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Background  The emergence of plasmid-mediated carbapenemases, such as NDM-1 in  Enterobacteriaceae  is a major public health issue. Since they mediate resistance to virtually all β-lactam antibiotics and there is often co-resistance to other antibiotic classes, the therapeutic options for infections caused by these organisms are very limited.    Methodology  We characterized the first NDM-1 producing  E. coli  isolate recovered in Hong Kong. The plasmid encoding the metallo-β-lactamase gene was sequenced.    Principal Findings  The plasmid, pNDM-HK readily transferred to  E. coli  J53 at high frequencies. It belongs to the broad host range IncL/M incompatibility group and is 88803 bp in size. Sequence alignment showed that pNDM-HK has a 55 kb backbone which shared 97% homology with pEL60 originating from the plant pathogen,  Erwina amylovora  in Lebanon and a 28.9 kb variable region. The plasmid backbone includes the  mucAB  genes mediating ultraviolet light resistance. The 28.9 kb region has a composite transposon-like structure which includes intact or truncated genes associated with resistance to β-lactams ( bla   TEM-1 ,  bla   NDM-1 , Δ bla   DHA-1 ), aminoglycosides ( aacC2 ,  armA ), sulphonamides ( sul 1) and macrolides ( mel ,  mph2 ). It also harbors the following mobile elements: IS 26 , IS CR1 ,  tnpU ,  tnpAcp2 ,  tnpD , Δ tnpA Tn 1  and  insL . Certain blocks within the 28.9 kb variable region had homology with the corresponding sequences in the widely disseminated plasmids, pCTX-M3, pMUR050 and pKP048 originating from bacteria in Poland in 1996, in Spain in 2002 and in China in 2006, respectively.    Significance  The genetic support of NDM-1 gene suggests that it has evolved through complex pathways. The association with broad host range plasmid and multiple mobile genetic elements explain its observed horizontal mobility in multiple bacterial taxa.

Complete Sequencing of pNDM-HK Encoding NDM-1 Carbapenemase from a Multidrug-Resistant Escherichia coli Strain Isolated in Hong Kong