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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Microbiol.</journal-id>
<journal-title>Frontiers in Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">1664-302X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmicb.2021.753979</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Characterization and Comparative Genomics Analysis of lncFII Multi-Resistance Plasmids Carrying <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> and Type1 Integrons From <italic>Escherichia coli</italic></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Zhou</surname> <given-names>Wei</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhang</surname> <given-names>Enbao</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhou</surname> <given-names>Jinzhi</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>He</surname> <given-names>Ze</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhou</surname> <given-names>Yuqiao</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Han</surname> <given-names>Jianzhong</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Qu</surname> <given-names>Daofeng</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1427291/overview"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Zhejiang Provincial Center for Animal Disease Prevention and Control</institution>, <addr-line>Hangzhou</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>Key Laboratory of Food Quality and Safety, School of Food Science and Biotechnology, Zhejiang Gongshang University</institution>, <addr-line>Hangzhou</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Henrietta Venter, University of South Australia, Australia</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Piklu Roy Chowdhury, University of Technology Sydney, Australia; Xiaoqiang Liu, Northwest A&#x0026;F University, China</p></fn>
<corresp id="c001">&#x002A;Correspondence: Daofeng Qu, <email>daofeng@mail.zjgsu.edu.cn</email></corresp>
<fn fn-type="equal" id="fn002"><p><sup>&#x2020;</sup>These authors have contributed equally to this work</p></fn>
<fn fn-type="other" id="fn004"><p>This article was submitted to Antimicrobials, Resistance and Chemotherapy, a section of the journal Frontiers in Microbiology</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>16</day>
<month>11</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>12</volume>
<elocation-id>753979</elocation-id>
<history>
<date date-type="received">
<day>05</day>
<month>08</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>29</day>
<month>10</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2021 Zhou, Zhang, Zhou, He, Zhou, Han and Qu.</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Zhou, Zhang, Zhou, He, Zhou, Han and Qu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>This research aimed to investigate the presence and transferability of the extended-spectrum &#x03B2;-lactamase resistance genes to identify the genetic context of multi-drug resistant (MDR) loci in two <italic>Escherichia coli</italic> plasmids from livestock and poultry breeding environment. MICs were determined by broth microdilution. A total of 137 <italic>E. coli</italic> resistant to extended-spectrum &#x03B2;-lactam antibiotics were screened for the presence of the ESBL genes by PCR. Only two <italic>E. coli</italic> out of 206 strains produced carbapenemases, including strain 11011 that produced enzyme A, and strain 417957 that produced enzyme B. The genes were <italic>bla</italic><sub>KPC</sub> and <italic>bla</italic><sub><italic>NDM</italic></sub>, respectively. The plasmids containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> were conjugatable, and the plasmids containing carbapenem resistance gene were not conjugatable. Six extended-spectrum &#x03B2;-lactamase resistance genes were detected in this research, including <italic>bla</italic><sub>TEM</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>, <italic>bla</italic><sub>SHV</sub>, <italic>bla</italic><sub>OAX</sub><sub>&#x2013;</sub><sub>1</sub>, <italic>bla</italic><sub>KPC</sub>, and <italic>bla</italic><sub><italic>NDM</italic></sub>, and the detection rates were 94.89% (130/137), 92.7% (127/137), 24.81% (34/137), 20.43% (28/137), 0.72% (1/137), and 0.72% (1/137), respectively. Two conjugative lncFII multi-resistance plasmids carrying <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>, p11011-fosA and p417957-CTXM, were sequenced and analyzed. Both conjugative plasmids were larger than 100 kb and contained three accessory modules, including MDR region. The MDR region of the two plasmids contained many antibiotic resistance genes, including <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>, <italic>mph (A)</italic>, <italic>dfrA17</italic>, <italic>aadA5</italic>, <italic>sul1</italic>, etc. After transfer, both the transconjugants displayed elevated MICs of the respective antimicrobial agents. A large number of resistance genes clusters in specific regions may contribute to the MDR profile of the strains. The presence of mobile genetic elements at the boundaries can possibly facilitate transfer among <italic>Enterobacteriaceae</italic> through inter-replicon gene transfer. Our study provides beta-lactam resistance profile of bacteria, reveals the prevalence of &#x03B2;-lactamase resistance genes in livestock and poultry breeding environment in Zhejiang Province, and enriches the research on IncFII plasmids containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>.</p>
</abstract>
<kwd-group>
<kwd>plasmid</kwd>
<kwd>&#x03B2;-Lactam antibiotics</kwd>
<kwd><italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub></kwd>
<kwd>MDR</kwd>
<kwd>mobile elements</kwd>
</kwd-group>
<contract-num rid="cn001">32172188</contract-num>
<contract-sponsor id="cn001">National Natural Science Foundation of China<named-content content-type="fundref-id">10.13039/501100001809</named-content></contract-sponsor>
<counts>
<fig-count count="4"/>
<table-count count="4"/>
<equation-count count="0"/>
<ref-count count="39"/>
<page-count count="10"/>
<word-count count="6747"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="intro">
<title>Introduction</title>
