Piperacillin/tazobactam resistance in a clinical isolate of Escherichia coli due to IS26-mediated amplification of bla<sub>TEM-1B</sub>.

Hubbard, Alasdair T M; Mason, Jenifer; Roberts, Paul; Parry, Christopher M; Corless, Caroline; van Aartsen, Jon; Howard, Alex; Bulgasim, Issra et al. · Nat Commun · 2020

basic_science · Level V

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Abstract

A phenotype of Escherichia coli and Klebsiella pneumoniae, resistant to piperacillin/tazobactam (TZP) but susceptible to carbapenems and 3rd generation cephalosporins, has emerged. The resistance mechanism associated with this phenotype has been identified as hyperproduction of the β-lactamase TEM. However, the mechanism of hyperproduction due to gene amplification is not well understood. Here, we report a mechanism of gene amplification due to a translocatable unit (TU) excising from an IS26-flanked pseudo-compound transposon, PTn6762, which harbours bla<sub>TEM-1B</sub>. The TU re-inserts into the chromosome adjacent to IS26 and forms a tandem array of TUs, which increases the copy number of bla<sub>TEM-1B,</sub> leading to TEM-1B hyperproduction and TZP resistance. Despite a significant increase in bla<sub>TEM-1B</sub> copy number, the TZP-resistant isolate does not incur a fitness cost compared to the TZP-susceptible ancestor. This mechanism of amplification of bla<sub>TEM-1B</sub> is an important consideration when using genomic data to predict susceptibility to TZP.

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