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Emergence of tigecycline-resistance  tet (X) gene orthologues rendered tigecycline ineffective as last-resort antibiotic. To understand the potential origin and transmission mechanisms of these genes, we survey the prevalence of  tet (X) and its orthologues in 2997 clinical  E. coli  and  K. pneumoniae  isolates collected nationwide in China with results showing very low prevalence on these two types of strains, 0.32% and 0%, respectively. Further surveillance of  tet (X) orthologues in 3692 different clinical Gram-negative bacterial strains collected during 1994–2019 in hospitals in Zhejiang province, China reveals 106 (2.7%)  tet (X)-bearing strains with  Flavobacteriaceae  being the dominant (97/376, 25.8%) bacteria. In addition,  tet (X)s are found to be predominantly located on the chromosomes of  Flavobacteriaceae  and share similar GC-content as  Flavobacteriaceae . It also further evolves into different orthologues and transmits among different species. Data from this work suggest that  Flavobacteriaceae  could be the potential ancestral source of the tigecycline resistance gene  tet (X).

Epidemiological and phylogenetic analysis reveals Flavobacteriaceae as potential ancestral source of tigecycline resistance gene tet(X)