CN1 had one copy of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC-2<\/jats:sub>\n            and three copies of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M-15<\/jats:sub>\n            integrated in the chromosome, for which the\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M-15<\/jats:sub>\n            genes were linked to an insertion sequence, IS\n            <jats:italic>Ecp1<\/jats:italic>\n            , whereas the\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC-2<\/jats:sub>\n            gene was in the context of a Tn\n            <jats:italic>4401a<\/jats:italic>\n            transposition unit conjugated with a PsP3-like prophage. Intriguingly, downstream of the Tn\n            <jats:italic>4401a-bla<\/jats:italic>\n            <jats:sub>KPC-2<\/jats:sub>\n            -prophage genomic island, CN1 also carried a clustered regularly interspaced short palindromic repeat (CRISPR)-\n            <jats:italic>cas<\/jats:italic>\n            array with four spacers targeting a variety of\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            plasmids harboring antimicrobial resistance genes. Comparative genomic analysis revealed that there were two subtypes of type I-E CRISPR-\n            <jats:italic>cas<\/jats:italic>\n            in\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            strains and suggested that the evolving CRISPR-\n            <jats:italic>cas<\/jats:italic>\n            , with its acquired novel spacer, induced the mobilization of antimicrobial resistance genes from plasmids into the chromosome. The integration and dissemination of multiple copies of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M<\/jats:sub>\n            and\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            from plasmids to chromosome depicts the complex pandemic scenario of multidrug-resistant\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            . Additionally, the implications from this study also raise concerns for the application of a CRISPR-\n            <jats:italic>cas<\/jats:italic>\n            strategy against antimicrobial resistance.\n          <\/jats:p>","DOI":"10.1128\/aac.00076-17","type":"journal-article","created":{"date-parts":[[2017,4,25]],"date-time":"2017-04-25T00:55:26Z","timestamp":1493081726000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":62,"title":["Emergence and Evolution of Multidrug-Resistant Klebsiella pneumoniae with both\n            <i>bla<\/i>\n            <sub>KPC<\/sub>\n            and\n            <i>bla<\/i>\n            <sub>CTX-M<\/sub>\n            Integrated in the Chromosome"],"prefix":"10.1128","volume":"61","author":[{"given":"Weihua","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Pathology, New York Medical College, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology, New York Medical College, Valhalla, New York, USA"},{"name":"Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Sebra","sequence":"additional","affiliation":[{"name":"Icahn Institute and Department of Genetics &amp; Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhuge","sequence":"additional","affiliation":[{"name":"Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changhong","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Pathology, New York Medical College, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Aguero-Rosenfeld","sequence":"additional","affiliation":[{"name":"Department of Pathology, New York University Langone Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey N.","family":"Schuetz","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevenka","family":"Dimitrova","sequence":"additional","affiliation":[{"name":"Philips Research North America, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Fallon","sequence":"additional","affiliation":[{"name":"Department of Pathology, New York Medical College, Valhalla, New York, USA"},{"name":"Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","volume-title":"Antibiotic resistance threats in the United States, 2013","author":"CDC","year":"2013","unstructured":"CDC. 2013. 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