<p><italic>Escherichia coli</italic> is the most common conditional pathogen in the culture environment, which can cause varying degrees of infection in livestock and poultry. These <italic>Escherichia coli</italic> strains, which contain a large number of antibiotic resistant genes, accumulate in humans and farmed animals, and are released into the environment via feces. They continue to contaminate the human food environments (e.g., agricultural, aquatic, and livestock products) as well as livestock and poultry breeding environment (<xref ref-type="bibr" rid="B27">Sajjad et al., 2011</xref>; <xref ref-type="bibr" rid="B9">Chaj&#x0229;cka-Wierzchowska et al., 2014</xref>; <xref ref-type="bibr" rid="B36">Yano et al., 2014</xref>; <xref ref-type="bibr" rid="B3">Blaak et al., 2015</xref>; <xref ref-type="bibr" rid="B20">Liao et al., 2015</xref>). Finally, multidrug-resistant <italic>E. coli</italic> accumulate in the human body through the food chain (<xref ref-type="bibr" rid="B34">Wellington et al., 2013</xref>).</p>
<p>Extended-spectrum &#x03B2;-lactamase (ESBLs) is currently considered one of the world&#x2019;s major public health problems. In <italic>Enterobacteriaceae</italic>, <italic>E. coli</italic> causes the most infections and is the main species producing ESBL (<xref ref-type="bibr" rid="B6">Bradford, 2001</xref>). Many genes are able to produce ESBLs that they can hydrolyze cephalosporins, penicillin, and monocyclic &#x03B2;-lactam antibiotics aztreonam (<xref ref-type="bibr" rid="B16">Kanayama et al., 2010</xref>). &#x03B2;-lactamases have been divided into four major classes (A, B, C, and D) according to the amino acid similarity. &#x03B2;-lactamases of classes A, C, and D are serine &#x03B2;-lactamases, whereas those of class B are metallo-&#x03B2;-lactamases (<xref ref-type="bibr" rid="B23">Paterson and Bonomo, 2005</xref>). Initially, the most prevalent ESBLs were TEM or SHV variants possessing amino acid substitutions (<xref ref-type="bibr" rid="B29">Sivaraman et al., 2021</xref>). <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> is one of the most important ESBL genes, which has been found in several conjugative plasmids of <italic>Enterobacteriaceae</italic> (<xref ref-type="bibr" rid="B1">Abera et al., 2016</xref>; <xref ref-type="bibr" rid="B2">Abraham et al., 2018</xref>). IncF plasmids are usually low copy number plasmids, &#x003E; 100 kb in size, and typically carry fused replicons with multiple replication initiation genes (<xref ref-type="bibr" rid="B19">Laura et al., 2010</xref>). The multi-replicon status is described as a means by which a plasmid with a narrow host range can replicate in a wide host range. Integrons were initially discovered because they are often associated with drug-resistant genes (<xref ref-type="bibr" rid="B31">Stokes and Hall, 1989</xref>). Class 1 integrons are the most frequently identified integron classes within clinical environments. This class was the first integron found, which mainly distributed on plasmids of Gram-negative bacteria (<xref ref-type="bibr" rid="B11">Goldstein et al., 2001</xref>). <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> gene was used as a query for BLAST search in the NCBI nucleotide sequence database, and it was found that it existed mainly in <italic>Enterobacterales</italic>. However, it is still unknown how frequently the gene occurs in the <italic>E. coli</italic> in Zhejiang Province, and the number of related IncFII plasmids containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> is not very high in the NCBI database. Moreover, the genetic background of <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> also needs to be further studied.</p>
<p>In this study, the relative abundance of the known ESBL genes in <italic>E. coli</italic> in livestock and poultry breeding environment was determined. This research provided beta-lactam resistance profile of bacteria isolated from livestock and poultry breeding environment in Zhejiang Province. Our study suggests that resistance to beta-lactam is too high in <italic>E. coli</italic>. Therefore, local farmers can possibly reduce the use of specific beta-lactam antibiotics, making a particular contribution to the reduction of local antibiotic resistance. Furthermore, two IncFII plasmids harboring <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> along with other resistance genes were analyzed to clarify the basis for dissemination. This research enriched the study of plasmids containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> resistance genes in the NCBI database.</p>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="S2.SS1">
<title>Bacterial Strains</title>
<p>A total of 206 non-duplicate <italic>E. coli</italic> isolates were collected from 6 livestock and poultry farms in Zhejiang Province, China, 2018. A list of collected samples from feces, urine, soil, and surrounding water environment was presented in <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 1</xref>. Colonies with a green metallic sheen growing on Eosin Methylene Blue Agar plates were initially considered <italic>E. coli</italic> strains. The isolates were identified by VITEK-2 Compact and 16S rRNA gene identification using the universal 16s primers 27F and 1492R (<xref ref-type="bibr" rid="B18">Lane, 1991</xref>). EC600 served as the recipient strain in conjugal transfer experiments. EC600 was resistant to rifampicin, but sensitive to ampicillin, carbapenem, quinolones, and sulfonamides.</p>
</sec>
<sec id="S2.SS2">
<title>Antimicrobial Susceptibility Testing</title>
<p><italic>E. coli</italic> strains were evaluated based on the size of the inhibition zones and classified as resistant, intermediate, or susceptible according to the CLSI criteria for <italic>Enterobacteriaceae</italic> as the breakpoints were shown in <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 2</xref> (<xref ref-type="bibr" rid="B15">Institute CLSI, 2018</xref>). <italic>E. coli</italic> strains exhibiting resistance to three or more classes of antimicrobials were considered to be multi-drug resistant (MDR). <italic>E. coli</italic> ATCC 25922 served as the control.</p>
</sec>
<sec id="S2.SS3">
<title>PCR Analysis</title>
<p><italic>E. coli</italic> strains were screened for the presence of the ESBLs gene by PCR using the primers listed in <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 3</xref> (<italic>bla</italic><sub>GES</sub>, <italic>bla</italic><sub>KPC</sub>, <italic>bla</italic><sub>SME</sub>, <italic>bla</italic><sub>IMI</sub>, etc.) and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 4</xref> (<italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> universal, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>1</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>2</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>8</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>9</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>25</sub>, etc.), as described previously (<xref ref-type="bibr" rid="B13">Hong et al., 2012</xref>). PCR amplification consisted of denaturation at 95&#x00B0;C for 5 min followed by denaturation at 94&#x00B0;C for 30 s, annealing at their respective annealing temperature for 30 s, and polymerization at 72&#x00B0;C for 40 s for a total of 30 cycles, and a final extension at 72&#x00B0;C for 10 min. All the PCR products were subjected to Sanger sequencing.</p>
