{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T13:16:02Z","timestamp":1770902162189,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"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. Microbiol."],"abstract":"<jats:p>The widespread emergence of carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CRKP) with limited therapeutic options has become a global concern. In this study, a <jats:italic>K. pneumoniae<\/jats:italic> strain called KP2e was recovered from a human case of fatal septic shock in a Chinese hospital. Polymerase chain reaction and sequencing, antimicrobial susceptibility testing, conjugation experiments, S1 nuclease-pulsed field gel electrophoresis\/southern blot, whole genome sequencing and comparative genomics were performed to investigate the phenotypic and molecular characteristics of this isolate. KP2e possessed the NDM-6-encoding gene and exhibited resistance to almost all \u03b2-lactams except for monobactam. This strain belonged to sequence type 4024, the complete genome of which was composed of one chromosome and three plasmids. Furthermore, <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM\u20136<\/jats:italic><\/jats:sub> coexisted on two self-transmissible plasmids, which were assigned to types IncFIB and IncN. A structure of IS<jats:italic>26<\/jats:italic>-composite transposon capturing an identical Tn<jats:italic>125<\/jats:italic> remnant (\u0394IS<jats:italic>Aba125<\/jats:italic>-<jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM\u20136<\/jats:italic><\/jats:sub>-<jats:italic>ble<\/jats:italic><jats:sub><jats:italic>MBL<\/jats:italic><\/jats:sub>-<jats:italic>trpF<\/jats:italic>-<jats:italic>dsbC<\/jats:italic>-<jats:italic>cutA<\/jats:italic>-<jats:italic>groES<\/jats:italic>-\u0394<jats:italic>groEL<\/jats:italic>) was identified in the two plasmids, and this conserved <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM<\/jats:italic><\/jats:sub>-surrounding genetic context was similar to that of few IncN plasmids found in other regions of China. Our research appears to be the first description of a clinical strain that emerged co-harbouring dual <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM<\/jats:italic><\/jats:sub>-carrying plasmids, and the first report of NDM-6-positive CRKP in China. These findings demonstrated that IncN is a key medium in the evolution and expanding dissemination of <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM<\/jats:italic><\/jats:sub> genes among various species, which indicates that close monitoring and rapid detection of <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>NDM<\/jats:italic><\/jats:sub>-harbouring plasmids is necessary.<\/jats:p>","DOI":"10.3389\/fmicb.2022.900831","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T08:14:15Z","timestamp":1652861655000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Emergence of a Carbapenem-Resistant Klebsiella pneumoniae Isolate Co-harbouring Dual blaNDM\u2013 6-Carrying Plasmids in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Yali","family":"Gong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifei","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongdong","family":"Xue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qimeng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuguang","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yizhi","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2164-12-402","article-title":"BLAST Ring Image Generator (BRIG): simple prokaryote genome comparisons.","volume":"12","author":"Alikhan","year":"2011","journal-title":"BMC Genomics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2164-9-75","article-title":"The RAST Server: rapid annotations using subsystems technology.","volume":"9","author":"Aziz","year":"2008","journal-title":"BMC Genomics"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e01849","DOI":"10.1128\/aac.01849-17","article-title":"Clinical evolution of new delhi metallo-\u03b2-lactamase (NDM) optimizes resistance under Zn(II) deprivation.","volume":"62","author":"Bahr","year":"2018","journal-title":"Antimicrob. 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