{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:52:33Z","timestamp":1790362353051,"version":"4.1.0"},"reference-count":42,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100014759","name":"Medical Scientific Research Foundation of Zhejiang Province, China","doi-asserted-by":"publisher","award":["2023KY438"],"award-info":[{"award-number":["2023KY438"]}],"id":[{"id":"10.13039\/501100014759","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014759","name":"Medical Scientific Research Foundation of Zhejiang Province, China","doi-asserted-by":"publisher","award":["2025KY543"],"award-info":[{"award-number":["2025KY543"]}],"id":[{"id":"10.13039\/501100014759","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Zhejiang Science and Technology Plan For Disease Prevention and Control","award":["2025JK016"],"award-info":[{"award-number":["2025JK016"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Serratia marcescens<\/jats:italic>\n                      is an emerging opportunistic pathogen with high genetic diversity. The emergence and prevalence of carbapenem-resistant\n                      <jats:italic toggle=\"yes\">S. marcescens<\/jats:italic>\n                      poses a major health threat due to its intrinsic resistance to multiple antibiotics, which severely restricts the selection and treatment of antibiotics for\n                      <jats:italic toggle=\"yes\">S. marcescens<\/jats:italic>\n                      infection. This study presents the first documented case in China of a bloodstream infection caused by\n                      <jats:italic toggle=\"yes\">Staphylococcus epidermidis<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">S. marcescens<\/jats:italic>\n                      strain (designated S96) co-producing\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      ,\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>KPC-2<\/jats:sub>\n                      , and\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>SRT-2<\/jats:sub>\n                      . Strain S96 exhibited resistance to nearly all categories of \u03b2-lactam antimicrobials, \u03b2-lactam\/inhibitor combinations, aminoglycosides, quinolones, and other clinical antibacterial agents, with the exception of tigecycline. Our main objective was to characterize the genetic mechanisms underlying its carbapenem resistance and plasmid transfer potential. Whole-genome sequencing revealed\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>KPC-2<\/jats:sub>\n                      on a 44,047 bp \u201cIncX6-like\u201d plasmid and\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      on a 100,081 bp IncFII(Yp)-type plasmid, alongside chromosomal\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>SRT-2<\/jats:sub>\n                      and\n                      <jats:italic toggle=\"yes\">aac<\/jats:italic>\n                      (6\u2032)\u2212\n                      <jats:italic toggle=\"yes\">Ic<\/jats:italic>\n                      . \u201cIncX6-like\u201d and IncFII(Yp)-type plasmids are widely distributed among carbapenem-resistant Enterobacteriaceae strains globally. Conjugation experiments demonstrated that the\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      -carrying plasmid could be successfully transferred to recipient\n                      <jats:italic toggle=\"yes\">Escherichia coli 600<\/jats:italic>\n                      , with no significant fitness cost observed (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). The experimental results demonstrate that carbapenem-resistant genes can disseminate among Enterobacteriaceae via plasmid-mediated horizontal transfer between bacterial cells. Comparative genomic analysis revealed plasmid structural homology with global counterparts, demonstrating IS-mediated recombination and horizontal gene transfer. The low adaptive cost of plasmid carriage and multidrug resistance phenotype pose significant challenges for clinical management. This study highlights the need for enhanced clinical surveillance and antibiotic stewardship to curb the spread of such multidrug-resistant pathogens.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Carbapenem resistance in\n                        <jats:italic toggle=\"yes\">Serratia marcescens<\/jats:italic>\n                        is primarily mediated by\n                        <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                        carbapenemase (KPC), with New Delhi metallo-\u03b2-lactamase (NDM) being a relatively uncommon alternative resistance mechanism. KPC-2 and NDM-1 coexisting in\n                        <jats:italic toggle=\"yes\">S. marcescens<\/jats:italic>\n                        is extremely rare clinically. This study reports the first clinical isolate of\n                        <jats:italic toggle=\"yes\">S. marcescens<\/jats:italic>\n                        in China co-harboring\n                        <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                        <jats:sub>NDM-1<\/jats:sub>\n                        ,\n                        <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                        <jats:sub>KPC-2<\/jats:sub>\n                        , and\n                        <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                        <jats:sub>SRT-2<\/jats:sub>\n                        . The isolate exhibits multidrug resistance to nearly all \u03b2-lactam antibiotics and \u03b2-lactam\/inhibitor combinations, with low adaptive costs and high dissemination potential. The potential spread of resistance genes through mobile genetic elements poses a serious public health risk. The study underscores the need for enhanced surveillance, rational antibiotic use, and novel strategies to combat resistance. It also provides insights into the evolutionary mechanisms of bacterial resistance, emphasizing the urgent need for interventions to address the growing threat of antimicrobial resistance.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00545-25","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:02:51Z","timestamp":1756818171000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":6,"title":["Emergence of carbapenem-resistant\n                    <i>Serratia marcescens<\/i>\n                    co-harboring\n                    <i>bla<\/i>\n                    <sub>NDM-1<\/sub>\n                    ,\n                    <i>bla<\/i>\n                    <sub>KPC-2<\/sub>\n                    , and\n                    <i>bla<\/i>\n                    <sub>SRT-2<\/sub>\n                    in bloodstream infection"],"prefix":"10.1128","volume":"13","author":[{"given":"Xuan","family":"Wang","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kzr5g33","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Laboratory, Zhejiang Hospital","place":["Hangzhou, People's Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanghua","family":"Fan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kzr5g33","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Laboratory, Zhejiang Hospital","place":["Hangzhou, People's Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6344-7502","authenticated-orcid":true,"given":"Shilei","family":"Dong","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kzr5g33","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Laboratory, Zhejiang Hospital","place":["Hangzhou, People's Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0445-2315","authenticated-orcid":true,"given":"Yapei","family":"Zhang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02kzr5g33","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Laboratory, Zhejiang Hospital","place":["Hangzhou, People's Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eimce.2021.05.014"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2023.454"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00017-11"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s42770-021-00477-4"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2021.127220"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2021.106463"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02255-19"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygeno.2021.08.009"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.4.1151-1161.2001"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2611.202203"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2807.212181"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.51620\/0869-2084-2022-67-3-180-185"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2024.107327"},{"key":"e_1_3_4_15_2","series-title":"M100","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"CLSI","year":"2020","unstructured":"CLSI. 2020. 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