{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:29:40Z","timestamp":1771234180529,"version":"3.50.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"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:sec><jats:title>Background<\/jats:title><jats:p>Carbapenem-resistant <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (CRPA) poses a significant global health risk, particularly for immunocompromised individuals. This study documents an outbreak of CRPA strains co-harboring <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub> on IncP-2 plasmids in a Chinese tertiary hospital, resulting in poor outcomes for transplant patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>17 ST313 VIM-1-IMP-45 CRPA strains were collected from transplant patients, and antibiotic susceptibility was tested via microbroth dilution. Whole genome sequencing (WGS) identified drug resistance and virulence mechanisms, analyzed ST313 <jats:italic>P. aeruginosa<\/jats:italic> phylogeny, and traced <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub> origins. Conjugation experiments were conducted to assess the conjugative potential of the IncP-2 plasmid co-harboring <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub>. Structural and molecular docking studies explored the PBP3 (P527S) mutation\u2019s role in aztreonam resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From February 2022 to July 2024, 17 ST313 VIM-1-IMP-45 CRPA strains from 10 transplant patients were identified. All strains were extensively drug-resistant but sensitive to colistin and cefiderocol. WGS showed <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> on an IncP-2 megaplasmid. Phylogenetic analysis indicated high homology with plasmids carrying <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub>. Further analysis of the genetic environment showed that the IncP-2 plasmid co-harboring <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub> was formed by the insertion of a Tn<jats:italic>3<\/jats:italic>-family transposon carrying <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> into the IncP-2 plasmid carrying <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub>. In addition aztreonam-resistant strains (14\/15) had a PBP3 (P527S) mutation, with molecular docking studies suggesting reduced aztreonam binding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study reports a clonal outbreak of ST313 <jats:italic>P. aeruginosa<\/jats:italic> strains co-producing IMP-45 and VIM-1 carbapenemases in a tertiary hospital. The evolutionary path of the IncP-2 plasmid co-harboring <jats:italic>bla<\/jats:italic><jats:sub>IMP-45<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>VIM-1<\/jats:sub> was elucidated.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1623241","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:30:44Z","timestamp":1750311044000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Tracing the evolutionary trajectory of the IncP-2 plasmid co-harboring blaIMP-45 and blaVIM-1: an outbreak of Pseudomonas aeruginosa co-producing IMP-45 and VIM-1 carbapenemases in China"],"prefix":"10.3389","volume":"15","author":[{"given":"Yiqun","family":"Ma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zichen","family":"Lei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yulin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feilong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Zu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinrui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binghuai","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3389","DOI":"10.1093\/nar\/25.17.3389","article-title":"Gapped BLAST and PSI-BLAST: a new generation of protein database search programs","volume":"25","author":"Altschul","year":"1997","journal-title":"Nucleic Acids Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.drudis.2018.07.003","article-title":"Updates on the pathogenicity status of Pseudomonas aeruginosa","volume":"24","author":"Azam","year":"2019","journal-title":"Drug Discov. 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