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Colistin represents one of the few available drugs for treating infections caused by carbapenem-resistant  Enterobacteriaceae . As such, the recent plasmid-mediated spread of the colistin resistance gene  mcr-1  poses a significant public health threat, requiring global monitoring and surveillance. Here, we characterize the global distribution of  mcr-1  using a data set of 457  mcr-1- positive sequenced isolates. We find  mcr-1  in various plasmid types but identify an immediate background common to all  mcr-1  sequences. Our analyses establish that all  mcr-1  elements in circulation descend from the same initial mobilization of  mcr-1  by an IS A  pl1  transposon in the mid 2000s (2002–2008; 95% highest posterior density), followed by a marked demographic expansion, which led to its current global distribution. Our results provide the first systematic phylogenetic analysis of the origin and spread of  mcr-1 , and emphasize the importance of understanding the movement of antibiotic resistance genes across multiple levels of genomic organization.

The global distribution and spread of the mobilized colistin resistance gene mcr-1