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A carbapenem-resistant  Klebsiella pneumoniae  strain 628 was isolated from a human case of intracranial infection in a Chinese teaching hospital. Strain 628 produces KPC-2 and CTX-M-55 encoded by two different conjugative plasmids, i.e., the IncFII K  plasmid p628-KPC and the IncI1 plasmid p628-CTXM respectively.  bla  KPC−2  is captured by a Tn 1722 -based unit transposon with a linear structure. ΔTn 3 -IS Kpn27-bla  KPC−2 -ΔIS Kpn6 -ΔTn 1722  and this transposon together with a mercury resistance  (mer ) gene locus constitutes a 34 kb acquired drug-resistance region.  bla  KPC−2  has two transcription starts (nucleotides G and C located at 39 and 250 bp upstream of its coding region respectively) which correspond to two promoters, i.e., the intrinsic P1 and the upstream ISK pn27 /Tn 3 -provided P2 with the core −35/−10 elements TAATCC/TTACAT and TTGACA/AATAAT respectively.  bla  CTX−M−55  is mobilized in an IS Ecp1 - bla  CTX−M−55 -Δ orf477  transposition unit and appears to be the sole drug-resistant determinant in p628-CTXM.  bla  CTX−M−55  possesses a single transcription start (nucleotides G located at 116 bp upstream of its coding region) corresponding to the IS Ecp1 -provided P1 promoter with the core −35/−10 element TTGAAA/TACAAT. All the above detected promoters display a characteristic of constitutive expression. Coexistence of  bla  KPC  and  bla  CTX−M  in  K. pneumoniae  has been reported many times but this is the first report to gain deep insights into genetic platforms, promoters, and expression of the two coexisting  bla  genes with determination of entire nucleotide sequences of the two corresponding plasmids.

Complete sequences of KPC-2-encoding plasmid p628-KPC and CTX-M-55-encoding p628-CTXM coexisted in Klebsiella pneumoniae