Get started
Work

Genomic investigation of NDM-1 producing Enterobacterales transmission in a South Korean hospital

Year: 2025
Type: article
Abstract: Objectives Prolonged detection of multispecies New Delhi metallo-β-lactamase (NDM)-1-producing Enterobacterales was observed previously in clinical and environmental samples collected from a South Korean hospital. This study aimed to investigate the transmission mechanisms of bla NDM-1 and assess the role of environmental reservoirs in its persistence. Methods Epidemiological data were collected, and antibiotic susceptibility testing, carbapenemases detection, and whole-genome sequencing were performed on 42 clinical and 13 environmental isolates collected between November 2018 and February 2021, during the pre-outbreak, outbreak (July–September 2019), and post-outbreak periods. Long-read complete-genome sequencing was performed on four clinical and four environmental isolates to characterize plasmids carrying bla NDM-1 and associated mobile genetic elements (MGEs). Phylogenetic analyses were also performed. Results bla NDM-1 was detected in 15 different species across clinical and environmental isolates. During the 2019 outbreak, clonal spread of Klebsiella pneumoniae and Klebsiella quasipneumoniae in the hospital was the primary mechanism of dissemination. During the post-outbreak period, horizontal gene transfer (HGT), mediated by the IncX3 plasmid carrying bla NDM-1 , was the dominant transmission mechanism. This plasmid, detected in both clinical and environmental isolates, showed high genetic conservation with IncX3 plasmids reported worldwide. These plasmids contained conserved MGEs, including the IS26- dsbD - trpF - ble - bla NDM-1 structure. Conclusion This study highlights the dual roles of clonal spread and plasmid-mediated HGT in the dissemination of bla NDM-1 in hospital settings. The persistence of highly conserved IncX3 plasmids in environmental isolates underscores the complexity of carbapenem resistance control. Comprehensive infection control strategies targeting patient-to-patient transmission and environmental reservoirs are crucial for mitigating the spread of NDM-producing Enterobacterales.
DOI: 10.1016/j.jgar.2025.05.010
Language: English
Open Access status: gold
Estimated APC paid: $1,890
OpenAlex ID: W4410529801
FWCI: 0.478
Cites: 25
Cited by: 2
Related to: 10