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Aim of this study was to genetically characterize two carbapenemase-producing  Escherichia coli  strains obtained from a pediatric patient affected by diarrhea, expressing OXA-181 and/or NDM-5 type enzymes. The above microorganisms were collected in the same Desenzano hospital (Northern Italy) where the  bla  NDM–  5  gene was detected for the first time in Italy 3 years ago. One strain (5P), belonged to sequence type ST405/ST477 (according to Pasture/Oxford schemes) and serotype O102:H6. It was characterized by a 130562 bp multi-replicon plasmid IncFII/IncFIA/IncFIB (pVSI_NDM-5) enclosing two main antibiotic resistance islands: (i) ARI-I, 10030 bp in size, carried genes coding for β-lactam- ( bla  OXA–  1 ,  bla  CTX–M–  15 ), fluoroquinolone/aminoglycoside- ( aac(6′)-lb-cr ) and phenicol- resistance ( catB3 ), (ii) ARI-II, 15326 bp in size, carried genes coding for sulfonamide- ( sul1 ), β-lactam- ( bla  NDM–  5 ,  bla  TEM–  1  B ), phenicol- ( catB3 ), trimethoprim- ( dfrA17 ), antiseptic- ( qacE Δ 1 ), and aminoglycoside- ( aadA5 ,  rmtB ) resistance. The other isolate (5M), belonged to sequence type ST2659/ST759 and serotype O50/02:H18, and carried four plasmids: a 153866 bp multi-replicon IncFII/IncFIA/IncFIB (pISV_IncFII_NDM-5), an 89866 bp IncI1 plasmid, a 51480 bp IncX3 plasmid (pISV_IncX3_OXA181), and a 41143 bp IncI plasmid (pISV_IncI_CMY-42). pISV_IncFII_NDM-5 carried two main antibiotic resistance islands: (i) ARI-III, 12220 bp in size, carried genes coding for β-lactam- ( bla  OXA–  1 ), fluoroquinolone/aminoglycoside- ( aac(6′)-lb-cr ), tetracycline- ( tet(B) ) and phenicol- resistance ( catB3 ,  catA1 ), and ii) ARI-IV, 26527 bp in size, carried determinants coding for macrolide- ( erm(B) ,  mph(A) ), sulfonamide- ( sul1 ), beta-lactam- ( bla  NDM–  5 ,  bla  TEM–  1  B ), trimethoprim- ( dfrA14 ,  dfrA12 ), antiseptic- ( qacE Δ 1 ), and aminoglycoside- resistance ( aadA5 ). pISV_IncI_CMY-42 harbored the  bla  CMY–  42  gene coding for beta-lactam resistance, pISV_IncX3_OXA181 harbored genes encoding fluoroquinolone- ( qnrS1 ) and beta-lactams- resistance ( bla  OXA–  181 ). In conclusion, the detection of two different NDM-5  E. coli  strains from a pediatric patient with a history of travel to the Far East countries strongly highlight an increasing trend and risk of importation from such areas.

Complete Nucleotide Sequence of Plasmids of Two Escherichia coli Strains Carrying blaNDM–5 and blaNDM–5 and blaOXA–181 From the Same Patient