{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:38:47Z","timestamp":1791470327936,"version":"4.3.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>The emergence and prevalence of carbapenem-resistant <jats:italic>Enterobacteriaceae<\/jats:italic> (CRE) have drawn worldwide attention. Ceftazidime\/avibactam (CAZ\/AVI) gives us a valuable alternative strategy to treat CRE infections. Unfortunately, CAZ\/AVI resistance could occur during CAZ\/AVI treatment. The CAZ\/AVI-resistant Carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CR-KP) (KP137060) and earlier CAZ\/AVI-susceptible isolate (KP135194) from the same hospitalized patient were collected at Fujian Medical University Union Hospital between October and November 2019. In this study, CAZ\/AVI MICs of CAZ\/AVI-susceptible and -resistant isolates (KP135194 and KP137060) were 4 mg\/L and 128 mg\/L, respectively; and the two isolates had the same antibiotic resistance pattern to other carbapenems. Two strains were then submitted for whole-genome sequencing and bioinformatic analysis. <jats:italic>ompK36<\/jats:italic> was not detected in two isolates. No mutation was observed in <jats:italic>bla<\/jats:italic><jats:sub>KPC-2<\/jats:sub>, <jats:italic>ompK35<\/jats:italic> and <jats:italic>ompK37<\/jats:italic> in this study and there was no significant difference of the expression in <jats:italic>bla<\/jats:italic><jats:sub>KPC-2<\/jats:sub>, <jats:italic>ompK35<\/jats:italic> and <jats:italic>ompK37<\/jats:italic> between the two isolates (<jats:italic>p<\/jats:italic>&amp;gt;0.05). Two isolates were sequence type 11 and harbored <jats:italic>bla<\/jats:italic><jats:sub>KPC-2<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>SHV-182<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>TEM-1B<\/jats:sub>. Compared with KP135194, KP137060 harbored an additional <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub> positive plasmid. <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub> gene could be successfully transferred into <jats:italic>E. coli<\/jats:italic> J53 at a conjugation frequency of 1.14\u00d710<jats:sup>-4<\/jats:sup>. Plasmid stability testing showed that <jats:italic>bla<\/jats:italic><jats:sub>KPC-2<\/jats:sub>- and <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub>-harboring plasmids were still stably maintained in the hosts. Growth assay and growth competition experiments showed there was no significant difference in fitness cost between two CR-KP isolates. Our study described the acquisition of a <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub>-harboring plasmid leading to resistance to ceftazidime\/avibactam in KPC-2-producing <jats:italic>Klebsiella pneumoniae<\/jats:italic> during treatment. This phenomenon deserves further exploration.<\/jats:p>","DOI":"10.3389\/fcimb.2021.658070","type":"journal-article","created":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T09:31:37Z","timestamp":1626773497000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Acquisition of a Stable and Transferable blaNDM-5-Positive Plasmid With Low Fitness Cost Leading to Ceftazidime\/Avibactam Resistance in KPC-2-Producing Klebsiella pneumoniae During Treatment"],"prefix":"10.3389","volume":"11","author":[{"given":"Jiangqing","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengcen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingping","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1093\/jac\/dkx143","article-title":"The Complete Nucleotide Sequence of an IncP-2 Megaplasmid Unveils a Mosaic Architecture Comprising a Putative Novel blaVIM-2-Harbouring Transposon in Pseudomonas Aeruginosa","volume":"72","author":"Botelho","year":"2017","journal-title":"J. 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