</sec>
<sec id="S2.SS4">
<title>The Enzyme-Producing Activity of Bacteria</title>
<p>The enzyme-producing activity was detected by a modified Carba NP method. The carbapenems producing types of <italic>Enterobacteriaceae</italic> mainly include A, B, and D, representing KPC, NDM, and OXA-48, respectively. According to the characteristics of the above enzymes, an improved Carba NP detection method was designed to detect specific enzyme production types. Class A carbapenems were at least partially inhibited by tazobactam, while class B carbapenems (metal-&#x03B2;-lactamases) were inhibited by divalent cationic chelators such as EDTA. No chemical inhibitors were available for class D carbapenems. The formulas for each system and the expected outcomes of different enzyme production types were shown in <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 5</xref>. 1705 was the control of enzyme A, and the well of substrate II and substrate IV turned yellow. 2146 was the control of enzyme B, and the wells of substrate II and substrate III turned yellow.</p>
</sec>
<sec id="S2.SS5">
<title>Conjugal Transfer Experiments</title>
<p>Conjugal transfer experiments were performed with rifampin-resistant <italic>E. coli</italic> EC600 used as a recipient and each of the <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>-positive 11011 and 417957 isolates as a donor. Brain Heart Infusion (BHI) was supplemented with 2.5 mg/mL rifampicin and 200 &#x03BC;g/L ampicillin to screen transconjugants. After incubation at 37&#x00B0;C for 24 h, colonies growing on these selective plates were further confirmed by antimicrobial sensitivity experiments and VITEK-2 Compact.</p>
</sec>
<sec id="S2.SS6">
<title>Sequencing and Analysis</title>
<p>The two conjugatable plasmids of the transconjugants 11011-EC600 and 417957-EC600 were sequenced by the Illumina MiSeq platforms. The two plasmids DNA was extracted from the transconjugants 11011-EC600 and 417957-EC600 using the Qiagen Large-Construct Kit. After extraction, the mate-pair library was constructed. Then MiSeq (Illumina, CA, United States) was used to sequence the plasmids, and Newbler 2.6 was used to assemble the Illumina read sets straight off the MiSeq. Quality control and removing low-quality data were performed with TrimMomatic 0.36 (<xref ref-type="bibr" rid="B5">Bolger et al., 2014</xref>). Gapfiller V1.11 is used to fill gaps (<xref ref-type="bibr" rid="B21">Nederbragt, 2014</xref>). Finally, Cytoscape was used to spline the sequence to obtain the final cyclized plasmids. The plasmid sequences were submitted to Rast, Genemarks, Glimmer, and Prodigal library for preliminary gene prediction then submitted to ISFinder, Integrall, ResFinder, and TN Number Registry for mobile elements (<xref ref-type="bibr" rid="B4">Boetzer and Pirovano, 2012</xref>). Gene organization diagrams were drawn by running a gene alignment program in Perl language (<xref ref-type="supplementary-material" rid="DS1">Supplementary File</xref>) with Ubuntu 18.04 LTS<sup><xref ref-type="fn" rid="footnote1">1</xref></sup> and Inkscape 0.48.1.<sup><xref ref-type="fn" rid="footnote2">2</xref></sup> The complement sequences of the two plasmids p417957-CTXM and p11011-fosA have been submitted in GenBank under accession numbers <ext-link ext-link-type="DDBJ/EMBL/GenBank" xlink:href="NZ_MH454107.1">NZ_MH454107.1</ext-link> and <ext-link ext-link-type="DDBJ/EMBL/GenBank" xlink:href="NZ_MG764548.1">NZ_MG764548.1</ext-link>, respectively.</p>
</sec>
</sec>
<sec id="S3" sec-type="results">
<title>Results</title>
<sec id="S3.SS1">
<title>Detection of the bla<sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> Gene in <italic>Escherichia coli</italic> Strains</title>
<p>In this study, 206 strains of <italic>E. coli</italic> were identified by VITEK-2 Compact and the amplification of 16S rRNA gene (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>). A total of 137 resistant strains to cephalosporins and carbapenems, isolated from farms, were screened for &#x03B2;-lactamase resistance genes (<xref ref-type="table" rid="T1">Table 1</xref>). The results showed that six extended-spectrum &#x03B2;-Lactamase resistance genes were detected in all antibiotic resistant strains, including <italic>bla</italic><sub>TEM</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>, <italic>bla</italic><sub>SHV</sub>, <italic>bla</italic><sub>OAX</sub><sub>&#x2013;</sub><sub>1</sub>, <italic>bla</italic><sub>KPC</sub>, and <italic>bla</italic><sub>NDM</sub>. The detection rates were 94.89% (130/137), 92.7% (127/137), 24.81% (34/137), 20.43% (28/137), 0.72% (1/137), and 0.72% (1/137), respectively. Only two strains carried the carbapenemases-producing resistance gene. Strain 11011 contained <italic>bla</italic><sub>KPC</sub>, and strain 417957 contained <italic>bla</italic><sub>NDM</sub>, which both contained <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> antibiotic resistance gene and were selected for further investigation.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>Resistant phenotype of 206 <italic>E. coli</italic> from livestock and poultry.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Antimicrobial agent</bold></td>
<td valign="top" align="center"><bold>Susceptible (strain)</bold></td>
<td valign="top" align="center"><bold>Susceptible rate</bold></td>
<td valign="top" align="center"><bold>Intermediate (strain)</bold></td>
<td valign="top" align="center"><bold>Resistant (strain)</bold></td>
<td valign="top" align="center"><bold>Resistant rate</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Cefazolin</td>
<td valign="top" align="center">35</td>
<td valign="top" align="center">16.99%</td>
<td valign="top" align="center">34</td>
<td valign="top" align="center">137</td>
<td valign="top" align="center">66.50%</td>
</tr>
<tr>
<td valign="top" align="left">Ceftazidime</td>
<td valign="top" align="center">131</td>
<td valign="top" align="center">63.59%</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">75</td>
<td valign="top" align="center">36.40%</td>
</tr>
<tr>
<td valign="top" align="left">Imipenem</td>
