{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:37:08Z","timestamp":1790339828540,"version":"4.1.0"},"reference-count":76,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T00:00:00Z","timestamp":1579219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Whole-genome sequence (WGS) analyses were employed to investigate the genomic epidemiology of extensively drug-resistant Klebsiella pneumoniae strains, focusing on the carbapenem resistance-encoding determinants, mobile genetic support, clonal and epidemiological relationships. A total of ten isolates were obtained from patients admitted to the intensive care unit (ICU) in a public hospital in South Africa. Five isolates were from rectal swabs of colonized patients and five from blood cultures of patients with invasive carbapenem-resistant infections. Following microbial identification and antibiotic susceptibility tests, the isolates were subjected to WGS on the Illumina MiSeq platform. All the isolates showed genotypic resistance to tested \u03b2-lactams (NDM-1, OXA-1, CTX-M-15, TEM-1B, SHV-1) and other antibiotics. All but one isolate belonged to the ST152 with a novel sequence type, ST3136, differing by a single-locus variant. The isolates had the same plasmid multilocus sequence type (IncF[K12:A-:B36]) and capsular serotype (KL149), supporting the epidemiological linkage between the clones. Resistance to carbapenems in the 10 isolates was conferred by the blaNDM-1 mediated by the acquisition of multi-replicon [ColRNAI, IncFIB(pB171), Col440I, IncFII, IncFIB(K) and IncFII(Yp)] p18-43_01 plasmid. These findings suggest that the acquisition of blaNDM-1-bearing plasmid structure (p18-43_01), horizontal transfer and clonal dissemination facilitate the spread of carbapenemases in South Africa. This emphasizes the importance of targeted infection control measures to prevent dissemination.<\/jats:p>","DOI":"10.3390\/microorganisms8010137","type":"journal-article","created":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T04:27:09Z","timestamp":1579494429000},"page":"137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Genomic Analysis of Carbapenemase-Producing Extensively Drug-Resistant Klebsiella pneumoniae Isolates Reveals the Horizontal Spread of p18-43_01 Plasmid Encoding blaNDM-1 in South Africa"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-8392","authenticated-orcid":false,"given":"Yogandree","family":"Ramsamy","sequence":"first","affiliation":[{"name":"Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"},{"name":"Medical Microbiology, National Health Laboratory Services, Durban 4000, South Africa"},{"name":"Medical Microbiology, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koleka P.","family":"Mlisana","sequence":"additional","affiliation":[{"name":"Medical Microbiology, National Health Laboratory Services, Durban 4000, South Africa"},{"name":"Medical Microbiology, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9875-6716","authenticated-orcid":false,"given":"Mushal","family":"Allam","sequence":"additional","affiliation":[{"name":"Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg 2131, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Amoako","sequence":"additional","affiliation":[{"name":"Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5194-2810","authenticated-orcid":false,"given":"Akebe L. K.","family":"Abia","sequence":"additional","affiliation":[{"name":"Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4672-5915","authenticated-orcid":false,"given":"Arshad","family":"Ismail","sequence":"additional","affiliation":[{"name":"Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg 2131, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravesh","family":"Singh","sequence":"additional","affiliation":[{"name":"Medical Microbiology, National Health Laboratory Services, Durban 4000, South Africa"},{"name":"Medical Microbiology, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1609-6962","authenticated-orcid":false,"given":"Theroshnie","family":"Kisten","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Discipline of Anaesthetics &amp; Critical Care, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"},{"name":"Inkosi Albert Luthuli Central Hospital, Department of Critical Care, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khine Swe","family":"Swe Han","sequence":"additional","affiliation":[{"name":"Medical Microbiology, National Health Laboratory Services, Durban 4000, South Africa"},{"name":"Medical Microbiology, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J. Jackson","family":"Muckart","sequence":"additional","affiliation":[{"name":"Inkosi Albert Luthuli Central Hospital, Department of Surgery &amp; Trauma Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Hardcastle","sequence":"additional","affiliation":[{"name":"Inkosi Albert Luthuli Central Hospital, Department of Surgery &amp; Trauma Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moosa","family":"Suleman","sequence":"additional","affiliation":[{"name":"Ahmed Al-Kadi Private Hospital, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3357-2761","authenticated-orcid":false,"given":"Sabiha Y.","family":"Essack","sequence":"additional","affiliation":[{"name":"Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.nmni.2015.02.007","article-title":"The global threat of antimicrobial resistance: Science for intervention","volume":"6","author":"Roca","year":"2015","journal-title":"New Microbes New Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog. Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1080\/21505594.2016.1222343","article-title":"The global epidemiology of carbapenemase-producing Enterobacteriaceae","volume":"8","author":"Doi","year":"2017","journal-title":"Virulence"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1093\/cid\/cix893","article-title":"Carbapenemase-Producing Organisms: A Global Scourge","volume":"66","author":"Bonomo","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Codjoe, F., and Donkor, E. (2017). Carbapenem Resistance: A Review. Med. Sci., 6.","DOI":"10.3390\/medsci6010001"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/2047-2994-1-11","article-title":"Ready for a world without antibiotics? The Pensi\u00e8res Antibiotic Resistance Call to Action","volume":"1","author":"Carlet","year":"2012","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Saeed, A., Bosch, A., Bettiol, M., Nossa Gonz\u00e1lez, D.L., Erben, M.F., and Lamberti, Y. (2018). Novel guanidine compound against multidrug-resistant cystic fibrosis-associated bacterial species. Molecules, 23.","DOI":"10.3390\/molecules23051158"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Patil, M., Noonikara-Poyil, A., Joshi, S.D., Patil, S.A., Patil, S.A., and Bugarin, A. (2019). New Urea Derivatives as Potential Antimicrobial Agents: Synthesis, Biological Evaluation, and Molecular Docking Studies. Antibiotics, 8.","DOI":"10.3390\/antibiotics8040178"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e02077-18","DOI":"10.1128\/AEM.02077-18","article-title":"1,4,7-Triazacyclononane Restores the Activity of \u03b2-Lactam Antibiotics against Metallo-\u03b2-Lactamase-Producing Enterobacteriaceae: Exploration of Potential Metallo-\u03b2-Lactamase Inhibitors","volume":"85","author":"Somboro","year":"2019","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/jam.14141","article-title":"In vitro potentiation of carbapenems with tannic acid against carbapenemase-producing enterobacteriaceae: Exploring natural products as potential carbapenemase inhibitors","volume":"126","author":"Somboro","year":"2019","journal-title":"J. Appl. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4943","DOI":"10.1128\/AAC.00296-11","article-title":"Carbapenems: Past, Present, and Future","volume":"55","author":"Endimiani","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"250","DOI":"10.4065\/mcp.2010.0674","article-title":"Current Concepts in Antimicrobial Therapy Against Resistant Gram-Negative Organisms: Extended-Spectrum \u03b2-Lactamase\u2013Producing Enterobacteriaceae, Carbapenem-Resistant Enterobacteriaceae, and Multidrug-Resistant Pseudomonas aeruginosa","volume":"86","author":"Kanj","year":"2011","journal-title":"Mayo Clin. Proc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1128\/CMR.00001-07","article-title":"Carbapenemases: The versatile \u03b2-lactamases","volume":"20","author":"Queenan","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.3389\/fmicb.2019.01823","article-title":"Carbapenemases in Enterobacteriaceae: Detection and Antimicrobial Therapy","volume":"10","author":"Cui","year":"2019","journal-title":"Front. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5873","DOI":"10.1128\/AAC.01019-15","article-title":"Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance","volume":"59","author":"Pitout","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2911","DOI":"10.1001\/jama.2008.896","article-title":"Carbapenem-resistant enterobacteriaceae: A potential threat","volume":"300","author":"Schwaber","year":"2008","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fasciana, T., Gentile, B., Aquilina, M., Ciammaruconi, A., Mascarella, C., Anselmo, A., Fortunato, A., Fillo, S., Petralito, G., and Lista, F. (2019). Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4565-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6189","DOI":"10.1128\/AAC.01201-16","article-title":"High Prevalence of Carbapenemase-Producing Enterobacteriaceae among Hospitalized Children in Luanda, Angola","volume":"60","author":"Kieffer","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sangare, S.A., Rondinaud, E., Maataoui, N., Maiga, A.I., Guindo, I., Maiga, A., Camara, N., Dicko, O.A., Dao, S., and Diallo, S. (2017). Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172652"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1089\/mdr.2016.0213","article-title":"First Case of NDM-1-Producing Klebsiella pneumoniae in Annaba University Hospital, Algeria","volume":"23","author":"Abderrahim","year":"2017","journal-title":"Microb. Drug Resist."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3201\/eid2302.161182","article-title":"Emergence of blaNDM-7\u2013producing enterobacteriaceaein Gabon, 2016","volume":"23","author":"Moussounda","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Jesumirhewe, C., Springer, B., Lepuschitz, S., Allerberger, F., and Ruppitsch, W. (2017). Carbapenemase-Producing Enterobacteriaceae Isolates from Edo State, Nigeria. Antimicrob. Agents Chemother., 61.","DOI":"10.1128\/AAC.00255-17"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.diagmicrobio.2014.04.003","article-title":"NDM-1\u2013producing Enterobacteriaceae from South Africa: Moving towards endemicity?","volume":"79","author":"Rubin","year":"2014","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1128\/AAC.01707-08","article-title":"Resistance Plasmid Families in Enterobacteriaceae","volume":"53","author":"Carattoli","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"5403","DOI":"10.1128\/AAC.00585-11","article-title":"Genetic Features of bla NDM-1 -Positive Enterobacteriaceae","volume":"55","author":"Poirel","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drup.2016.09.002","article-title":"The rapid spread of carbapenem-resistant Enterobacteriaceae","volume":"29","author":"Potter","year":"2016","journal-title":"Drug Resist. Updat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"446","DOI":"10.3389\/fcimb.2018.00446","article-title":"The genetic structures of an extensively drug resistant (XDR) Klebsiella pneumoniae and its plasmids","volume":"8","author":"Li","year":"2019","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1128\/JCM.00020-12","article-title":"Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: A Hidden Reservoir in Hospitalized and Nonhospitalized Patients","volume":"50","author":"Gijon","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2986","DOI":"10.1128\/JCM.00901-13","article-title":"A Combined Disk Test for Direct Differentiation of Carbapenemase-Producing Enterobacteriaceae in Surveillance Rectal Swabs","volume":"51","author":"Pournaras","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1128\/CMR.00097-16","article-title":"A Decade of Development of Chromogenic Culture Media for Clinical Microbiology in an Era of Molecular Diagnostics","volume":"30","author":"Perry","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_32","unstructured":"Clinical and Laboratory Standards Institute (2017). Performance Standards for Antimicrobial Susceptibility Testing: 27th Edition Informational Supplement M100-S27, CLSI."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1128\/JCM.00888-17","article-title":"Susceptibility Testing for the Polymyxins: Two Steps Back, Three Steps Forward?","volume":"55","author":"Vasoo","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1089\/cmb.2012.0021","article-title":"SPAdes: A new genome assembly algorithm and its applications to single-cell sequencing","volume":"19","author":"Bankevich","year":"2012","journal-title":"J. Comput. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Aziz, R.K., Bartels, D., Best, A., DeJongh, M., Disz, T., Edwards, R.A., Formsma, K., Gerdes, S., Glass, E.M., and Kubal, M. (2008). The RAST Server: Rapid annotations using subsystems technology. BMC Genom., 9.","DOI":"10.1186\/1471-2164-9-75"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1093\/jac\/dks261","article-title":"Identification of acquired antimicrobial resistance genes","volume":"67","author":"Zankari","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"D566","DOI":"10.1093\/nar\/gkw1004","article-title":"CARD 2017: Expansion and model-centric curation of the comprehensive antibiotic resistance database","volume":"45","author":"Jia","year":"2017","journal-title":"Nucleic Acids Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3895","DOI":"10.1128\/AAC.02412-14","article-title":"In Silico Detection and Typing of Plasmids using PlasmidFinder and Plasmid Multilocus Sequence Typing","volume":"58","author":"Carattoli","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/nar\/gkr485","article-title":"PHAST: A Fast Phage Search Tool","volume":"39","author":"Zhou","year":"2011","journal-title":"Nucleic Acids Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"D32","DOI":"10.1093\/nar\/gkj014","article-title":"ISfinder: The reference centre for bacterial insertion