Emergence of a plasmid-encoded resistance-nodulation- division efflux pump conferring resistance to multiple drugs, including tigecycline, in Klebsiella pneumoniae

Luchao Lv, Miao Wan, Chengzhen Wang, Xun Gao, Qiwen Yang, Sally R. Partridge, Yang Wang, Zhiyong Zong, Yohei Doi, Jianzhong Shen, Peiyao Jia, Qianhua Song, Qianhui Zhang, Jun Yang, Xianhui Huang, Minggui Wang, Jian Hua Liu

Research output: Contribution to journalArticlepeer-review

128 Citations (Scopus)


Transporters belonging to the chromosomally encoded resistancenodulation- division (RND) superfamily mediate multidrug resistance in Gramnegative bacteria. However, the cotransfer of large gene clusters encoding RND-type pumps from the chromosome to a plasmid appears infrequent, and no plasmidmediated RND efflux pump gene cluster has yet been found to confer resistance to tigecycline. Here, we identified a novel RND efflux pump gene cluster, designated tmexCD1-toprJ1, on plasmids from five pandrug-resistant Klebsiella pneumoniae isolates of animal origin. TMexCD1-TOprJ1 increased (by 4- to 32-fold) the MICs of tetracyclines (including tigecycline and eravacycline), quinolones, cephalosporins, and aminoglycosides for K. pneumoniae, Escherichia coli, and Salmonella. TMexCD1- TOprJ1 is closely related (64.5% to 77.8% amino acid identity) to the MexCD-OprJ efflux pump encoded on the chromosome of Pseudomonas aeruginosa. In an IncFIA plasmid, pHNAH8I, the tmexCD1-toprJ1 gene cluster lies adjacent to two genes encoding site-specific integrases, which may have been responsible for its acquisition. Expression of TMexCD1-TOprJ1 in E. coli resulted in increased tigecycline efflux and in K. pneumoniae negated the efficacy of tigecycline in an in vivo infection model. Expression of TMexCD1-TOprJ1 reduced the growth of E. coli and Salmonella but not K. pneumoniae. tmexCD1-toprJ1-positive Enterobacteriaceae isolates were rare in humans (0.08%) but more common in chicken fecal (14.3%) and retail meat (3.4%) samples. Plasmid-borne tmexCD1-toprJ1-like gene clusters were identified in sequences in GenBank from Enterobacteriaceae and Pseudomonas strains from multiple continents. The possibility of further global dissemination of the tmexCD1-toprJ1 gene cluster and its analogues in Enterobacteriaceae via plasmids may be an important consideration for public health planning. IMPORTANCE In an era of increasing concerns about antimicrobial resistance, tigecycline is likely to have a critically important role in the treatment of carbapenemresistant Enterobacteriaceae, the most problematic pathogens in human clinical settings- especially carbapenem-resistant K. pneumoniae. Here, we identified a new plasmid-borne RND-type tigecycline resistance determinant, TMexCD1-TOprJ1, which is widespread among K. pneumoniae isolates from food animals. tmexCD1-toprJ1 appears to have originated from the chromosome of a Pseudomonas species and may have been transferred onto plasmids by adjacent site-specific integrases. Although tmexCD1-toprJ1 still appears to be rare in human clinical isolates, considering the transferability of the tmexCD1-toprJ1 gene cluster and the broad substrate spectrum of TMexCD1-TOprJ1, further dissemination of this mobile tigecycline resistance determinant is possible. Therefore, from a “One Health” perspective, measures are urgently needed to monitor and control its further spread. The current low prevalence in human clinical isolates provides a precious time window to design and implement measures to tackle this.

Original languageEnglish
Article numbere02930-19
Issue number2
Publication statusPublished - 01-03-2020

All Science Journal Classification (ASJC) codes

  • Microbiology
  • Virology


Dive into the research topics of 'Emergence of a plasmid-encoded resistance-nodulation- division efflux pump conferring resistance to multiple drugs, including tigecycline, in Klebsiella pneumoniae'. Together they form a unique fingerprint.

Cite this