<td valign="top" align="center">201</td>
<td valign="top" align="center">97.57%</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">5</td>
<td valign="top" align="center">2.43%</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="S3.SS2">
<title>Determination of the Activity of Carbapenem</title>
<p>The modified Carba NP method was used to detect the type of enzyme production of related test strains. Only two strains out of 206 <italic>E. coli</italic> produced the enzymes. According to the color changes of the test strains that existed in the wells of substrate II, substrate III, and substrate IV, strain 11011 produced enzyme A and strain 417957 produced enzyme B (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 1</xref>).</p>
</sec>
<sec id="S3.SS3">
<title>The <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> Gene Is Transferable</title>
<p>The transconjugants isolated by mating 11011 and 417957 strains with EC600 were resistant to rifampicin and ampicillin antibiotics, likely indicating plasmid transfer. According to the MIC results of wild strains and transconjugant, the resistant plasmid has been successfully introduced into the recipient bacteria (<xref ref-type="table" rid="T2">Table 2</xref>). The two transconjugants were not resistant to carbapenem but resistant to &#x03B2;-lactam, and both isolates carried two plasmids. It indicated that the plasmid containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> was conjugatable, and the plasmid containing carbapenem resistance gene was not conjugatable.</p>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>The result of MIC by using VITEK-2.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Category</bold></td>
<td valign="top" align="left"><bold>Antimicrobial agent</bold></td>
<td valign="top" align="center" colspan="5"><bold>MIC (mg/L)/antimicrobial susceptibility</bold><hr/></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="center"><bold>11011</bold></td>
<td valign="top" align="center"><bold>11011-fosA-EC600</bold></td>
<td valign="top" align="center"><bold>417957</bold></td>
<td valign="top" align="center"><bold>417957-CTXM-EC600</bold></td>
<td valign="top" align="center"><bold>EC600</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Penicillin</td>
<td valign="top" align="left">Ampicillin</td>
<td valign="top" align="center">&#x2265;32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">4/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Ampicillin/Sulbactam</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">&#x2265; 32/R</td>
<td valign="top" align="center">4/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Piperacillin</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2265;128/R</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2264; 4/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Piperacillin/Tazobactam</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2265; 128/R</td>
<td valign="top" align="center">&#x2264; 4/S</td>
</tr>
<tr>
<td valign="top" align="left">Cephalosporins</td>
<td valign="top" align="left">Cefazolin</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2264; 4/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cefuroxime</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">16/I</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cefuroxime Axetil</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">16/I</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Ceftriaxone</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2264; 1/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cefepime</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2264; 1</td>
</tr>
<tr>
<td valign="top" align="left">Monobactams</td>
<td valign="top" align="left">Aztreonam</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2265; 64/R</td>
<td valign="top" align="center">&#x2264; 1/S</td>
</tr>
<tr>
<td valign="top" align="left">Carbapenems</td>
<td valign="top" align="left">Imipenem</td>
<td valign="top" align="center">&#x2265; 16/R</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2265; 16/R</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Meropenem</td>
<td valign="top" align="center">&#x2265; 16/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">&#x2265; 16/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
</tr>
<tr>
<td valign="top" align="left">Aminoglycosides</td>
<td valign="top" align="left">Amikacin</td>
<td valign="top" align="center">&#x2264; 2/S</td>
<td valign="top" align="center">&#x2264; 2/S</td>
<td valign="top" align="center">&#x2264; 2/S</td>
<td valign="top" align="center">&#x2264; 2/S</td>
<td valign="top" align="center">&#x2264; 2/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Gentamicin</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Tobramycin</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
<td valign="top" align="center">&#x2264; 1/S</td>
</tr>
<tr>
<td valign="top" align="left">Quinolones</td>
<td valign="top" align="left">Ciprofloxacin</td>
<td valign="top" align="center">&#x2265; 4/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">&#x2265; 4/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Levofloxacin</td>
<td valign="top" align="center">&#x2265; 8/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">&#x2265; 8/R</td>
<td valign="top" align="center">&#x2264; 0.25/S</td>
<td valign="top" align="center">0.5/S</td>
</tr>
<tr>
<td valign="top" align="left">Nitrofurantoins</td>
<td valign="top" align="left">Nitrofurantoin</td>
<td valign="top" align="center">128/R</td>
<td valign="top" align="center">&#x2264; 16/S</td>
<td valign="top" align="center">128/R</td>
<td valign="top" align="center">&#x2264; 16/S</td>
<td valign="top" align="center">&#x2264; 16S</td>
</tr>
<tr>
<td valign="top" align="left">Sulfonamides</td>
<td valign="top" align="left">Trimethoprim/Sulfamethoxazole</td>
<td valign="top" align="center">&#x2265; 320/R</td>
<td valign="top" align="center">&#x2264;20/S</td>
<td valign="top" align="center">&#x2265; 320/R</td>
<td valign="top" align="center">&#x2264; 20/S</td>
<td valign="top" align="center">&#x2264; 20/S</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p><italic>S, Susceptible; R, Resistant; I, Intermediate.</italic></p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S3.SS4">
<title>Characterization of Plasmids p11011-fosA and p417957-CTXM</title>