sequences","volume":"34","author":"Siguier","year":"2006","journal-title":"Nucleic Acids Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ahrenfeldt, J., Skaarup, C., Hasman, H., Pedersen, A.G., Aarestrup, F.M., and Lund, O. (2017). Bacterial whole genome-based phylogeny: Construction of a new benchmarking dataset and assessment of some existing methods. BMC Genom., 18.","DOI":"10.1186\/s12864-016-3407-6"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/bioinformatics\/btx610","article-title":"Phandango: An interactive viewer for bacterial population genomics","volume":"34","author":"Hadfield","year":"2017","journal-title":"Bioinformatics"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5114","DOI":"10.1038\/s41467-018-07641-9","article-title":"High throughput ANI analysis of 90K prokaryotic genomes reveals clear species boundaries","volume":"9","author":"Jain","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e01300","DOI":"10.1128\/MRA.01300-18","article-title":"Whole-Genome Sequence of a Novel Sequence Type 3136 Carbapenem-Resistant Klebsiella pneumoniae Strain Isolated from a Hospitalized Patient in Durban, South Africa","volume":"7","author":"Ramsamy","year":"2018","journal-title":"Microbiol. Resour. Announc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"14455","DOI":"10.1038\/s41598-019-51002-5","article-title":"Dissemination of carbapenemase-producing Enterobacteriaceae harbouring blaNDM or blaIMI in local market foods of Yangon, Myanmar","volume":"9","author":"Sugawara","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3389\/fmicb.2019.00080","article-title":"Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Update on Therapeutic Options","volume":"10","author":"Sheu","year":"2019","journal-title":"Front. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"895","DOI":"10.3389\/fmicb.2016.00895","article-title":"Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods","volume":"7","author":"Lee","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jhin.2012.02.007","article-title":"Reduced susceptibility to chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae","volume":"81","author":"Naparstek","year":"2012","journal-title":"J. Hosp. Infect."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ijantimicag.2011.04.021","article-title":"Diverse prevalence of 16S rRNA methylase genes armA and rmtB amongst clinical multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolates","volume":"38","author":"Yang","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"877","DOI":"10.7196\/SAMJ.2016.v106i9.11028","article-title":"Invasive carbapenem-resistant Enterobacteriaceae infection at a paediatric hospital: A case series","volume":"106","author":"Malande","year":"2016","journal-title":"S. Afr. Med. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.3346\/jkms.2019.34.e140","article-title":"Prevalence and Risk Factors of Carbapenem-resistant Enterobacteriaceae Acquisition in an Emergency Intensive Care Unit in a Tertiary Hospital in Korea: A Case-Control Study","volume":"34","author":"Kang","year":"2019","journal-title":"J. Korean Med. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12941-019-0335-8","article-title":"A 7-year surveillance of the drug resistance in Klebsiella pneumoniae from a primary health care center","volume":"18","author":"Li","year":"2019","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jhin.2017.08.012","article-title":"Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: Prevalence, risk factors, and acquisition rate","volume":"97","author":"Duailibi","year":"2017","journal-title":"J. Hosp. Infect."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"297","DOI":"10.2147\/IDR.S39186","article-title":"Impact of the New Delhi metallo-beta-lactamase on beta-lactam antibiotics","volume":"8","author":"Nicolau","year":"2015","journal-title":"Infect. Drug Resist."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/AEM.00698-18","article-title":"Diversity and Proliferation of Metallo-\u03b2-Lactamases: A Clarion Call for Clinically Effective Metallo-\u03b2-Lactamase Inhibitors","volume":"84","author":"Somboro","year":"2018","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_57","first-page":"873","article-title":"NDM-1 has arrived: First report of a carbapenem resistance mechanism in South Africa","volume":"101","author":"Lowman","year":"2011","journal-title":"S. Afr. Med. J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e02178-17","DOI":"10.1128\/AAC.02178-17","article-title":"Spread of Plasmid-Encoded NDM-1 and GES-5 Carbapenemases among Extensively Drug-Resistant and Pandrug-Resistant Clinical Enterobacteriaceae in Durban, South Africa","volume":"62","author":"Pedersen","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_59","first-page":"209","article-title":"Current State of Resistance to Antibiotics of Last-Resort in South Africa: A Review From a Public Health Perspective","volume":"4","year":"2016","journal-title":"Front. Public Health"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1089\/mdr.2015.0053","article-title":"The Molecular Epidemiology and Genetic Environment of Carbapenemases Detected in Africa","volume":"22","author":"Sekyere","year":"2015","journal-title":"Microb. Drug Resist."