{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:06:57Z","timestamp":1789020417489,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"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":"\n Introduction<\/jats:title>\n \n Carbapenem-resistant\n Klebsiella pneumoniae<\/jats:italic>\n (CRKP) poses a severe global public health threat, driven largely by plasmid-borne carbapenemase genes such as\n bla<\/jats:italic>\n NDM\u20131<\/jats:sub>\n and\n bla<\/jats:italic>\n KPC\u20132<\/jats:sub>\n . Although CRKP strains co-producing multiple carbapenemases are increasingly reported, the co-localization of these genes on a single plasmid remains rare, and the evolutionary dynamics and stability of such hybrid resistance plasmids are poorly understood.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this study, we characterized a highly imipenem-resistant clinical ST11 CRKP isolate (W61) by combining whole-genome sequencing, conjugation assays, structural variation (SV) analysis, S1-PFGE, Southern blotting, and antibiotic susceptibility testing.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The isolate harbored a novel 224-kbp chimeric plasmid (pW61_1) and exhibited an imipenem minimum inhibitory concentration (MIC) of 512 \u03bcg\/mL. Plasmid pW61_1 was composed of three modules fused through IS\n 26<\/jats:italic>\n -mediated cointegration: module 1 (IncFIB), module 2 (IncFII,\n bla<\/jats:italic>\n KPC\u20132<\/jats:sub>\n +<\/jats:sup>\n ), and module 3 (IncN2,\n bla<\/jats:italic>\n NDM\u20131<\/jats:sub>\n +<\/jats:sup>\n ). Under laboratory conditions, W61 maintained a high carbapenem-resistance retention rate in its native host even after 10 days of serial passage without antibiotic exposure. In addition, pW61_1 retained high structural stability after 10 days of serial passage under high imipenem concentrations. In the\n K. pneumoniae<\/jats:italic>\n recipient, pW61_1 rearranged into smaller, resistance-retaining SVs, including SV-D3 (\n bla<\/jats:italic>\n NDM\u20131<\/jats:sub>\n +<\/jats:sup>\n ) and SV-D4 (\n bla<\/jats:italic>\n KPC\u20132<\/jats:sub>\n +<\/jats:sup>\n ), primarily through IS\n 26<\/jats:italic>\n -driven replication-associated excision. In the\n Escherichia coli<\/jats:italic>\n J53 recipient, only small rearranged derivatives of pW61_1 were retained, each carrying one or both carbapenemase genes.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Our findings demonstrate that the tri-modular plasmid is transferable and undergoes post-transfer rearrangement under laboratory conditions. We hypothesize that this tri-modular plasmid may play an important role in the dissemination of carbapenemase genes, and therefore continued surveillance of this plasmid and its rearranged derivatives is warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1916718","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:31:14Z","timestamp":1789018274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An IS26-assembled three-module chimeric plasmid co-localizing blaNDM\u20131 and blaKPC\u20132 undergoes post-transfer rearrangement in Klebsiella pneumoniae"],"prefix":"10.3389","volume":"17","author":[{"given":"Zaikun","family":"Xiong","sequence":"first","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]},{"name":"Kunming Medical University Haiyuan College","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rucai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caibing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianyi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianyao","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyuan","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"He","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Key Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1038\/s41467-022-28819-2","article-title":"Role of 790 mobile genetic elements in the global dissemination of the carbapenem resistance gene blaNDM.","volume":"13","author":"Acman","year":"2022","journal-title":"Nat. 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