<p>As shown in <xref ref-type="table" rid="T3">Table 3</xref> and <xref ref-type="fig" rid="F1">Figure 1</xref>, the total length of plasmid p11011-fosA was 217.4 kb, contained 275 ORFs in total. The content of GC was 52.7%, and the plasmid contained three accessory modules, comprising Tn<italic>2</italic>-related region, MDR-1 region, and <italic>raf</italic>-related region. The total length of plasmid p417957-CTXM was 126.4 kb, which included 151ORFs. GC content was 51.4%, and the plasmid also contained three accessory modules, comprising MDR, <italic>raf</italic>- and <italic>arc</italic>-related regions. The plasmid backbone sequences of the two plasmids were similar to that of plasmid pHN7A8 from <italic>Klebsiella pneumoniae.</italic> The single replicon IncFII plasmid pHN7A8 (Genbank: NC_019073.1) was chosen as the reference plasmid. The length of plasmid pHN7A8 was 76.8 kb, and only contained one accessory modules-a 14.5 kb MDR region. The three plasmids consist of the backbone area and accessory modules. They were formed by inserting antibiotic resistance genes and adjacent mobile elements into different positions in the backbone area. Both plasmids p11011-fosA and p417957-CTXM contain numerous antibiotic resistance genes (<xref ref-type="table" rid="T4">Table 4</xref>), and plasmids can be transferred to EC600 by conjugation.</p>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Major features of plasmids analyzed.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Type</bold></td>
<td valign="top" align="justify" colspan="3"><bold>Plasmid Name</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><bold>p11011-fosA</bold></td>
<td valign="top" align="left"><bold>p417957-CTXM</bold></td>
<td valign="top" align="left"><bold>pHN7A8</bold></td>
</tr>
<tr>
<td valign="top" align="left">Sequence Type</td>
<td valign="top" align="left"><italic>[F36:A4:B-]</italic></td>
<td valign="top" align="left"><italic>[F22:A1:B-]</italic></td>
<td valign="top" align="left"><italic>[F33:A-:B-]</italic></td>
</tr>
<tr>
<td valign="top" align="left">Allele</td>
<td valign="top" align="left">FIA_4, FII_36, FII_33</td>
<td valign="top" align="left">FIA_1, FII_22, FII_36</td>
<td valign="top" align="left">FII_33</td>
</tr>
<tr>
<td valign="top" align="left">The total length(kb)</td>
<td valign="top" align="left">217.4</td>
<td valign="top" align="left">126.4</td>
<td valign="top" align="left">76.8</td>
</tr>
<tr>
<td valign="top" align="left">The number of ORF</td>
<td valign="top" align="left">275</td>
<td valign="top" align="left">151</td>
<td valign="top" align="left">102</td>
</tr>
<tr>
<td valign="top" align="left">Average GC content (%)</td>
<td valign="top" align="left">53.92</td>
<td valign="top" align="left">53.82</td>
<td valign="top" align="left">54.52</td>
</tr>
<tr>
<td valign="top" align="left">Accessory modules</td>
<td valign="top" align="left">Tn<italic>2</italic>-related region, MDR-1 region and <italic>raf</italic>-related region</td>
<td valign="top" align="left">MDR region, <italic>raf</italic>-region and <italic>arc</italic>-related region</td>
<td valign="top" align="left">MDR region</td>
</tr>
</tbody>
</table>
</table-wrap>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>The complete sequence diagram of p11011-fosA and p417957-CTXM. Note: In the figure, the innermost ring represents (G-C)/(G + C); the blue ring indicates GC content, and the outward depression indicates that the GC content is higher than the mean value. Black area in the outer circle represents the backbone area and gray area represents the accessory modules. The outermost circle shows the distribution of genes represented by colored arrows in the plasmid.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmicb-12-753979-g001.tif"/>
</fig>
<table-wrap position="float" id="T4">
<label>TABLE 4</label>
<caption><p>Antibiotic resistance genes in sequenced plasmids.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Plasmid</bold></td>
<td valign="top" align="center"><bold>Resistance gene</bold></td>
<td valign="top" align="left"><bold>Resistance phenotype</bold></td>
<td valign="top" align="left"><bold>Nucleotide position</bold></td>
<td valign="top" align="center"><bold>Region located</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">p11011-fosA</td>
<td valign="top" align="center"><italic>mph(A)</italic></td>
<td valign="top" align="left">Macrolides resistance</td>
<td valign="top" align="left">17065.17970</td>
<td valign="top" align="center">MDR-1 region</td>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>floR</italic></td>
<td valign="top" align="left">Florfenicol resistance</td>
<td valign="top" align="left">25301.26515</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>strAB</italic></td>
<td valign="top" align="left">Streptomycin resistance</td>
<td valign="top" align="left">27471.29110</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>sul2</italic></td>
<td valign="top" align="left">Sulfonamides resistance</td>
<td valign="top" align="left">29171.29986</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>erm(B)</italic></td>
<td valign="top" align="left">Macrolides resistance</td>
<td valign="top" align="left">31936.32673</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>bla</italic><sub>TEM</sub><sub>&#x2013;1B</sub></td>
<td valign="top" align="left">&#x03B2;-lactam resistance</td>
<td valign="top" align="left">36041.36091</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>fosA3</italic></td>
<td valign="top" align="left">Fosfomycin resistance</td>
<td valign="top" align="left">40467.40883</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub></td>
<td valign="top" align="left">&#x03B2;-lactam resistance</td>
<td valign="top" align="left">43548.44423</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>tetAR</italic></td>
<td valign="top" align="left">Tetracycline resistance</td>
<td valign="top" align="left">113327.115182</td>
<td valign="top" align="center">MDR-2 region</td>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>dfrA17</italic></td>
<td valign="top" align="left">Trimethoprim resistance</td>
<td valign="top" align="left">119457.119930</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>aadA5</italic></td>
<td valign="top" align="left">Aminoglycosides resistance</td>
<td valign="top" align="left">120016.120849</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>sul1</italic></td>
<td valign="top" align="left">Sulfonamides resistance</td>
<td valign="top" align="left">121309.122235</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>mph(A)</italic></td>
<td valign="top" align="left">Macrolides resistance</td>
<td valign="top" align="left">127546.128451</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">p417957-CTXM</td>