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Khan, A.U., Maryam, L., and Zarrilli, R. (2017). Structure, Genetics and Worldwide Spread of New Delhi Metallo-\u03b2-lactamase (NDM): A threat to public health. BMC Microbiol., 17.","DOI":"10.1186\/s12866-017-1012-8"},{"key":"ref_62","first-page":"228","article-title":"Carbonyl Cyanide m-Chlorophenylhydrazine (CCCP) Reverses Resistance to Colistin, but Not to Carbapenems and Tigecycline in Multidrug-Resistant Enterobacteriaceae","volume":"8","author":"Amoako","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ijid.2019.05.025","article-title":"Genomic characterization of multidrug-resistant ESBL-producing Klebsiella pneumoniae isolated from a Ghanaian teaching hospital","volume":"85","author":"Agyepong","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Osei Sekyere, J., and Amoako, D.G. (2017). Genomic and phenotypic characterisation of fluoroquinolone resistance mechanisms in Enterobacteriaceae in Durban, South Africa. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178888"},{"key":"ref_65","first-page":"e000102","article-title":"Identification of Klebsiella capsule synthesis loci from whole genome data","volume":"2","author":"Wyres","year":"2016","journal-title":"Microb. Genom."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Wyres, K.L., Nguyen, T.N., Lam, M.M., Judd, L.M., van Vinh Chau, N., Dance, D.A., Ip, M., Karkey, A., Ling, C.L., and Miliya, T. (2019). Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from south and southeast Asia. bioRxiv.","DOI":"10.1101\/557785"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.3389\/fmicb.2017.01230","article-title":"Extensively drug-resistant klebsiella pneumoniae causing nosocomial bloodstream infections in China: Molecular investigation of antibiotic resistance determinants, Informing therapy, and clinical outcomes","volume":"8","author":"Bi","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Carattoli, A., Seiffert, S.N., Schwendener, S., Perreten, V., and Endimiani, A. (2015). Differentiation of IncL and IncM Plasmids Associated with the Spread of Clinically Relevant Antimicrobial Resistance. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123063"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1089\/mdr.2015.0083","article-title":"bla NDM-1 Carriage on IncR Plasmid in Enterobacteriaceae Strains","volume":"22","author":"Kocsis","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Sahl, J.W., Johnson, J.K., Harris, A.D., Phillippy, A.M., Hsiao, W.W., Thom, K.A., and Rasko, D.A. (2011). Genomic comparison of multi-drug resistant invasive and colonizing Acinetobacter baumannii isolated from diverse human body sites reveals genomic plasticity. BMC Genom., 12.","DOI":"10.1186\/1471-2164-12-291"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.scitotenv.2019.03.110","article-title":"Genomic analysis of methicillin-resistant Staphylococcus aureus isolated from poultry and occupational farm workers in Umgungundlovu District, South Africa","volume":"670","author":"Amoako","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.tig.2012.12.006","article-title":"Horizontal gene transfer and the evolution of bacterial and archaeal population structure","volume":"29","author":"Polz","year":"2013","journal-title":"Trends Genet."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"a018036","DOI":"10.1101\/cshperspect.a018036","article-title":"Horizontal Gene Transfer and the History of Life","volume":"8","author":"Daubin","year":"2016","journal-title":"Cold Spring Harb. Perspect. Biol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3389\/fgene.2019.00426","article-title":"Long-Read Sequencing Emerging in Medical Genetics","volume":"10","author":"Mantere","year":"2019","journal-title":"Front. Genet."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"6905450","DOI":"10.1155\/2017\/6905450","article-title":"What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit","volume":"2017","author":"Russotto","year":"2017","journal-title":"Biomed. Res. Int."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13756-017-0259-z","article-title":"Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: Guidance from the European Centre for Disease Prevention and Control","volume":"6","author":"Magiorakos","year":"2017","journal-title":"Antimicrob. Resist. Infect. 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