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Background  Increasing use of colistin has led to the world-wide emergence of mobile colistin resistant gene ( mcr ). The present study aimed to identify and characterise mcr and other drug-resistant genes in colistin resistant  Klebsiella pneumoniae  clinical isolates.    Methods  Twenty-two colistin resistant  K. pneumoniae  were analysed for mcr and other drug-resistant genes, efflux pumps, and virulence genes, and for their biofilm forming ability. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were performed for all  mcr-1  positive isolates. S1-PFGE and Southern hybridisation were performed for localisation of  mcr-1  and  bla   NDM .    Results  Nineteen colistin resistant  K. pneumoniae  harboured  mcr-1  and 3 had  mgrB  disruption. All isolates harboured  bla   OXA-48 -type and ESBL genes; eight strains (five with  mcr-1  and three with  mgrB  disruption) co-harboured  bla   NDM . Efflux pumps genes  AcrAB  and  mdtK  were detected in all 22 and  tol-C  in 21 isolates. Virulence-related genes entB and  irp-1  were detected in all 22,  mrkD  in 20, and  fimH-1  in 18 isolates; 11 isolates were strong biofilm producers. PFGE clustered  mcr-1  positive isolates into eight groups based on ≥90% similarity; MLST revealed diverse sequence types, predominant being ST-15 (n = 4) and ST-16 (n = 4). Both  mcr-1  and  bla   NDM  were localised on plasmid and chromosome;  mcr-1  was present on IncFII type and  bla   NDM  on IncFIB and IncA/C type plasmids.    Conclusions  Colistin resistance in  K. pneumoniae  was predominantly mediated by  mcr-1 . Co-existence of colistin, carbapenem, and other drug-resistant genes along with efflux pumps indicates towards enormous genomic plasticity in  K. pneumoniae  with ability to emerge as super-spreader of drug-resistance.

Genetic Characterisation of Colistin Resistant Klebsiella pneumoniae Clinical Isolates From North India