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NDM-1-producing multidrug-resistant  Proteus mirabilis  brings formidable clinical challenges. We report a nosocomial outbreak of carbapenem-resistant  P. mirabilis  in China. Six  P. mirabilis  strains collected in the same ward showed close phylogenetic relatedness, indicating clonal expansion. Illumina and MinION sequencing revealed that three isolates harbored a novel  Salmonella  genomic island 1 carrying a  bla  NDM–1  gene (SGI1-1NDM), while three other isolates showed elevated carbapenem resistance and carried a similar SGI1 but with two  bla  NDM–1  gene copies (SGI1-2NDM). Four new single nucleotide mutations were present in the genomes of the two- bla  NDM–1 -harboring isolates, indicating later emergence of the SGI1-2NDM structure. Passage experiments indicated that both SGI variants were stably persistent in this clone without  bla  NDM–1  copy number changes. This study characterizes two novel  bla  NDM–1 -harboring SGI1 variants in  P. mirabilis  and provides a new insight into resistance gene copy number variation in bacteria.

frontiers in microbiology

Nosocomial Outbreak of Carbapenemase-Producing Proteus mirabilis With Two Novel Salmonella Genomic Island 1 Variants Carrying Different blaNDM–1 Gene Copies in China