<td valign="top" align="center"><italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub></td>
<td valign="top" align="left">&#x03B2;-lactam resistance</td>
<td valign="top" align="left">7839.8714</td>
<td valign="top" align="center">MDR-1 region</td>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>aacC2</italic></td>
<td valign="top" align="left">Aminoglycosides resistance</td>
<td valign="top" align="left">11222.12083</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>tmrB</italic></td>
<td valign="top" align="left">Tunicamycin resistance</td>
<td valign="top" align="left">12095.12637</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>dfrA17</italic></td>
<td valign="top" align="left">Trimethoprim resistance</td>
<td valign="top" align="left">27180.27653</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>aadA5</italic></td>
<td valign="top" align="left">Aminoglycosides resistance</td>
<td valign="top" align="left">27784.28572</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>sul1</italic></td>
<td valign="top" align="left">Sulfonamides resistance</td>
<td valign="top" align="left">29032.29958</td>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="center"><italic>mph(A)</italic></td>
<td valign="top" align="left">Macrolides resistance</td>
<td valign="top" align="left">35269.36174</td>
<td/>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="S3.SS5">
<title>Replicon repA2-6-1-4 of the Backbone Area</title>
<p>Comparing the sequences in the database revealed that both plasmids p11011-fosA and p417957-CTXM belonged to multi-replicon IncFII plasmids, which both contained the main replicon repA2-6-1-4 (<xref ref-type="fig" rid="F2">Figure 2</xref>). The sequence of this gene was identical to the replication initiation region of the reference plasmid pHN7A8. p417957-CTXM also contained a repFIA replicon and the backbone area, including core butler genes (<italic>ccdAB</italic>, <italic>vagCD</italic>, <italic>sopAB</italic>, <italic>ycgA</italic>, <italic>klcA</italic>, and <italic>ssb</italic>) responsible for maintaining the stability of the plasmid. In addition to the main replicon repA2-6-1-4 and the auxiliary replicon repFIA, plasmid p11011-fosA also contained a replicon repA2-6-1-4 structure. The sequence of this structure was different from that of pHN7A8. Therefore, the plasmid was likely to be hybridized by two IncFII plasmids. The backbone area of p417957-CTXM had a conjugal transfer region similar to the reference plasmid pHN7A8, considering their nucleic acid alignment and expressed proteins. The plasmid p11011-fosA contained two conjugal transfer regions. Conjugal transfer proteins and flagella proteins promoted flagella production, which collectively facilitated horizontal transfer of plasmids between bacteria.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p><bold>(A)</bold> Linear comparison of p11011-fosA with related plasmids. <bold>(B)</bold> Linear comparison of p417957-CTXM with related plasmids. Genes are indicated by arrows. Genes, mobile elements and other features are colored based on functional classification. Shadows indicate nucleotide homology is greater than 95%. p11011-fosA and p417957-CTXM were sequenced in this study, while the sequence of pHN7A8, p28078-NDM, and p61806-<italic>dfrA</italic> was from GenBank as reference plasmids.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmicb-12-753979-g002.tif"/>
</fig>
</sec>
<sec id="S3.SS6">
<title>Analysis of Multi-Drug Resistant Region in p11011-fosA and p417957-CTXM</title>
<p>As shown in <xref ref-type="fig" rid="F3">Figure 3</xref>, the MDR-1 region of plasmid p11011-fosA consists of the following mobile elements: IS<italic>15DI</italic>-<italic>mph (A)</italic>-IS<italic>15DI</italic> unit [containing macrolide resistance gene <italic>mph (A)</italic>], &#x0394;ICEVchNep1_virable region III (containing florfenicol resistance gene <italic>floR</italic>, streptomycin resistance gene <italic>strAB</italic>, sulfonamides resistance gene <italic>sul2</italic>), IS<italic>15DI</italic>-<italic>erm (B)</italic>-IS<italic>15DI</italic> unit [macrolide resistance genes <italic>erm (B)</italic>], Tn<italic>2</italic> remnant, IS<italic>26</italic>-<italic>fosA</italic>-IS<italic>26</italic> unit (containing fosfomycin resistance gene <italic>fosA3</italic>), and IS<italic>Ecp1</italic>-<italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>-<italic>orf477</italic> transposition unit (containing &#x03B2;-lactam antibiotic <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>). The MDR region of pHN7A8 was similar to the MDR-1 region of p11011-fosA, which contained fosfomycin resistance genes mediated by IS<italic>26</italic> and aminoglycoside resistance genes mediated by Tn<italic>2</italic>.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>The MDR-1 region of p11011-fosA. Genes are indicated by arrows. Genes, mobile elements and other features are colored based on functional classification. Shadows indicate nucleotide homology is greater than 95%. The number in parentheses indicates the location of the fragment in the plasmid.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmicb-12-753979-g003.tif"/>
</fig>
<p>The MDR region of p417957-CTXM contained integron In<italic>54</italic>, IS<italic>26</italic>-<italic>mph (A)</italic>-<italic>mrx</italic>-<italic>mphR (A)</italic>-IS<italic>6100</italic> unit, IS<italic>Ecp1</italic>-<italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>-<italic>orf477</italic> transposition unit (containing &#x03B2;-lactamase resistance gene <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>), and <italic>aacC2</italic>-<italic>tmrB</italic> region (containing aminoglycoside resistance gene <italic>aacC2</italic> and tunicamycin resistance gene <italic>tmrB</italic>).</p>
