{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T09:19:25Z","timestamp":1760347165925,"version":"3.41.2"},"reference-count":40,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Zhejiang Provincial Health Commission","award":["2023KY1326"],"award-info":[{"award-number":["2023KY1326"]}]},{"name":"Zhejiang Provincial Health Commission","award":["2024KY535"],"award-info":[{"award-number":["2024KY535"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              To illustrate the genomic and drug resistance traits of the\n              <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n              Kpn_XM9, which harbors a transposon (Tn) As1 and was barely susceptible to ceftazidime\u2013avibactam (CZA). Whole-genome sequencing, gene deletion, antimicrobial susceptibility, and conjugation tests were carried out to illustrate the traits of Kpn_XM9. As confirmed by whole-genome sequencing, the Kpn_XM9 harbored a 5,523,536 bp chromosome and five plasmids with lengths being 128,129, 196,512, 84,812, 43,695, and 5,596 bp, respectively. Plasmid p1_Kpn_XM9 (128,219 bp) contained four resistance genes,\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>CTX-M-65<\/jats:sub>\n              ,\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>TEM-1B<\/jats:sub>\n              ,\n              <jats:italic>rmt<\/jats:italic>\n              B, and two copies of\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>KPC-2<\/jats:sub>\n              . Genes\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>KPC-2<\/jats:sub>\n              were bracketed by ISKpn17 and ISKpn16 within a new composite Tn3-like TnAs1. The two tandem repeats, positioned opposite each other, were spaced 93,447 bp apart in p1_Kpn_XM9. Kpn_XM9 belonged to K64 and sequence type (ST) 11. The Kpn_XM9 was resistant to amikacin, aztreonam, ticarcillin\/clavulanic acid, piperacillin\/tazobactam, ceftazidime, cefepime, imipenem, meropenem, tobramycin, ciprofloxacin, levofloxacin, doxycycline, minocycline, tigecycline, colistin, and trimethoprim\/sulfamethoxazole; it was barely susceptible to CZA with a minimum inhibitory concentration of 8\/4 \u00b5g\/mL, which declined to 2\/4 \u00b5g\/mL after a 18,555 bp nucleotide was knocked out and one copy of\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>KPC-2<\/jats:sub>\n              was sustained on p1_Kpn_XM9. Kpn_XM9 had virulence genes encoding Types 1 and 3 fimbriae, four siderophores, and capsular polysaccharide anchoring protein but no genes upregulating capsular polysaccharide synthesis. The Kpn_XM9 presented a classical phenotype with extreme drug resistance. The emergence of double copies of\n              <jats:italic>bla<\/jats:italic>\n              <jats:sub>KPC-2<\/jats:sub>\n              in a single plasmid from the predominant ST11\n              <jats:italic>K. pneumoniae<\/jats:italic>\n              represents a new therapeutic challenge.\n            <\/jats:p>\n            <jats:sec>\n              <jats:title>IMPORTANCE<\/jats:title>\n              <jats:p>\n                With the wide use of ceftazidime\u2013avibactam against carbapenem-resistant organisms, its resistance is increasingly documented; among the corresponding resistance mechanisms, mutations of\n                <jats:italic>bla<\/jats:italic>\n                <jats:sub>KPC-2<\/jats:sub>\n                or\n                <jats:italic>bla<\/jats:italic>\n                <jats:sub>KPC-3<\/jats:sub>\n                into other subtypes are dominant to date. However, more copies of\n                <jats:italic>bla<\/jats:italic>\n                <jats:sub>KPC-2<\/jats:sub>\n                may also greatly increase the minimum inhibitory concentration of ceftazidime\u2013avibactam, which could be conferred by transposon As1 and insertion sequence 26 and should be of concern.\n              <\/jats:p>\n            <\/jats:sec>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.00331-24","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T13:00:33Z","timestamp":1720616433000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":2,"title":["Double\n            <i>bla<\/i>\n            <sub>KPC-2<\/sub>\n            copies quadrupled minimum inhibitory concentration of ceftazidime\u2013avibactam in hospital-derived\n            <i>Klebsiella pneumoniae<\/i>"],"prefix":"10.1128","volume":"12","author":[{"given":"Dakang","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shijie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Xiamen Humanity Hospital Fujian Medical University, Xiamen, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengqiao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhua","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4509-6928","authenticated-orcid":false,"given":"Qinfei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2150-5062","authenticated-orcid":true,"given":"Xiaobo","family":"Ma","sequence":"additional","affiliation":[{"name":"Xiamen Key Laboratory of Genetic Testing, Department of Clinical Laboratory, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00399-6"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00725-23"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02185-7"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00008-23"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01092-21"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01279-22"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/Spectrum.00954-21"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00374-23"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01886-15"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106011"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00191-22"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.724272"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy660"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaa431"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac791"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.120163297"},{"key":"e_1_3_5_18_2","volume-title":"M100-S30Performance standards for antimicrobial susceptibility testing","author":"Standards ICaL","year":"2020","unstructured":"Standards ICaL. 2020. M100-S30. Performance standards for antimicrobial susceptibility testing. CLSI, Wayne, PA."},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00020-10"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88861-w"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41429-023-00659-2"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-021-00542-3"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2024.02.015"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2019.0079"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2018.11.017"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1147855"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00001-19"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02655-21"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2020.0390"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.24743"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2021.2013105"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00955-22"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00328705"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1244511"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00025-11"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00447-22"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00890-21"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2958.1994.tb02177.x"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02616-22"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2022.2103454"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-021-00936-5"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00331-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00331-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T13:18:09Z","timestamp":1722950289000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.00331-24"}},"subtitle":[],"editor":[{"given":"Brian","family":"Conlon","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":40,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,6]]}},"alternative-id":["10.1128\/spectrum.00331-24"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.00331-24","relation":{},"ISSN":["2165-0497"],"issn-type":[{"type":"electronic","value":"2165-0497"}],"subject":[],"published":{"date-parts":[[2024,8,6]]},"assertion":[{"value":"2024-02-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00331-24"}}