Determination of incompatibility group plasmids and copy number of the bla NDM-1 gene in carbapenem-resistant Klebsiella pneumoniae strains recovered from different hospitals in Kerman, Iran.

Introduction. New Delhi metallo-β-lactamase (NDM)-producing Klebsiella pneumoniae has become a serious global health concern. Hypothesis/Gap Statement. Due to the high genetic diversity among NDM-positive K. pneumoniae, we need further surveillance and studies to better understand the relationships between them. In addition, the coexistence of several plasmid replicon types in NDM-positive K. pneumoniae may affect the copy number of bla NDM , the MIC level to antibiotics, as well as increasing the chance of horizontal gene transfer. Aim. The aim of this study was to determine incompatible plasmid groups and copy numbers of bla NDM , and to investigate the genetic relationship of 37 NDM-positive K. pneumoniae in Kerman, Iran. Methodology. The bla NDM-1 gene was detected and confirmed by PCR-sequencing. The plasmid replicon types were determined by PCR-based replicon typing (PBRT) and the copy number of bla NDM-1 was determined by quantitaive real time-PCR (qPCR). Random amplified polymorphic DNA (RAPD)-PCR typing was used to detect genetic relationships between the strains. Results. In this study, 10 different replicon types, including Frep [ n =25 (67.5 %)], FIIAs [ n =11 (29.7 %)], FIA [ n =5 (13.5 %)], FIB [ n =3 (8.1 %)], I1-Iγ [ n =2 (5.4 %)], L/M [ n =7 (18.9 %)], A/C [ n =7 (18.9 %)], Y [ n =3 (8.1 %)], P [ n =1 (2.7 %)] and FIC [ n =1 (2.7 %)] were reported. The copy numbers of the bla NDM-1 gene varied from 30.00 to 5.0×10 6  and no statistically significant correlation was observed between a rise of the MIC to imipenem and the copy numbers of bla NDM-1 ( P >0.05). According to RAPD typing results, 35 strains were divided into five clusters, while two strains were non-typeable. Conclusion. The spread of NDM-1-producing K. pneumoniae strains that carry several plasmid replicon types increases the chance of horizontal transfer of antibiotic resistance genes in hospital settings. In this study, 10 different replicon types were identified. We could not find any relationship between the increase of MIC levels to imipenem and the copy numbers of bla NDM-1 . Therefore, due to the identification of different replicon types in this study, the type and genetic characteristics of bla NDM-1 -carrying plasmids, and other factors such as antibiotic selective pressure, probably affect the copy number of bla NDM-1 and change the MIC level to imipenem.