<p>The multi-drug resistance region MDR-2 of the plasmid p11011-fosA was composed of the following mobile elements in sequence: Tn<italic>5403</italic>, &#x0394;Tn<italic>1721</italic> (containing tetracycline resistance gene <italic>tetAR</italic>), IS<italic>26</italic>, In<italic>54</italic> (containing trimethoprim resistance gene <italic>drfA17</italic>, sulfonamides resistance gene <italic>sul1</italic>), IS<italic>26</italic>-<italic>mph(A)</italic>-<italic>mrx</italic>-<italic>mphR (A)</italic>-IS<italic>6100</italic> unit (containing macrolide resistance genes), Tn<italic>3</italic> family transposon remnant, Iron acquisition gene cluster, IS<italic>1R</italic> and IS<italic>1A</italic> (<xref ref-type="fig" rid="F4">Figure 4</xref>). The typical structure of type 1 integron included IRi, 5 prime -CS, GCA, 3 prime -CS, Tn<italic>402</italic> tni module, and IRt. In<italic>54</italic> was a type I integron in both plasmids p11011-fosA and p417957-CTXM. The 5 prime -CS region contained integrase <italic>Intl1</italic> responsible for the integration of capture resistance genes, and downstream of <italic>Intl1</italic> contained trimethoprim resistance gene <italic>dfrA17</italic> and aminoglycoside resistance gene <italic>aadA5</italic>. In addition, the 3 prime -CS region also contained sulfonamides resistance gene <italic>sul1</italic>. Moreover, the <italic>tni</italic> region of In<italic>54</italic> was replaced by the <italic>chrA</italic> region, which was responsible for chromate particle transport. <italic>ChrA</italic> region was usually located in IS<italic>26</italic>-<italic>mph (A)</italic>-<italic>mrx</italic>-<italic>mphR (A)</italic>-IS<italic>6100</italic> unit.</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption><p><bold>(A)</bold> The MDR-1 region of p11011-fosA and MDR region of p417957-CTXM. <bold>(B)</bold> The <italic>raf</italic> region of p110011-<italic>fosA</italic> and p417957-CTXM. <bold>(C)</bold> The <italic>arc</italic> region of p417957-CTXM. Genes are indicated by arrows. Genes, mobile elements, and other features are colored based on functional classification. Shadows indicate nucleotide homology is greater than 95%. The number in parentheses indicates the location of the fragment in the plasmid.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmicb-12-753979-g004.tif"/>
</fig>
</sec>
</sec>
<sec id="S4" sec-type="discussion">
<title>Discussion</title>
<p>In this study, <italic>E. coli</italic> strains isolated from the livestock and poultry breeding environment in Zhejiang Province showed high-level resistance (137/204) to extended-spectrum &#x03B2;-lactam antibiotics (Cefazolin, Ceftazidime, and Imipenem). These antibiotics are prevalently used for the treatment of infections caused by <italic>Enterobacteriaceae</italic>. Essentially, all ESBL producers demonstrated multi-drug resistance profiles and carried at least one ESBL resistance gene, especially <italic>bla</italic><sub>TEM</sub> (94.89%) and <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> (92.7%). Among all the <italic>E. coli</italic> strains investigated in the current study, the prevalence of ESBL producers (67.2%) is quite close to that previously reported in Henan Province (60.8%) from 2007 to 2008 (<xref ref-type="bibr" rid="B37">Yuan et al., 2009</xref>). However, it is still lower than those reported in northeast China (Jilin, Liaoning, and Heilongjiang Provinces (100%) from 2011 to 2013 (<xref ref-type="bibr" rid="B32">Tong et al., 2015</xref>).</p>
<p>In this study, six extended-spectrum &#x03B2;-Lactamase resistance genes were detected in all antibiotic resistant strains, and <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> was the second common resistance gene. However, <xref ref-type="bibr" rid="B32">Tong et al. (2015)</xref> found that CTX-M-type ESBL resistance genes were the most common genotype of <italic>E. coli</italic> isolated from chickens in China. These contradictories may be due to different regions where the strains were isolated and various poultry species. However, it might be related to mobile genetic elements such as plasmids and transposons as well. Previous reports showed that CTX-M-encoding genes in <italic>E. coli</italic>, isolated from food animals, have a high diversity in China, and CTX-M-14 was the most widespread CTX-M enzyme, followed by CTX-M-55 (<xref ref-type="bibr" rid="B38">Zheng et al., 2012</xref>). <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub> has been widely reported in food-producing animals and pets in China (<xref ref-type="bibr" rid="B25">Rao et al., 2014</xref>). In this study, the strains carrying CTX-M-55-type ESBL showed different MDR profiles. In order to further study the mobile genetic elements related to CTX-M gene transfer, we selected two plasmids of two strains for sequencing and analysis.</p>
<p>We identified two conjunctive IncFII multi-resistance plasmids carrying <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub> and analyzed the genetic context of <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub> and MDR region. Most CTX-M genes were identified to be associated with IncFII or IncI1 plasmids (<xref ref-type="bibr" rid="B8">Carattoli, 2009</xref>; <xref ref-type="bibr" rid="B7">Cao et al., 2011</xref>). The most common IncFII type plasmid was F2:A-: B-, which had also been reported to be linked to <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> genes in <italic>Enterobacteriaceae</italic> strains isolated from other regions (<xref ref-type="bibr" rid="B19">Laura et al., 2010</xref>; <xref ref-type="bibr" rid="B17">Kim et al., 2011</xref>). In the current study, the IncFII plasmid p11011-fosA contains another ESBL resistance genes <italic>bla</italic><sub>TEM</sub><sub>&#x2013;1B</sub> and fosfomycin resistance gene <italic>fosA3</italic>, while the other IncFII plasmid p417957-CTXM don&#x2019;t have the two resistance genes. <italic>fosA3</italic> is frequently co-transferred with <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> genes, and the dissemination of <italic>fosA3</italic> may be related to the co-selection of cephalosporins (<xref ref-type="bibr" rid="B14">Hou et al., 2012</xref>). In previous epidemic plasmids, it was observed that the <italic>fosA3</italic> gene is frequently co-transferred with <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>14</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>, <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>65</sub>, <italic>floR</italic>, and <italic>rmtB</italic> genes. Thus, reducing the total use of antibiotics, especially cephalosporins, in livestock and poultry breeding environment contributes to controlling the dissemination of plasmid-mediated fosfomycin and &#x03B2;-Lactamase resistance genes (<xref ref-type="bibr" rid="B35">Yang et al., 2014</xref>).</p>
<p>In this study, we found that <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub> was located on the IS<italic>Ecp1</italic>-<italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>-<italic>orf477</italic> transposition unit, which was similar to previous studies (<xref ref-type="bibr" rid="B38">Zheng et al., 2012</xref>). IS<italic>Ecp1</italic>-<italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>-<italic>orf477</italic> transposition unit is a significant element in the propagation of <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>55</sub>. IS<italic>Ecp1</italic> is bounded by 14-bp inverted repeats, with IR<sub>L</sub> at the left end of the transcription direction of the transposase gene and IR<sub><italic>R</italic></sub> at the right end. In addition, IS<italic>Ecp1</italic> uses IR<sub>L</sub> in conjunction with alternative sequences like these IR to mobilize adjacent regions, forming a 5-bp direct repeat (DR) on transposition (<xref ref-type="bibr" rid="B24">Poirel et al., 2005</xref>; <xref ref-type="bibr" rid="B33">Wachino et al., 2006</xref>). The MDR region in pHN7A8 and p11011-fosA is mainly formed by the insertion of mobile elements. The insertion of Tn<italic>2</italic>-<italic>rmtB</italic> element into the i<italic>nsB</italic> of IS<italic>1R</italic> results in only 214 bp residue in <italic>insB</italic>. The insertion of the region of 9.4 kb [IS<italic>26</italic>, &#x0394; Tn<italic>6377</italic>, the IS<italic>26</italic>-<italic>fosA3</italic>-IS<italic>26</italic> unit (<xref ref-type="bibr" rid="B12">Ho et al., 2013</xref>) and IS<italic>1294</italic>] between <italic>tnpA</italic> and <italic>tnpR</italic> of Tn<italic>2</italic> leads to the loss of <italic>res</italic> site of Tn<italic>2</italic>. Tn<italic>2</italic>-<italic>rmtB</italic> element (<xref ref-type="bibr" rid="B10">Doi et al., 2008</xref>) and the variant of this element have been widely found in <italic>Enterobacteriaceae</italic>. Tn<italic>6377</italic> was originally identified on the plasmid pKP96 (<xref ref-type="bibr" rid="B28">Shen et al., 2008</xref>) in <italic>Klebsiella pneumoniae</italic>, and the transposon was formed by inserting Tn<italic>1722</italic> (<xref ref-type="bibr" rid="B39">Zong et al., 2011</xref>) into the IS<italic>Ecp1</italic> &#x2013; <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub><sub>&#x2013;</sub><sub>65</sub>-IS <italic>903D</italic> unit of the Tn<italic>3</italic> family. Tn<italic>6377</italic> in pHN7A8 is interrupted at both terminals by IS<italic>26</italic>.</p>
<p>The MGEs, such as transposons, play an essential role in the rapid spread of AMR by horizontal gene transfer due to the selective pressure imposed by antibiotics (<xref ref-type="bibr" rid="B30">Snesrud et al., 2018</xref>). Tn<italic>5403</italic> found in MDR-2 region in plasmid p11011-fosA did not contain antibiotic resistance genes and was first identified in the plasmid of <italic>Klebsiella pneumoniae</italic> (<xref ref-type="bibr" rid="B26">Rinkel et al., 1994</xref>). Another transposon Tn<italic>1721</italic> belongs to the transposon of the Tn<italic>21</italic> family and has three 38 bp repeats and two transposase genes <italic>tnpA</italic> with the same sequence. There are <italic>tnpA</italic>, <italic>tnpR</italic>, <italic>res</italic> sites, and the gene <italic>mcp</italic> that encodes methyl-chemotactic proteins at one terminal, with 38 bp reverse repeats on both sides of this terminal. This terminal is named Tn<italic>1722</italic> and can be moved independently. The rest of Tn<italic>1721</italic> contains the tetracycline resistance gene <italic>tetA</italic>. Although Tn<italic>1721</italic> in the MDR-2 region of p11011-fosA is interrupted by IS<italic>26</italic> and Tn<italic>5403</italic>, the key tetracycline resistance gene in this transposon remains intact. IS<italic>26</italic>-<italic>mph (A)</italic>-<italic>mrx</italic>-<italic>mphR (A)</italic>-IS<italic>6100</italic> unit is the carrier element for common macrolide resistance genes, which are usually located on resistant plasmids in <italic>E. coli</italic> (<xref ref-type="bibr" rid="B22">Partridge, 2011</xref>).</p>
</sec>
<sec id="S5" sec-type="conclusion">
<title>Conclusion</title>
<p>The presence of multiple mobile elements in a <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub>-carrying multi-resistance plasmid makes it flexible. These elements aid its persistence and dissemination among <italic>E. coli</italic> and potentially other Gram-negative bacteria. This study demonstrated the abundance of &#x03B2;-lactamase resistance genes in livestock and poultry breeding environment in Zhejiang Province. It also upgraded the research on IncFII plasmids containing <italic>bla</italic><sub>CTX</sub><sub>&#x2013;</sub><sub>M</sub> antibiotic resistance genes in the NCBI database. This research also provided beta-lactam resistance profile of bacteria isolated from farms in Zhejiang Province, indicating that local farmers can possibly reduce the use of specific beta-lactam antibiotics to reduce the evolution of multi-resistant strains.</p>
</sec>
<sec id="S6" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>Publicly available datasets were analyzed in this study. This data can be found here: <ext-link ext-link-type="uri" xlink:href="https://www.ncbi.nlm.nih.gov/nuccore/NZ_MH454107.1">https://www.ncbi.nlm.nih.gov/nuccore/NZ_MH454107.1</ext-link> and <ext-link ext-link-type="uri" xlink:href="https://www.ncbi.nlm.nih.gov/nuccore/NZ_MG764548">https://www.ncbi.nlm.nih.gov/nuccore/NZ_MG764548</ext-link>. 1NCBI, GenBank accession numbers <ext-link ext-link-type="DDBJ/EMBL/GenBank" xlink:href="NZ_MH454107.1">NZ_MH454107.1</ext-link> and <ext-link ext-link-type="DDBJ/EMBL/GenBank" xlink:href="NZ_MG764548.1">NZ_MG764548.1</ext-link>.</p>
</sec>
<sec id="S7">
<title>Author Contributions</title>
<p>WZ: visualization, data curation, software, and writing&#x2014;original draft preparation. EZ: conceptualization, methodology, formal analysis, and writing&#x2014;original draft preparation. JZ: visualization and investigation. ZH: software and writing&#x2014;review and Editing. YZ: software and validation. JH: formal analysis and resources. DQ: conceptualization, resources, supervision, and writing&#x2014;review and Editing. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="pudiscl1">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<sec id="S8" sec-type="funding-information">
<title>Funding</title>
<p>This work was supported by the National Natural Science Foundation of China (No. 32172188).</p>
</sec>
<ack>
<p>We gratefully acknowledge the reviewers for their constructive comments and suggestions.</p>
</ack>
<sec id="S10" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fmicb.2021.753979/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fmicb.2021.753979/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Data_Sheet_1.zip" id="DS1" mimetype="application/zip" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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